Does Blue Shield of California Cover Naltrexone/Bupropion (Contrave)

Learn why Blue Shield of California might deny Contrave coverage, how to get it covered, costs without insurance, and find answers to FAQ.
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Blue Shield of California Coverage for Contrave

 

  • Blue Shield of California may cover Naltrexone/Bupropion (Contrave) for weight management in patients with a body mass index (BMI) of 30 or higher, or 27 with weight-related comorbidities.
  •  

  • Coverage determination often depends on medical necessity, which may require documentation from your healthcare provider detailing relevant health conditions and previous weight loss attempts.
  •  

  • Pre-authorization might be required, meaning your physician will need to submit a request to Blue Shield explaining why Contrave is appropriate for you.
  •  

  • Pharmacy benefit plans may differ, so it's important to review your specific plan's formulary to confirm coverage conditions and any associated co-pays or restrictions.

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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 Naltrexone/Bupropion (Contrave) Coverage with Blue Shield of California

 

Verify Insurance Coverage

 

  • Contact Blue Shield of California customer service via the number on your insurance card to confirm if Naltrexone/Bupropion (Contrave) is covered under your specific plan.
  •  

  • Verify any coverage restrictions such as prior authorization, step therapy, or a specific formulary tier placement.
  •  

  • Review your policy documents, either online or mailed to you by Blue Shield, for information on prescription drug coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your weight management goals and medical history with your healthcare provider to determine if Contrave is appropriate for you.
  •  

  • Request a prescription from your provider if Contrave is deemed a suitable treatment option.
  •  

  • Inquire if your healthcare provider needs to submit any additional documentation, like a letter of medical necessity, to support the insurance claim.

 

Fulfill Prior Authorization Requirements

 

  • If required, have your doctor submit a prior authorization request to Blue Shield of California. This may include justification for using Contrave over other treatments.
  •  

  • Provide any additional medical records or documentation that might support the necessity of Contrave.
  •  

  • Follow up with both Blue Shield and your healthcare provider to ensure that the prior authorization is received and processed in a timely manner.

 

Visit an In-Network Pharmacy

 

  • Have your prescription filled at a pharmacy that is in-network with Blue Shield of California to ensure lower out-of-pocket costs.
  •  

  • Present your insurance card to the pharmacist and inquire if they require any additional information before filling your prescription.
  •  

  • Contact the pharmacy ahead of your visit to verify that they have Contrave in stock.

 

Manage Denials or Appeals

 

  • If your prescription is denied, review the denial letter from Blue Shield of California for specific reasons why the claim was not approved.
  •  

  • Coordinate with your healthcare provider to address any issues listed in the denial and to submit an appeal if necessary.
  •  

  • Submit any additional documentation requested by Blue Shield during the appeals process, which may include further explanation from your doctor.

 

Monitor Prescription Refills

 

  • Stay aware of your medication supply to ensure you have sufficient time to manage prior authorizations or other insurance requirements for refills.
  •  

  • Communicate regularly with your provider and pharmacist to streamline the refill process, particularly if there have been changes to your prescription or insurance plan.
  •  

  • Understand any limits on the number of refills or duration, as specified by your insurance plan, and plan appointments accordingly.

 

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FAQs

Does Blue Shield of California Cover Naltrexone/Bupropion (Contrave)

Learn why Blue Shield of California might deny Contrave coverage, how to get it covered, costs without insurance, and find answers to FAQ.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Blue Shield of California

 

Blue Shield of California Coverage for Contrave

 

  • Blue Shield of California may cover Naltrexone/Bupropion (Contrave) for weight management in patients with a body mass index (BMI) of 30 or higher, or 27 with weight-related comorbidities.
  •  

  • Coverage determination often depends on medical necessity, which may require documentation from your healthcare provider detailing relevant health conditions and previous weight loss attempts.
  •  

  • Pre-authorization might be required, meaning your physician will need to submit a request to Blue Shield explaining why Contrave is appropriate for you.
  •  

  • Pharmacy benefit plans may differ, so it's important to review your specific plan's formulary to confirm coverage conditions and any associated co-pays or restrictions.

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Blue Shield of California's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Eligibility Criteria for Naltrexone/Bupropion Coverage

 

  • The patient must be 18 years of age or older.
  •  

  • The patient has a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.

 

Documentation Requirements

 

  • Submission of a completed prior authorization request form.
  •  

  • Documented medical records indicating BMI and coexisting conditions, if applicable.
  •  

  • A history of previous weight management efforts (e.g., previous prescription medications, lifestyle modifications, dietary interventions) by the patient.

 

Treatment Plan

 

  • The prescribing physician must provide a comprehensive treatment plan that includes details on dosing, intended duration of therapy, and monitoring of patient progress.
  •  

  • The treatment plan should explicitly incorporate lifestyle interventions such as diet, exercise, and behavioral changes.

 

Healthcare Provider Requirements

 

  • A licensed healthcare provider must prescribe the medication.
  •  

  • Healthcare providers should have expertise in managing obesity.

 

Follow-Up and Monitoring

 

  • The patient must attend regular follow-up appointments to assess efficacy, safety, and adherence to the treatment plan.
  •  

  • Regular documentation of weight, BMI changes, and overall health improvement must be recorded and reported to the insurer.

 

Why Blue Shield of California Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons for Denial of Naltrexone/Bupropion (Contrave) Coverage by Blue Shield of California

 

  • Blue Shield of California may deny coverage if the medication is not deemed medically necessary based on their specific medical guidelines and criteria.
  •  

  • Treatment with Naltrexone/Bupropion (Contrave) may not be covered if the patient does not meet the required Body Mass Index (BMI) criteria or other specified weight thresholds outlined by Blue Shield of California's policy.
  •  

  • Coverage could be denied if the patient has not demonstrated prior attempts at weight loss through lifestyle interventions such as diet and exercise, or if these efforts are not documented or verified by a healthcare provider.
  •  

  • Patients with certain pre-existing medical conditions that contraindicate the use of Naltrexone/Bupropion may not have coverage, especially if these conditions are noted within Blue Shield of California's exclusion criteria.
  •  

  • Prescription may be denied if there is non-compliance with formulary guidelines, including requirements for step therapy with other weight management medications prior to consideration for coverage of Naltrexone/Bupropion.
  •  

  • Blue Shield of California might not cover the medication if the prescriber is not within the plan's network or if the prescription was not authorized by a physician recognized by the network.
  •  

  • Prescription coverage might be denied if the usage is intended for indications that are not approved by the FDA or for off-label uses not supported by the insurance plan's policy.

 

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How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Blue Shield of California

 

Verify Insurance Coverage

 

  • Contact Blue Shield of California customer service via the number on your insurance card to confirm if Naltrexone/Bupropion (Contrave) is covered under your specific plan.
  •  

  • Verify any coverage restrictions such as prior authorization, step therapy, or a specific formulary tier placement.
  •  

  • Review your policy documents, either online or mailed to you by Blue Shield, for information on prescription drug coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your weight management goals and medical history with your healthcare provider to determine if Contrave is appropriate for you.
  •  

  • Request a prescription from your provider if Contrave is deemed a suitable treatment option.
  •  

  • Inquire if your healthcare provider needs to submit any additional documentation, like a letter of medical necessity, to support the insurance claim.

 

Fulfill Prior Authorization Requirements

 

  • If required, have your doctor submit a prior authorization request to Blue Shield of California. This may include justification for using Contrave over other treatments.
  •  

  • Provide any additional medical records or documentation that might support the necessity of Contrave.
  •  

  • Follow up with both Blue Shield and your healthcare provider to ensure that the prior authorization is received and processed in a timely manner.

 

Visit an In-Network Pharmacy

 

  • Have your prescription filled at a pharmacy that is in-network with Blue Shield of California to ensure lower out-of-pocket costs.
  •  

  • Present your insurance card to the pharmacist and inquire if they require any additional information before filling your prescription.
  •  

  • Contact the pharmacy ahead of your visit to verify that they have Contrave in stock.

 

Manage Denials or Appeals

 

  • If your prescription is denied, review the denial letter from Blue Shield of California for specific reasons why the claim was not approved.
  •  

  • Coordinate with your healthcare provider to address any issues listed in the denial and to submit an appeal if necessary.
  •  

  • Submit any additional documentation requested by Blue Shield during the appeals process, which may include further explanation from your doctor.

 

Monitor Prescription Refills

 

  • Stay aware of your medication supply to ensure you have sufficient time to manage prior authorizations or other insurance requirements for refills.
  •  

  • Communicate regularly with your provider and pharmacist to streamline the refill process, particularly if there have been changes to your prescription or insurance plan.
  •  

  • Understand any limits on the number of refills or duration, as specified by your insurance plan, and plan appointments accordingly.

 

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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.

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Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

Have questions left?

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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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