Does CareFirst BlueCross BlueShield Cover Diethylpropion (Tenuate)

Explore Diethylpropion coverage by CareFirst BCBS, how to secure it, potential denial reasons, costs without insurance, and key FAQs in this detailed guide.
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Coverage Overview for Diethylpropion (Tenuate)

 

  • Diethylpropion (Tenuate) is typically covered by CareFirst BlueCross BlueShield when prescribed for weight loss in conjunction with a comprehensive weight management program.

 

Situations and Criteria for Coverage

 

  • Coverage is generally available when the medication is prescribed for individuals diagnosed with obesity-related health issues.
  • A physician may need to show that alternate weight loss methods have been ineffective.
  • Documentation supporting the need for Diethylpropion may be required, including a detailed weight loss plan.

 

Coverage Rules and Prior Authorization

 

  • Some plans may require prior authorization, ensuring that the medication is essential and part of a structured treatment plan.
  • Patients might need to meet specific Body Mass Index (BMI) criteria to qualify for coverage.
  • Continuous use might be subject to periodic review, requiring documentation of weight loss progress and any health improvements.

 

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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.

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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.

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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 Diethylpropion (Tenuate) Coverage with CareFirst BlueCross BlueShield

 

Verify Your Benefits

 

  • Begin by logging into your CareFirst BlueCross BlueShield member account on their official website. This account will provide specific coverage details related to your health plan.
  •  

  • Locate your benefits booklet or Summary of Benefits and Coverage (SBC) document. This document details covered medications and the terms of coverage, including any formulary restrictions.
  •  

  • Contact CareFirst customer service directly via the phone number on your insurance card for confirmation about Diethylpropion (Tenuate) coverage.

 

Consult with Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Diethylpropion for your health condition.
  •  

  • Request that your doctor provide any necessary clinical documentation that demonstrates the medical necessity of the prescription. This may include your medical history and previous treatments.
  •  

  • Ensure that your provider writes a detailed prescription that complies with CareFirst BlueCross BlueShield's requirements.

 

Prescription Drug Formulary

 

  • Check if Diethylpropion (Tenuate) is listed on CareFirst's formulary, which can often be found online or obtained via your CareFirst member portal.
  •  

  • If the medication is not on the formulary, inquire about possible alternatives or the process to request a formulary exception.
  •  

  • Work with your healthcare provider to explore other covered medication options if Diethylpropion is not covered.

 

Submit a Prior Authorization Request

 

  • In some cases, you will need to obtain prior authorization from CareFirst BlueCross BlueShield for coverage of Diethylpropion.
  •  

  • Your healthcare provider or pharmacist can aid in filing a prior authorization request, which involves submitting the necessary documentation to CareFirst.
  •  

  • Track the progress of your authorization request by contacting CareFirst directly or checking your member portal for updates.

 

Follow Up

 

  • If your prior authorization is approved, you will be notified by CareFirst or your healthcare provider.
  •  

  • Discuss any restrictions or limitations regarding the medication with your provider or the CareFirst representative.
  •  

  • If your authorization request is denied, review the reasons for denial and consider submitting an appeal or asking for guidance on next steps from your healthcare provider.

 

Fill Your Prescription

 

  • Once you have obtained approval, have your provider send the prescription to a pharmacy that accepts CareFirst BlueCross BlueShield insurance.
  •  

  • Present your insurance card at the pharmacy and verify that the charge matches your coverage documentation.
  •  

  • Maintain copies of all documentation, receipts, and correspondences related to your Diethylpropion coverage for future reference.

 

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FAQs

Does CareFirst BlueCross BlueShield Cover Diethylpropion (Tenuate)

Explore Diethylpropion coverage by CareFirst BCBS, how to secure it, potential denial reasons, costs without insurance, and key FAQs in this detailed guide.
Curex allergy drops unboxing

Is Diethylpropion (Tenuate) Covered by CareFirst BlueCross BlueShield

 

Coverage Overview for Diethylpropion (Tenuate)

 

  • Diethylpropion (Tenuate) is typically covered by CareFirst BlueCross BlueShield when prescribed for weight loss in conjunction with a comprehensive weight management program.

 

Situations and Criteria for Coverage

 

  • Coverage is generally available when the medication is prescribed for individuals diagnosed with obesity-related health issues.
  • A physician may need to show that alternate weight loss methods have been ineffective.
  • Documentation supporting the need for Diethylpropion may be required, including a detailed weight loss plan.

 

Coverage Rules and Prior Authorization

 

  • Some plans may require prior authorization, ensuring that the medication is essential and part of a structured treatment plan.
  • Patients might need to meet specific Body Mass Index (BMI) criteria to qualify for coverage.
  • Continuous use might be subject to periodic review, requiring documentation of weight loss progress and any health improvements.

 

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CareFirst BlueCross BlueShield's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Criteria for Coverage of Diethylpropion (Tenuate) by CareFirst BlueCross BlueShield

 

  • Patient has a documented diagnosis of obesity, characterized by a body mass index (BMI) of 30 kg/m2 or greater, or a BMI of 27 kg/m2 or greater with related co-morbid conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Diethylpropion (Tenuate) is being prescribed as part of a comprehensive weight management program, which includes a reduced-calorie diet, increased physical activity, and behavioral counseling.
  •  

  • Documentation indicates that the patient has attempted weight loss through diet and exercise alone without pharmacological intervention, but has been unsuccessful, as evidenced by a lack of significant weight loss after a specified period.
  •  

  • The prescribing healthcare provider specializes in or has substantial experience in the management of obesity and its related disorders.
  •  

  • Diethylpropion (Tenuate) is prescribed at the FDA-approved dosage and for the FDA-approved duration of use for obesity treatment. The intended usage duration does not exceed the recommended short-term use, typically a few weeks, unless otherwise justified for longer treatment based on clinical circumstances.
  •  

  • The patient has been evaluated for potential contraindications to the use of Diethylpropion (Tenuate), and it has been determined that the benefits outweigh the risks involved.
  •  

  • There is an absence of intersecting contraindications such as advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, glaucoma, agitated states, or a history of drug abuse.
  •  

Why CareFirst BlueCross BlueShield Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Denial of Diethylpropion (Tenuate) Coverage by CareFirst BlueCross BlueShield

 

  • **Non-compliance with Medical Necessity Criteria:** Diethylpropion may be denied if it is not deemed medically necessary according to the insurer's criteria. The specific medical requirements can vary based on age, health conditions, and other risk factors that are not met according to policy guidelines.
  •  

  • **Use for Unapproved Indications:** CareFirst BlueCross BlueShield does not cover Diethylpropion prescriptions for off-label uses that are not FDA-approved or not supported by peer-reviewed medical research according to their formulary guidelines.
  •  

  • **Alternative Treatment Availability:** If other lower-cost or more effective treatment options are considered first-line according to their formulary, the prescription for Diethylpropion may be denied in favor of alternatives.
  •  

  • **Failure to Obtain Prior Authorization:** Coverage may be denied if prior authorization from the insurer is not secured before the medication is dispensed. Not meeting this requirement can lead to a denial.
  •  

  • **Policy Exclusions:** Certain health plans may have specific exclusions concerning weight loss medications, including Diethylpropion, as part of their benefit design or policy exclusions.
  •  

  • **Past Medical History:** Individuals with certain medical histories, including cardiovascular issues or other contraindications highlighted in policy exclusions, may be denied coverage based on risk factors associated with Diethylpropion.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with CareFirst BlueCross BlueShield

 

Verify Your Benefits

 

  • Begin by logging into your CareFirst BlueCross BlueShield member account on their official website. This account will provide specific coverage details related to your health plan.
  •  

  • Locate your benefits booklet or Summary of Benefits and Coverage (SBC) document. This document details covered medications and the terms of coverage, including any formulary restrictions.
  •  

  • Contact CareFirst customer service directly via the phone number on your insurance card for confirmation about Diethylpropion (Tenuate) coverage.

 

Consult with Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Diethylpropion for your health condition.
  •  

  • Request that your doctor provide any necessary clinical documentation that demonstrates the medical necessity of the prescription. This may include your medical history and previous treatments.
  •  

  • Ensure that your provider writes a detailed prescription that complies with CareFirst BlueCross BlueShield's requirements.

 

Prescription Drug Formulary

 

  • Check if Diethylpropion (Tenuate) is listed on CareFirst's formulary, which can often be found online or obtained via your CareFirst member portal.
  •  

  • If the medication is not on the formulary, inquire about possible alternatives or the process to request a formulary exception.
  •  

  • Work with your healthcare provider to explore other covered medication options if Diethylpropion is not covered.

 

Submit a Prior Authorization Request

 

  • In some cases, you will need to obtain prior authorization from CareFirst BlueCross BlueShield for coverage of Diethylpropion.
  •  

  • Your healthcare provider or pharmacist can aid in filing a prior authorization request, which involves submitting the necessary documentation to CareFirst.
  •  

  • Track the progress of your authorization request by contacting CareFirst directly or checking your member portal for updates.

 

Follow Up

 

  • If your prior authorization is approved, you will be notified by CareFirst or your healthcare provider.
  •  

  • Discuss any restrictions or limitations regarding the medication with your provider or the CareFirst representative.
  •  

  • If your authorization request is denied, review the reasons for denial and consider submitting an appeal or asking for guidance on next steps from your healthcare provider.

 

Fill Your Prescription

 

  • Once you have obtained approval, have your provider send the prescription to a pharmacy that accepts CareFirst BlueCross BlueShield insurance.
  •  

  • Present your insurance card at the pharmacy and verify that the charge matches your coverage documentation.
  •  

  • Maintain copies of all documentation, receipts, and correspondences related to your Diethylpropion coverage for future reference.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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.

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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.

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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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