Does Christiana Care Health System Cover Phentermine/Topiramate ER (Qsymia)

Discover if Christiana Care covers Qsymia, explore denial reasons, learn how to gain coverage, and uncover costs without insurance. FAQs included!
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Coverage for Phentermine/Topiramate ER (Qsymia)

 

  • Christiana Care Health System may cover Qsymia, typically for patients with a BMI of 30 or higher, or those with a BMI of 27 or higher with at least one weight-related condition.
  •  

  • Coverage depends on the specific health insurance plan under Christiana Care, as individual plans may have different rules regarding prescription medications.

 

Criteria and Process

 

  • Patients must usually demonstrate that other weight loss measures, such as diet and exercise, have not been effective.
  •  

  • A prior authorization from a healthcare provider is often necessary, detailing the patient's need and how Qsymia fits into their weight management plan.
  •  

  • Some plans may require participation in a weight management program or regular follow-ups to maintain coverage for the medication.

 

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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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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 Phentermine/Topiramate ER (Qsymia) Coverage with Christiana Care Health System

 

Initiate Contact with Christiana Care Health System

 

  • Visit the official Christiana Care Health System website to find contact information for the patient services or insurance department.
  •  

  • Call or email the appropriate contact to inquire about the process for obtaining medication coverage, specifically for Phentermine/Topiramate ER (Qsymia).
  •  

  • Request information on any specific forms or documentation required to initiate a coverage request for Qsymia.
  •  

  • Inquire if there are preferred or in-network pharmacies where prescriptions can be filled for enhanced coverage benefits.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider within the Christiana Care Health System or an affiliated doctor.
  •  

  • Discuss your health needs and the potential benefit of Phentermine/Topiramate ER (Qsymia) for your treatment plan.
  •  

  • Ask your healthcare provider to evaluate your eligibility for this medication and consider writing a prescription for it if deemed appropriate.
  •  

  • Ensure your healthcare provider knows the necessity of documenting the medical need for Qsymia when submitting necessary paperwork to the insurance company.

 

Submit Required Documentation

 

  • Gather all necessary documentation, including your prescription, medical history, and any forms provided by Christiana Care Health System.
  •  

  • Work with your healthcare provider to complete and submit any prior authorization forms required by Christiana Care Health System or your insurer.
  •  

  • Include detailed notes from your healthcare provider explaining the medical necessity of Qsymia if required.

 

Follow Up with Insurance

 

  • Contact your insurance provider or the Christiana Care Health System insurance department to confirm receipt of your documentation.
  •  

  • Inquire about the status of your coverage request and ask for an estimated timeline for a decision.
  •  

  • If your request is initially denied, seek information on the appeals process and required steps to challenge the decision.

 

Fill Your Prescription

 

  • Upon approval, get your prescription filled at an in-network pharmacy as advised by Christiana Care Health System.
  •  

  • Monitor any out-of-pocket costs and understand your coverage levels, including any copayments or coinsurance.
  •  

  • Use the medication as prescribed by your healthcare provider and adhere to follow-up appointments to assess the efficacy and adjust treatment if necessary.

 

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FAQs

Does Christiana Care Health System Cover Phentermine/Topiramate ER (Qsymia)

Discover if Christiana Care covers Qsymia, explore denial reasons, learn how to gain coverage, and uncover costs without insurance. FAQs included!
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Is Phentermine/Topiramate ER (Qsymia) Covered by Christiana Care Health System

 

Coverage for Phentermine/Topiramate ER (Qsymia)

 

  • Christiana Care Health System may cover Qsymia, typically for patients with a BMI of 30 or higher, or those with a BMI of 27 or higher with at least one weight-related condition.
  •  

  • Coverage depends on the specific health insurance plan under Christiana Care, as individual plans may have different rules regarding prescription medications.

 

Criteria and Process

 

  • Patients must usually demonstrate that other weight loss measures, such as diet and exercise, have not been effective.
  •  

  • A prior authorization from a healthcare provider is often necessary, detailing the patient's need and how Qsymia fits into their weight management plan.
  •  

  • Some plans may require participation in a weight management program or regular follow-ups to maintain coverage for the medication.

 

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Christiana Care Health System's Approved Criteria for Phentermine/Topiramate ER (Qsymia) Coverage

 

Eligibility Criteria for Coverage

 

  • Patients must be at least 18 years old to qualify for Phentermine/Topiramate ER (Qsymia) coverage.
  • Eligibility requires a body mass index (BMI) of 30 kg/m² or greater. Alternatively, a BMI of 27 kg/m² or above with at least one weight-related comorbidity can also qualify a patient.

 

Clinical Evaluation Requirements

 

  • Patients should have a documented and unsuccessful history of weight loss attempts using lifestyle modifications, including diet and exercise.
  • A comprehensive medical evaluation by a healthcare provider is required to assess the patient’s overall health and determine the appropriateness of the medication.

 

Documentation & Prior Authorization

 

  • Healthcare providers must submit a prior authorization request to ensure coverage for the medication under Christiana Care Health System insurance.
  • The request should include detailed medical records supporting the clinical necessity and showing previous weight management efforts.

 

Continued Use Evaluation

 

  • Ongoing evaluation of the effectiveness and safety of the medication is required. Patients must demonstrate a significant and sustained weight loss within the first few months.
  • Healthcare providers must document and review periodic weight assessment and health improvements or maintenance during follow-up consultations.

 

Adherence to Prescribed Plan

 

  • Patients are required to adhere strictly to the prescribed dosage and treatment plan as determined by their healthcare provider.
  • Participation in a structured weight loss program alongside medication is encouraged to enhance treatment outcomes.

 

Why Christiana Care Health System Might Deny Phentermine/Topiramate ER (Qsymia) Coverage

 

Situations Where Coverage Is Denied

 

  • Patients who do not meet the BMI requirements specified by the health system. Typically, a certain BMI threshold must be met to qualify for obesity treatment medications.
  •  

  • Patients with a history of cardiovascular disease, as the medication may have contraindications for individuals with certain heart conditions.
  •  

  • Individuals who have not previously attempted alternative weight management options, such as lifestyle modifications or other pharmacological treatments, may be denied coverage.
  •  

  • Patients with certain contraindicated medical conditions, such as untreated hyperthyroidism or glaucoma, may not be eligible for coverage under the health system's criteria.
  •  

  • Pregnant individuals or those planning to conceive, as the medication is not recommended during pregnancy due to potential risks.
  •  

  • Failure to provide complete documentation of prior treatments and medical necessity as required by the health system’s policy.
  •  

  • Lack of adherence to specific health and wellness programs that are required prerequisites for medication coverage by the health system.
  •  

  • Requests for the medication exceeding the allotted time frame for coverage without adequate justification of continued medical necessity.

 

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How Much Does Phentermine/Topiramate ER (Qsymia) Cost without Insurance?

 

Cost of Phentermine/Topiramate ER (Qsymia) Without Insurance

 

  • The average retail price for Phentermine/Topiramate ER (Qsymia), a medication typically prescribed for weight loss, ranges from $120 to $240 for a 30-day supply, depending on the pharmacy and location.
  •  

  • Prices may vary slightly due to specific factors such as dosage strength, with differing costs for varying dosages like 3.75 mg/23 mg, 7.5 mg/46 mg, 11.25 mg/69 mg, and 15 mg/92 mg.
  •  

  • Discount programs or pharmacy coupons might offer lower prices, potentially reducing the cost to as low as $100 for a monthly supply. It is advisable for patients to explore these options for financial relief.
  •  

  • Some pharmacies provide price matching, which can be helpful in securing the best available price without insurance.
  •  

  • Patients should check for any available manufacturer's savings programs or patient assistance plans that might further aid in reducing 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 Phentermine/Topiramate ER (Qsymia) Coverage with Christiana Care Health System

 

Initiate Contact with Christiana Care Health System

 

  • Visit the official Christiana Care Health System website to find contact information for the patient services or insurance department.
  •  

  • Call or email the appropriate contact to inquire about the process for obtaining medication coverage, specifically for Phentermine/Topiramate ER (Qsymia).
  •  

  • Request information on any specific forms or documentation required to initiate a coverage request for Qsymia.
  •  

  • Inquire if there are preferred or in-network pharmacies where prescriptions can be filled for enhanced coverage benefits.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider within the Christiana Care Health System or an affiliated doctor.
  •  

  • Discuss your health needs and the potential benefit of Phentermine/Topiramate ER (Qsymia) for your treatment plan.
  •  

  • Ask your healthcare provider to evaluate your eligibility for this medication and consider writing a prescription for it if deemed appropriate.
  •  

  • Ensure your healthcare provider knows the necessity of documenting the medical need for Qsymia when submitting necessary paperwork to the insurance company.

 

Submit Required Documentation

 

  • Gather all necessary documentation, including your prescription, medical history, and any forms provided by Christiana Care Health System.
  •  

  • Work with your healthcare provider to complete and submit any prior authorization forms required by Christiana Care Health System or your insurer.
  •  

  • Include detailed notes from your healthcare provider explaining the medical necessity of Qsymia if required.

 

Follow Up with Insurance

 

  • Contact your insurance provider or the Christiana Care Health System insurance department to confirm receipt of your documentation.
  •  

  • Inquire about the status of your coverage request and ask for an estimated timeline for a decision.
  •  

  • If your request is initially denied, seek information on the appeals process and required steps to challenge the decision.

 

Fill Your Prescription

 

  • Upon approval, get your prescription filled at an in-network pharmacy as advised by Christiana Care Health System.
  •  

  • Monitor any out-of-pocket costs and understand your coverage levels, including any copayments or coinsurance.
  •  

  • Use the medication as prescribed by your healthcare provider and adhere to follow-up appointments to assess the efficacy and adjust treatment if necessary.

 

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Phentermine/Topiramate ER (Qsymia) FAQ

What are the common side effects of Phentermine/Topiramate ER (Qsymia)?

 

Common Side Effects of Qsymia

 

  • **Paraesthesia:** Often described as a tingling sensation, typically in the hands and feet.
  •  

  • **Dizziness and lightheadedness:** These sensations may occur, especially when standing up quickly.
  •  

  • **Dry mouth:** Increased thirst or the feeling of not having enough saliva can be common with Qsymia use.
  •  

  • **Insomnia:** Difficulty falling asleep or staying asleep may be experienced.
  •  

  • **Constipation:** A common digestive side effect, characterized by infrequent bowel movements.
  •  

  • **Taste alteration:** Some users report a change in taste perception or a metallic taste.

How effective is Qsymia for weight loss?

 

Effectiveness of Qsymia

 

  • Qsymia combines phentermine and topiramate ER, proven effective for weight loss by enhancing satiety and reducing appetite.
  •  

  • Clinical trials report an average weight loss of about 5%–10% of initial body weight over a year, higher than diet and exercise alone.
  •  

  • Study results can vary based on individual factors such as diet adherence and lifestyle changes.
  •  

 

Considerations

 

  • Best results occur alongside a reduced-calorie diet and increased physical activity.
  •  

  • Assess for potential side effects, including increased heart rate, mood changes, and birth defects if used during pregnancy.
  •  

  • Long-term efficacy beyond one year is less established, requiring ongoing lifestyle modifications for sustained weight management.

 

Can Qsymia be taken long-term for weight management?

 

Long-term Use of Qsymia

 

  • Qsymia is an obesity medication combining phentermine and topiramate. It's approved for long-term use along with a reduced-calorie diet and increased physical activity.
  •  

  • Potential benefits include sustainable weight loss, improved metabolic health, and reduced risk of obesity-related conditions.

 

Monitoring and Safety

 

  • Regular follow-ups with a healthcare provider are essential to monitor side effects and effectiveness.
  •  

  • Common side effects include numbness, dizziness, taste changes, and insomnia. More severe risks include mood alterations and birth defects.

 

Continuing Treatment

 

  • Periodic assessment is crucial to decide if continued treatment is appropriate based on weight loss progress and side effect profile.
  •  

  • Should significant weight loss not occur within 12 weeks, alternative therapies might be considered.

 

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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.

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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