Does CareFirst BlueCross BlueShield Cover Naltrexone/Bupropion (Contrave)

Discover if CareFirst BlueCross BlueShield covers Contrave, explore coverage options, costs, and FAQs in this insightful guide.
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Does CareFirst BlueCross BlueShield Cover Naltrexone/Bupropion?

 

  • Coverage may vary depending on your specific plan. Check your plan's drug formulary to see if Naltrexone/Bupropion (Contrave) is included.
  •  

  • Prescription is typically covered for obesity management when other interventions have not been effective. Specific BMI criteria or diagnosis of weight-related conditions might be required.
  •  

  • Your physician may need to provide documentation of medical necessity, including previous weight management attempts and health records.
  •  

  • Pre-authorization could be required. Confirm this with CareFirst customer service or consult your policy documents for details.
  •  

  • Pharmacy benefit restrictions might apply. Ensure the pharmacy you use is within CareFirst’s network to maximize coverage and lower out-of-pocket costs.

 

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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 CareFirst BlueCross BlueShield

 

Verify Your Coverage

 

  • Log into your CareFirst BlueCross BlueShield member account for specific information on prescription coverage.
  •  

  • Navigate to your plan’s benefits section and review the formulary list to check if Naltrexone/Bupropion (Contrave) is included.
  •  

  • If not listed, call the customer service number on your insurance card for confirmation.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Naltrexone/Bupropion (Contrave) with your healthcare provider.
  •  

  • Your healthcare provider may need to provide a detailed explanation or documentation supporting the necessity for this medication due to medical reasons.

 

Prior Authorization and Pre-Approval

 

  • Find out if CareFirst requires prior authorization for Naltrexone/Bupropion (Contrave). This information can be obtained from your healthcare provider, pharmacy, or directly from CareFirst.
  •  

  • If prior authorization is needed, your healthcare provider will submit the required forms to CareFirst.

 

Submit a Prescription

 

  • Once pre-approval or prior authorization is confirmed, your healthcare provider will send a prescription for Naltrexone/Bupropion (Contrave) to your preferred pharmacy.
  •  

  • Ensure the pharmacy is within the CareFirst network to minimize out-of-pocket expenses.

 

Appeal a Denied Claim

 

  • If CareFirst denies coverage for Naltrexone/Bupropion (Contrave), you have the right to appeal the decision.
  •  

  • Gather any documented evidence from your healthcare provider that supports the necessity of the medication and submit it to CareFirst along with a formal appeal letter.
  •  

  • Keep records of all submitted documents and follow up periodically to check the status of your appeal.

 

Utilize Patient Assistance Programs

 

  • If coverage is denied, explore patient assistance programs offered by the medication’s manufacturer which may provide discounts or free medication.
  •  

  • Discuss alternative treatment options with your healthcare provider if coverage remains unresolved.

 

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Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does CareFirst BlueCross BlueShield Cover Naltrexone/Bupropion (Contrave)

Discover if CareFirst BlueCross BlueShield covers Contrave, explore coverage options, costs, and FAQs in this insightful guide.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by CareFirst BlueCross BlueShield

 

Does CareFirst BlueCross BlueShield Cover Naltrexone/Bupropion?

 

  • Coverage may vary depending on your specific plan. Check your plan's drug formulary to see if Naltrexone/Bupropion (Contrave) is included.
  •  

  • Prescription is typically covered for obesity management when other interventions have not been effective. Specific BMI criteria or diagnosis of weight-related conditions might be required.
  •  

  • Your physician may need to provide documentation of medical necessity, including previous weight management attempts and health records.
  •  

  • Pre-authorization could be required. Confirm this with CareFirst customer service or consult your policy documents for details.
  •  

  • Pharmacy benefit restrictions might apply. Ensure the pharmacy you use is within CareFirst’s network to maximize coverage and lower out-of-pocket costs.

 

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CareFirst BlueCross BlueShield's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Criteria for Coverage of Naltrexone/Bupropion (Contrave) under CareFirst BlueCross BlueShield

 

  • Documentation indicating a Body Mass Index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with an accompanying weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • A complete medical history assessment confirming that the patient has attempted at least one controlled weight loss program, such as a lifestyle intervention, with insufficient results or lapse in sustaining weight loss.
  •  

  • Verification from a healthcare provider indicating that the patient does not have any contraindications for using Naltrexone/Bupropion, such as uncontrolled hypertension, seizure disorders, or chronic opioid use.
  •  

  • Documented agreement from the prescribing healthcare professional that they have discussed potential benefits and risks of Naltrexone/Bupropion therapy with the patient.
  •  

  • Monitoring and tracking plan to ensure ongoing evaluation of efficacy and safety. This involves regularly scheduled follow-up appointments to assess progress and side effects.
  •  

  • Confirmation of patient commitment to healthy lifestyle changes, including a reduced-calorie diet and regular physical activity during the course of medication.
  •  

 

Why CareFirst BlueCross BlueShield Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons CareFirst BlueCross BlueShield Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

  • **Off-label Use:** CareFirst BlueCross BlueShield does not cover Naltrexone/Bupropion if it is prescribed for conditions that are not FDA-approved or are used off-label.
  •  

  • **Lack of Medical Necessity:** The coverage may be denied if CareFirst determines that the use of Naltrexone/Bupropion is not medically necessary based on their clinical guidelines.
  •  

  • **Non-compliance with Medical Criteria:** If the prescribed usage does not align with CareFirst’s specific medical criteria or if prior authorization requirements are not met, the coverage may be denied.
  •  

  • **Exceeding Dosage Limits:** Coverage might be denied if the prescription exceeds the dosage limits set forth by CareFirst BlueCross BlueShield guidelines.
  •  

  • **Age Restrictions:** If the patient does not fall within the specified age range for approved use of Naltrexone/Bupropion, coverage can be denied by CareFirst.
  •  

  • **Lack of Coverage in Specific Plans:** Certain CareFirst BlueCross BlueShield plans might not cover weight management medications, including Naltrexone/Bupropion.
  •  

  • **Non-compliance with Lifestyle Modifications:** Patients who have not demonstrated adherence to required lifestyle modifications or participation in a comprehensive weight management program may face denial of coverage.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 CareFirst BlueCross BlueShield

 

Verify Your Coverage

 

  • Log into your CareFirst BlueCross BlueShield member account for specific information on prescription coverage.
  •  

  • Navigate to your plan’s benefits section and review the formulary list to check if Naltrexone/Bupropion (Contrave) is included.
  •  

  • If not listed, call the customer service number on your insurance card for confirmation.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Naltrexone/Bupropion (Contrave) with your healthcare provider.
  •  

  • Your healthcare provider may need to provide a detailed explanation or documentation supporting the necessity for this medication due to medical reasons.

 

Prior Authorization and Pre-Approval

 

  • Find out if CareFirst requires prior authorization for Naltrexone/Bupropion (Contrave). This information can be obtained from your healthcare provider, pharmacy, or directly from CareFirst.
  •  

  • If prior authorization is needed, your healthcare provider will submit the required forms to CareFirst.

 

Submit a Prescription

 

  • Once pre-approval or prior authorization is confirmed, your healthcare provider will send a prescription for Naltrexone/Bupropion (Contrave) to your preferred pharmacy.
  •  

  • Ensure the pharmacy is within the CareFirst network to minimize out-of-pocket expenses.

 

Appeal a Denied Claim

 

  • If CareFirst denies coverage for Naltrexone/Bupropion (Contrave), you have the right to appeal the decision.
  •  

  • Gather any documented evidence from your healthcare provider that supports the necessity of the medication and submit it to CareFirst along with a formal appeal letter.
  •  

  • Keep records of all submitted documents and follow up periodically to check the status of your appeal.

 

Utilize Patient Assistance Programs

 

  • If coverage is denied, explore patient assistance programs offered by the medication’s manufacturer which may provide discounts or free medication.
  •  

  • Discuss alternative treatment options with your healthcare provider if coverage remains unresolved.

 

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.

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.

 

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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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