Does CareFirst BlueCross BlueShield Cover Saxenda

Explore reasons for denied coverage of Saxenda by CareFirst BlueCross BlueShield, steps to secure approval, cost specifics, and answers to common questions.
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Coverage for Saxenda by CareFirst BlueCross BlueShield

 

  • **Eligibility Criteria:** CareFirst BlueCross BlueShield may cover Saxenda, a weight management medication, under certain medical situations, primarily for obesity treatment. Coverage often requires a documented history of weight-related health issues.
  •  

  • **Prior Authorization:** Typically, obtaining Saxenda requires prior authorization from CareFirst, which includes validation of medical necessity and adherence to prescribed treatment plans.
  •  

  • **Medical Necessity:** The prescription must be deemed medically necessary by a healthcare provider, supported by evidence of previous unsuccessful weight-loss attempts through lifestyle modifications alone.
  •  

  • **Doctor Consultation:** Regular consultations with your healthcare provider may be required to monitor the efficacy and adjust dosages, ensuring continued eligibility for coverage under CareFirst's plan.
  •  

  • **Policy Specifics:** Check CareFirst's specific policy documents or contact their customer service for detailed coverage options, as plans and requirements may vary based on individual health plans.

 

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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 Saxenda Coverage with CareFirst BlueCross BlueShield

 

Initial Verification with CareFirst BlueCross BlueShield

 

  • Contact CareFirst BlueCross BlueShield customer service to verify your plan's prescription drug coverage. Obtain any specific policy details related to weight management medications like Saxenda.
  •  

  • Request a copy of the drug formulary, which will outline covered medications, to see if Saxenda is included and under what tier.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about starting Saxenda and obtain a prescription if they determine it's appropriate for your situation.
  •  

  • Ensure your healthcare provider is willing to document the medical necessity of Saxenda, as this may be essential for insurance approval.

 

Check for Prior Authorization Requirements

 

  • Consult the CareFirst BlueCross BlueShield formulary or contact them to determine if Saxenda requires prior authorization.
  •  

  • If prior authorization is needed, your healthcare provider will need to submit a request on your behalf, including documentation supporting its necessity.

 

Submit the Prescription

 

  • Have your healthcare provider send the Saxenda prescription to a pharmacy within your CareFirst BlueCross BlueShield network.
  •  

  • Verify with the pharmacy that they accept your insurance and that Saxenda is covered under your plan.

 

Review Your Coverage Details

 

  • Review any co-payment or co-insurance information related to Saxenda coverage under your specific plan. This will help you understand potential out-of-pocket costs.
  •  

  • If your plan includes a deductible, ensure you have met this before expecting full coverage benefits on medications like Saxenda.

 

Appeal if Necessary

 

  • If Saxenda is not initially covered, or if the prior authorization is denied, request information on the appeals process from CareFirst BlueCross BlueShield.
  •  

  • Work with your healthcare provider to gather additional documentation or evidence supporting the need for Saxenda and submit an appeal to CareFirst BlueCross BlueShield.

 

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FAQs

Does CareFirst BlueCross BlueShield Cover Saxenda

Explore reasons for denied coverage of Saxenda by CareFirst BlueCross BlueShield, steps to secure approval, cost specifics, and answers to common questions.
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Is Saxenda Covered by CareFirst BlueCross BlueShield

 

Coverage for Saxenda by CareFirst BlueCross BlueShield

 

  • **Eligibility Criteria:** CareFirst BlueCross BlueShield may cover Saxenda, a weight management medication, under certain medical situations, primarily for obesity treatment. Coverage often requires a documented history of weight-related health issues.
  •  

  • **Prior Authorization:** Typically, obtaining Saxenda requires prior authorization from CareFirst, which includes validation of medical necessity and adherence to prescribed treatment plans.
  •  

  • **Medical Necessity:** The prescription must be deemed medically necessary by a healthcare provider, supported by evidence of previous unsuccessful weight-loss attempts through lifestyle modifications alone.
  •  

  • **Doctor Consultation:** Regular consultations with your healthcare provider may be required to monitor the efficacy and adjust dosages, ensuring continued eligibility for coverage under CareFirst's plan.
  •  

  • **Policy Specifics:** Check CareFirst's specific policy documents or contact their customer service for detailed coverage options, as plans and requirements may vary based on individual health plans.

 

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CareFirst BlueCross BlueShield's Approved Criteria for Saxenda Coverage

 

Eligibility Criteria for Saxenda Coverage

 

  • **Diagnosis of Obesity or Overweight**: The patient must have a documented body mass index (BMI) of 30 kg/m2 or more, or a BMI of 27 kg/m2 or more in the presence of at least one weight-related comorbid condition (such as hypertension, type 2 diabetes, or dyslipidemia).
  •  

  • **Participation in a Comprehensive Weight Management Program**: The patient should be actively engaged in an ongoing weight management program. This program should include dietary intervention, physical activity, and behavioral counseling tailored to the individual's weight loss goals.
  •  

  • **Age Requirement**: The patient must be 18 years of age or older to qualify for Saxenda coverage.
  •  

  • **Trial and Failure or Contraindication to Other Weight Loss Medications**: The patient should have a documented history of inadequate response or intolerance to other weight loss medications approved by CareFirst BlueCross BlueShield, unless contraindicated or not considered medically appropriate as determined by the prescribing physician.
  •  

  • **Physician Prescription and Supervision**: Saxenda must be prescribed by a healthcare provider specializing in obesity management or a primary care physician familiar with the patient's medical history and weight management efforts.
  •  

  • **Regular Monitoring and Follow-ups**: Continued coverage of Saxenda requires regular follow-up visits with the healthcare provider to monitor the patient's progress, side effects, and adherence to the prescribed treatment.

 

Why CareFirst BlueCross BlueShield Might Deny Saxenda Coverage

 

Saxenda Coverage Denial by CareFirst BlueCross BlueShield

 

  • Saxenda is not covered for weight loss management if not deemed medically necessary according to the plan's criteria.
  •  

  • Coverage is denied if there is insufficient documentation proving obesity-related comorbidities that require Saxenda as a treatment.
  •  

  • The patient does not meet specific BMI requirements as outlined in CareFirst policies for medication-eligible obesity treatment.
  •  

  • Lack of trials or documented failures with alternative weight management strategies can lead to denial of coverage.
  •  

  • If Saxenda is prescribed for conditions other than those approved by the CareFirst policy, including off-label uses.
  •  

  • CareFirst may deny coverage if there is no prior authorization or if the required documentation for prior authorization is incomplete.
  •  

  • The patient does not meet the age restrictions or other demographic criteria specified by the insurance policy for Saxenda use.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket 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 Saxenda Coverage with CareFirst BlueCross BlueShield

 

Initial Verification with CareFirst BlueCross BlueShield

 

  • Contact CareFirst BlueCross BlueShield customer service to verify your plan's prescription drug coverage. Obtain any specific policy details related to weight management medications like Saxenda.
  •  

  • Request a copy of the drug formulary, which will outline covered medications, to see if Saxenda is included and under what tier.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about starting Saxenda and obtain a prescription if they determine it's appropriate for your situation.
  •  

  • Ensure your healthcare provider is willing to document the medical necessity of Saxenda, as this may be essential for insurance approval.

 

Check for Prior Authorization Requirements

 

  • Consult the CareFirst BlueCross BlueShield formulary or contact them to determine if Saxenda requires prior authorization.
  •  

  • If prior authorization is needed, your healthcare provider will need to submit a request on your behalf, including documentation supporting its necessity.

 

Submit the Prescription

 

  • Have your healthcare provider send the Saxenda prescription to a pharmacy within your CareFirst BlueCross BlueShield network.
  •  

  • Verify with the pharmacy that they accept your insurance and that Saxenda is covered under your plan.

 

Review Your Coverage Details

 

  • Review any co-payment or co-insurance information related to Saxenda coverage under your specific plan. This will help you understand potential out-of-pocket costs.
  •  

  • If your plan includes a deductible, ensure you have met this before expecting full coverage benefits on medications like Saxenda.

 

Appeal if Necessary

 

  • If Saxenda is not initially covered, or if the prior authorization is denied, request information on the appeals process from CareFirst BlueCross BlueShield.
  •  

  • Work with your healthcare provider to gather additional documentation or evidence supporting the need for Saxenda and submit an appeal to CareFirst BlueCross BlueShield.

 

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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.

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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