Does Centene Corporation Cover Diethylpropion (Tenuate)

Explore Centene's coverage for Diethylpropion (Tenuate), reasons for denial, cost without insurance, and FAQs to help you secure coverage.
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Diethylpropion (Tenuate) Coverage by Centene Corporation

 

  • Centene Corporation may cover Diethylpropion (Tenuate) for weight management in specific instances, primarily prescribed for patients facing obesity-related health conditions.
  •  

  • Coverage typically requires prior authorization, ensuring it aligns with the patient's treatment plan and clinical necessity.
  •  

  • Criteria for coverage generally include a documented history of obesity unmanageable by diet or exercise alone, alongside potential co-morbid conditions like hypertension or diabetes.
  •  

  • Physicians must provide documentation proving that other, less intensive weight-loss approaches have been ineffective before approval.
  •  

  • The drug prescription is usually part of a comprehensive weight-loss program, encompassing diet, exercise, and behavioral changes.

 

Basic Rules and Criteria

 

  • Patients need to demonstrate a BMI typically over 30, or over 27 with associated risk factors such as cardiovascular disease.
  •  

  • Continued coverage may require periodic reviews of treatment efficacy and adherence to prescribed lifestyle changes.
  •  

  • Centene might limit coverage to specific treatment durations to monitor the patient's progress and side effects.
  •  

  • Prescriptions are generally given in conjunction with a qualified healthcare provider's guidance, integrated into a structured weight management plan.

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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 Diethylpropion (Tenuate) Coverage with Centene Corporation

 

Research Centene Corporation Insurance Plans

 

  • Visit Centene Corporation’s official website to explore the various insurance plans they offer. Understanding which plan or subsidiary, like Ambetter or WellCare, fits your needs is crucial.
  •  
  • Contact a Centene representative through the customer service number provided on their website if you need personalized assistance in choosing the right plan that may cover Diethylpropion.

 

Check Prescription Drug Coverage

 

  • Carefully review the formulary (drug list) associated with the insurance plan you’re interested in. This list is typically available on Centene's website under the specific insurance plan's details.
  •  
  • Ensure Diethylpropion (Tenuate) is included in the coverage. If it is not listed, you may need to inquire about whether it can be considered for coverage under certain conditions.

 

Consult with a Healthcare Provider

 

  • Before proceeding, discuss with your healthcare provider about your need for Diethylpropion. They can offer insights on necessary documentation or alternative treatments if coverage challenges arise.
  •  
  • Request your healthcare provider to write a detailed prescription and provide any necessary justification for the medication. This can support any claims or appeals you might need to make with Centene.

 

Contact Centene Member Services

 

  • Reach out to Centene’s member services to inquire about specific requirements for Diethylpropion coverage under your chosen plan. They may have additional documentation or steps required.
  •  
  • Request information regarding any prior authorization forms or processes necessary to process Diethylpropion coverage requests.

 

Prepare Necessary Documentation

 

  • Gather all necessary documentation, including your healthcare provider’s prescription, any prior authorization forms, and your insurance plan details.
  •  
  • Ensure that all documents are accurate and complete to prevent any delays in processing your coverage request.

 

Submit Your Application

 

  • Follow the submission process as instructed by Centene for your specific insurance plan. This could be through the member portal, by mail, or via fax.
  •  
  • Track your application status through Centene’s portal or by contacting member services to ensure it is being processed in a timely manner.

 

Appeal if Necessary

 

  • If coverage for Diethylpropion is denied, review the denial notice carefully. It should provide information on the reason for denial and your rights to appeal.
  •  
  • Work with your healthcare provider to gather any additional documentation that might strengthen your appeal. Submit the appeal as per the instructions provided in the denial notice.

 

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FAQs

Does Centene Corporation Cover Diethylpropion (Tenuate)

Explore Centene's coverage for Diethylpropion (Tenuate), reasons for denial, cost without insurance, and FAQs to help you secure coverage.
Curex allergy drops unboxing

Is Diethylpropion (Tenuate) Covered by Centene Corporation

 

Diethylpropion (Tenuate) Coverage by Centene Corporation

 

  • Centene Corporation may cover Diethylpropion (Tenuate) for weight management in specific instances, primarily prescribed for patients facing obesity-related health conditions.
  •  

  • Coverage typically requires prior authorization, ensuring it aligns with the patient's treatment plan and clinical necessity.
  •  

  • Criteria for coverage generally include a documented history of obesity unmanageable by diet or exercise alone, alongside potential co-morbid conditions like hypertension or diabetes.
  •  

  • Physicians must provide documentation proving that other, less intensive weight-loss approaches have been ineffective before approval.
  •  

  • The drug prescription is usually part of a comprehensive weight-loss program, encompassing diet, exercise, and behavioral changes.

 

Basic Rules and Criteria

 

  • Patients need to demonstrate a BMI typically over 30, or over 27 with associated risk factors such as cardiovascular disease.
  •  

  • Continued coverage may require periodic reviews of treatment efficacy and adherence to prescribed lifestyle changes.
  •  

  • Centene might limit coverage to specific treatment durations to monitor the patient's progress and side effects.
  •  

  • Prescriptions are generally given in conjunction with a qualified healthcare provider's guidance, integrated into a structured weight management plan.

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Centene Corporation's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility Criteria for Diethylpropion (Tenuate) Coverage

 

  • Member must be 16 years of age or older.
  •  

  • Documentation must confirm that the member has a diagnosis of exogenous obesity.
  •  

  • Member's Body Mass Index (BMI) must be 30 kg/m² or greater, or 27 kg/m² or greater with accompanying obesity-related comorbid conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Member must have unsuccessfully attempted to achieve weight loss through lifestyle changes such as diet and exercise, documented over the previous three months.
  •  

  • Physician must provide a treatment plan indicating the use of diethylpropion as an adjunct to a reduced-calorie diet and increased physical activity.

 

Prescription and Dispensation Criteria

 

  • Prescription must be written by a healthcare provider specializing in obesity treatment or with expertise in weight management.
  •  

  • Treatment is approved for a short-term use period, typically up to 12 weeks, determined by the prescriber based on patient progress.
  •  

  • Prescription limits include a maximum daily dose of 75 mg, in accordance with FDA labeling guidelines.

 

Monitoring and Follow-up Requirements

 

  • Member must have follow-up appointments scheduled to track weight loss progress and any side effects during the treatment period.
  •  

  • Documentation of member's adherence to the prescribed diet and exercise regimen must be maintained and reviewed every month.
  •  

  • Renewal of coverage requires documented evidence of weight loss efficacy and a continued need for pharmacotherapy based on medical assessment.

 

Why Centene Corporation Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Denial of Diethylpropion (Tenuate) Coverage

 

  • Diethylpropion (Tenuate) is prescribed for off-label uses not approved by the FDA.
  •  

  • The patient does not meet the clinical criteria outlined in Centene's coverage policy for weight loss medications.
  •  

  • Prolonged use beyond the approved duration set forth in the coverage guidelines without adequate documentation of effectiveness.
  •  

  • There is a lack of documentation demonstrating a comprehensive weight loss plan incorporating lifestyle modifications or other first-line interventions.
  •  

  • The prescription does not meet the minimum age requirement set by Centene's policy for coverage.
  •  

  • Coverage is sought for a patient who does not meet the BMI threshold established by Centene for weight loss medication approval.
  •  

  • Previous history of substance abuse or dependency concerns related to the prescribed medication.
  •  

  • The request for Diethylpropion (Tenuate) is outside the formulary restrictions or is on a specific exclusion list managed by Centene.

 

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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 Centene Corporation

 

Research Centene Corporation Insurance Plans

 

  • Visit Centene Corporation’s official website to explore the various insurance plans they offer. Understanding which plan or subsidiary, like Ambetter or WellCare, fits your needs is crucial.
  •  
  • Contact a Centene representative through the customer service number provided on their website if you need personalized assistance in choosing the right plan that may cover Diethylpropion.

 

Check Prescription Drug Coverage

 

  • Carefully review the formulary (drug list) associated with the insurance plan you’re interested in. This list is typically available on Centene's website under the specific insurance plan's details.
  •  
  • Ensure Diethylpropion (Tenuate) is included in the coverage. If it is not listed, you may need to inquire about whether it can be considered for coverage under certain conditions.

 

Consult with a Healthcare Provider

 

  • Before proceeding, discuss with your healthcare provider about your need for Diethylpropion. They can offer insights on necessary documentation or alternative treatments if coverage challenges arise.
  •  
  • Request your healthcare provider to write a detailed prescription and provide any necessary justification for the medication. This can support any claims or appeals you might need to make with Centene.

 

Contact Centene Member Services

 

  • Reach out to Centene’s member services to inquire about specific requirements for Diethylpropion coverage under your chosen plan. They may have additional documentation or steps required.
  •  
  • Request information regarding any prior authorization forms or processes necessary to process Diethylpropion coverage requests.

 

Prepare Necessary Documentation

 

  • Gather all necessary documentation, including your healthcare provider’s prescription, any prior authorization forms, and your insurance plan details.
  •  
  • Ensure that all documents are accurate and complete to prevent any delays in processing your coverage request.

 

Submit Your Application

 

  • Follow the submission process as instructed by Centene for your specific insurance plan. This could be through the member portal, by mail, or via fax.
  •  
  • Track your application status through Centene’s portal or by contacting member services to ensure it is being processed in a timely manner.

 

Appeal if Necessary

 

  • If coverage for Diethylpropion is denied, review the denial notice carefully. It should provide information on the reason for denial and your rights to appeal.
  •  
  • Work with your healthcare provider to gather any additional documentation that might strengthen your appeal. Submit the appeal as per the instructions provided in the denial notice.

 

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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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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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