Does Blue Shield of California Cover Contrave

Explore why Blue Shield of California might deny Contrave, how to secure coverage, costs without insurance, and FAQs in this comprehensive guide.
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Coverage Details for Contrave

 

  • Blue Shield of California may cover Contrave, a weight management medication, under specific health plans and conditions.
  •  

  • Coverage typically requires a doctor's prescription and may necessitate prior authorization from the insurance provider.
  •  

  • Patients generally need to meet certain criteria, such as a minimum body mass index (BMI) or having weight-related health issues.

 

Criteria and Requirements

 

  • Patients must demonstrate attempts at lifestyle changes for weight loss to qualify for coverage.
  •  

  • Coverage can vary based on the specific plan, so members should consult their plan's benefits or contact customer service for detailed information.
  •  

  • Out-of-pocket costs might be applicable, which can depend on the type of plan and pharmacy benefits.

 

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Contrave Coverage with Blue Shield of California

 

Contact Blue Shield of California for Information

 

  • Reach out to Blue Shield of California's customer service for guidance on their coverage policy regarding Contrave. They can provide information tailored to your specific plan.
  •  

  • Ask if a prior authorization is required for Contrave and what documents or justifications are needed for approval.

 

Discuss with Your Doctor

 

  • Inform your healthcare provider about your aim to have Contrave covered by Blue Shield of California. Your doctor may need to provide medical documentation indicating the necessity for Contrave.
  •  

  • Ensure that your doctor specifies a clear justification for prescribing Contrave over other medications.

 

Verify the Prescription Drug List (Formulary)

 

  • Check Blue Shield of California's formulary (preferred drug list) to see if Contrave is included. This list is available on their official website or through customer service.
  •  

  • If Contrave isn't listed, discuss with your doctor about alternative medications that are covered and assess their suitability.

 

Obtain Prior Authorization

 

  • If required, work with your doctor to complete the necessary prior authorization forms. This may involve submitting medical records and detailing the need for Contrave.
  •  

  • Ensure that all documentation is thorough and submitted as per Blue Shield of California's guidelines to avoid delays.

 

Follow Up on the Authorization Process

 

  • Monitor the status of your prior authorization request. It may take some time, and being proactive can help speed up the process.
  •  

  • If denied, inquire about the reasons and gather information on the appeals process, if needed.

 

Cost Considerations

 

  • Discuss any potential costs with Blue Shield of California, including co-pays or deductibles, to ensure these align with your budget.
  •  

  • Explore any discount programs or patient assistance options provided by the manufacturer of Contrave.

 

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FAQs

Does Blue Shield of California Cover Contrave

Explore why Blue Shield of California might deny Contrave, how to secure coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Contrave Covered by Blue Shield of California

 

Coverage Details for Contrave

 

  • Blue Shield of California may cover Contrave, a weight management medication, under specific health plans and conditions.
  •  

  • Coverage typically requires a doctor's prescription and may necessitate prior authorization from the insurance provider.
  •  

  • Patients generally need to meet certain criteria, such as a minimum body mass index (BMI) or having weight-related health issues.

 

Criteria and Requirements

 

  • Patients must demonstrate attempts at lifestyle changes for weight loss to qualify for coverage.
  •  

  • Coverage can vary based on the specific plan, so members should consult their plan's benefits or contact customer service for detailed information.
  •  

  • Out-of-pocket costs might be applicable, which can depend on the type of plan and pharmacy benefits.

 

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Blue Shield of California's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Patient must be 18 years of age or older.
  •  

  • A diagnosis of obesity, defined as a Body Mass Index (BMI) of 30 kg/m² or higher, or a BMI of 27 kg/m² or higher with the presence of at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Documented failure of weight loss with prior use of other weight management programs or medications, unless contraindicated, as indicated by the healthcare provider.
  •  

  • Participation in a comprehensive weight management program that includes a low-calorie diet, and increased physical activity, as well as behavioral interventions.
  •  

  • The healthcare provider must conduct periodic evaluations to assess efficacy and safety, with continued approval contingent upon documented weight loss progress such as a reduction in body weight of at least 5% after 12 weeks of therapy.

 

Prescription Requirements

 

  • Prescription must be written by a licensed healthcare provider who specializes in obesity management such as an endocrinologist, bariatrician, or other relevant specialist.
  •  

  • A clear medical necessity must be documented for the use of Contrave, highlighting its benefits over other therapeutic options.
  •  

  • The provider must provide a comprehensive treatment plan which includes lifestyle modification recommendations.

 

Reauthorization Criteria

 

  • Evidence of maintenance or further reduction in body weight, with the patient's weight documented as stable after an initial 5% loss during the first 12 weeks.
  •  

  • Confirmation that the patient remains actively engaged in a weight management program complementing medication assistance.
  •  

  • Absence of adverse effects that outweigh the benefits of continued treatment.

 

Why Blue Shield of California Might Deny Contrave Coverage

 

Situations When Blue Shield of California Does Not Cover Contrave

 

  • **Non-FDA Approved Uses**: Blue Shield of California will deny coverage for Contrave if it is prescribed for uses that are not approved by the FDA. Coverage is contingent upon the medication being prescribed for its intended, approved uses for treating obesity in adults.
  •  

  • **Lack of Medical Necessity**: Coverage may be denied if the need for Contrave is not adequately demonstrated, especially if the patient does not meet the specific clinical criteria set by Blue Shield. Adequate documentation proving medical necessity must be provided.
  •  

  • **Failure to Meet BMI Criteria**: Blue Shield may deny coverage if the patient does not meet the required body mass index (BMI) criteria, which usually includes having a BMI over a specified threshold, often 30, or 27 with related comorbidities.
  •  

  • **No Prior Authorization**: If prior authorization is required and not obtained by the prescribing physician or healthcare provider, coverage for Contrave will likely be denied.
  •  

  • **Incomplete Medical Records**: Lack of comprehensive or accurate medical records supporting the prescription can lead to denial of coverage. This includes missing any required diagnostic tests or evaluations.
  •  

  • **Pre-existing Conditions**: If the patient has certain health conditions that contraindicate the use of Contrave (such as uncontrolled hypertension, seizure disorders, or pregnancy), coverage may be denied based on safety concerns.
  •  

  • **Non-compliance with Prescribed Treatment**: If there's evidence of non-compliance with previously prescribed weight loss treatments, Blue Shield may deny coverage for Contrave due to doubts about treatment adherence.
  •  

  • **Duplicate Therapy**: Coverage may be denied if Contrave is prescribed alongside another weight-loss medication unless a clear, documented rationale is provided and approved.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing costs.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Contrave Coverage with Blue Shield of California

 

Contact Blue Shield of California for Information

 

  • Reach out to Blue Shield of California's customer service for guidance on their coverage policy regarding Contrave. They can provide information tailored to your specific plan.
  •  

  • Ask if a prior authorization is required for Contrave and what documents or justifications are needed for approval.

 

Discuss with Your Doctor

 

  • Inform your healthcare provider about your aim to have Contrave covered by Blue Shield of California. Your doctor may need to provide medical documentation indicating the necessity for Contrave.
  •  

  • Ensure that your doctor specifies a clear justification for prescribing Contrave over other medications.

 

Verify the Prescription Drug List (Formulary)

 

  • Check Blue Shield of California's formulary (preferred drug list) to see if Contrave is included. This list is available on their official website or through customer service.
  •  

  • If Contrave isn't listed, discuss with your doctor about alternative medications that are covered and assess their suitability.

 

Obtain Prior Authorization

 

  • If required, work with your doctor to complete the necessary prior authorization forms. This may involve submitting medical records and detailing the need for Contrave.
  •  

  • Ensure that all documentation is thorough and submitted as per Blue Shield of California's guidelines to avoid delays.

 

Follow Up on the Authorization Process

 

  • Monitor the status of your prior authorization request. It may take some time, and being proactive can help speed up the process.
  •  

  • If denied, inquire about the reasons and gather information on the appeals process, if needed.

 

Cost Considerations

 

  • Discuss any potential costs with Blue Shield of California, including co-pays or deductibles, to ensure these align with your budget.
  •  

  • Explore any discount programs or patient assistance options provided by the manufacturer of Contrave.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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