Does Cigna Cover Phendimetrazine

Explore Cigna's coverage for Phendimetrazine, reasons for denial, how to secure coverage, costs without insurance, and FAQs.
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Cigna Coverage for Phendimetrazine

 

  • Cigna's coverage for Phendimetrazine, an appetite suppressant, largely depends on the policyholder's specific plan. Some plans might include it under prescription drug coverage, but others may require prior authorization.
  •  

  • The drug is typically covered when prescribed for obesity treatment, provided that it's deemed medically necessary. A doctor must document that the patient has a BMI over 30 or over 27 with obesity-related conditions.
  •  

  • Patients must have attempted weight loss through diet and exercise without success before Cigna may approve Phendimetrazine coverage. This is to ensure that medication is only used when absolutely needed.
  •  

  • In some cases, Cigna may require documentation showing that alternative weight-loss medications have been ineffective. This can include previous prescriptions or doctor evaluations.
  •  

  • Always review your specific plan details or consult with a representative to understand exact coverage rules as they can differ widely between policies.

 

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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.

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 Phendimetrazine Coverage with Cigna

 

Confirm Phendimetrazine is Covered

 

  • Check Cigna's formulary list on their website to ensure Phendimetrazine is covered under your specific plan. Formularies may vary based on state and specific plans.
  • Contact Cigna's customer service for direct confirmation if you cannot find the information online. They can provide detailed insight into prescription coverages.

 

Understand Coverage Requirements

 

  • Consult with your healthcare provider to ensure Phendimetrazine is medically necessary for you. Health insurance companies often require indication of medical necessity for coverage.
  • Request your healthcare provider to provide documentation or write a necessity letter if required by Cigna.

 

Doctor's Prescription and Prior Authorization

 

  • Obtain a prescription from your healthcare provider for Phendimetrazine. Ensure your provider is aware of any form requirements by Cigna.
  • Cigna may require prior authorization for Phendimetrazine. Work with your healthcare provider to submit any necessary prior authorization paperwork to Cigna. This often involves filling out specific forms and providing justification for the medication.

 

Utilize Cigna's Member Portal

 

  • Create or log into your account on the Cigna member portal to manage your prescription coverage and submit any additional documentation required.
  • Track your prior authorization request status or any other submissions directly through the member portal. This facilitates easier follow-up and ensures everything is on track for approval.

 

Explore Alternative Pharmacies

 

  • Use Cigna’s pharmacy directory in your plan documents or on their website to locate in-network pharmacies, as using preferred pharmacies can help with coverage and cost reduction.
  • Check if a specific pharmacy offers special services or discounts for Cigna members. Some pharmacies may have special arrangements with insurance providers that affect coverage terms favorably.

 

Appeal Denials

 

  • If Cigna denies the coverage for Phendimetrazine, review the denial letter carefully. It typically explains the reason for denial and the steps necessary for appeal.
  • Prepare for an appeal by gathering additional documentation that supports the necessity of Phendimetrazine, such as letters from your healthcare provider.
  • Follow Cigna's specific process for submitting an appeal, making sure to adhere to any deadlines for appeals submission.

 

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FAQs

Does Cigna Cover Phendimetrazine

Explore Cigna's coverage for Phendimetrazine, reasons for denial, how to secure coverage, costs without insurance, and FAQs.
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Is Phendimetrazine Covered by Cigna

 

Cigna Coverage for Phendimetrazine

 

  • Cigna's coverage for Phendimetrazine, an appetite suppressant, largely depends on the policyholder's specific plan. Some plans might include it under prescription drug coverage, but others may require prior authorization.
  •  

  • The drug is typically covered when prescribed for obesity treatment, provided that it's deemed medically necessary. A doctor must document that the patient has a BMI over 30 or over 27 with obesity-related conditions.
  •  

  • Patients must have attempted weight loss through diet and exercise without success before Cigna may approve Phendimetrazine coverage. This is to ensure that medication is only used when absolutely needed.
  •  

  • In some cases, Cigna may require documentation showing that alternative weight-loss medications have been ineffective. This can include previous prescriptions or doctor evaluations.
  •  

  • Always review your specific plan details or consult with a representative to understand exact coverage rules as they can differ widely between policies.

 

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Cigna's Approved Criteria for Phendimetrazine Coverage

 

Criteria for Phendimetrazine Coverage by Cigna

 

  • Patient must be 16 years of age or older to be eligible for phendimetrazine coverage.
  •  

  • The individual should have a body mass index (BMI) of 30 kg/m2 or more; alternatively, a BMI of 27 kg/m2 or more is acceptable if the patient has associated comorbidities such as hypertension, diabetes, or dyslipidemia.
  •  

  • The patient should have attempted at least one weight reduction program (e.g., diet, exercise) supervised by a healthcare professional and failed to achieve weight loss.
  •  

  • Phendimetrazine is intended for individuals who require short-term use as part of a comprehensive weight management program, including lifestyle changes like a reduced-calorie diet and increased physical activity.
  •  

  • Documentation from a healthcare provider must indicate that the potential benefits of using phendimetrazine outweigh the potential risks for the patient and that the medication is prescribed for weight loss purposes.
  •  

  • The prescribing healthcare professional must evaluate the patient's medical history to ensure no contraindications to the use of phendimetrazine.
  •  

  • Continued coverage may require evidence of weight reduction progress or another review by a healthcare provider confirming the medication's ongoing need and effectiveness.

 

Why Cigna Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage by Cigna

 

  • Cigna may deny coverage if the prescription for Phendimetrazine does not meet their medical necessity criteria. The medication must be deemed essential for the patient's treatment plan. If it is deemed not medically necessary, coverage might be denied.
  •  

  • If the prescription is not written by a licensed healthcare provider authorized to prescribe controlled substances, Cigna is likely to deny coverage for Phendimetrazine.
  •  

  • Cigna typically requires prior authorization for Phendimetrazine. If the authorization process is not completed or if it's denied due to insufficient justification, the coverage can be denied.
  •  

  • If the use of Phendimetrazine is not supported by clinical guidelines or if the patient does not meet the specific clinical criteria set forth by Cigna, coverage may be denied. This includes situations where the patient’s Body Mass Index (BMI) does not meet the threshold for anti-obesity medications.
  •  

  • In cases where Phendimetrazine is prescribed for off-label uses not recognized by Cigna's policy or is not FDA-approved, coverage is unlikely to be provided.
  •  

  • Cigna might also deny coverage if the patient has a history of substance abuse or other contraindications identified in their policy guidelines relating to Phendimetrazine.
  •  

  • If the patient has other health conditions that contraindicate the use of Phendimetrazine, Cigna may deny coverage based on their safety protocols.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Cigna

 

Confirm Phendimetrazine is Covered

 

  • Check Cigna's formulary list on their website to ensure Phendimetrazine is covered under your specific plan. Formularies may vary based on state and specific plans.
  • Contact Cigna's customer service for direct confirmation if you cannot find the information online. They can provide detailed insight into prescription coverages.

 

Understand Coverage Requirements

 

  • Consult with your healthcare provider to ensure Phendimetrazine is medically necessary for you. Health insurance companies often require indication of medical necessity for coverage.
  • Request your healthcare provider to provide documentation or write a necessity letter if required by Cigna.

 

Doctor's Prescription and Prior Authorization

 

  • Obtain a prescription from your healthcare provider for Phendimetrazine. Ensure your provider is aware of any form requirements by Cigna.
  • Cigna may require prior authorization for Phendimetrazine. Work with your healthcare provider to submit any necessary prior authorization paperwork to Cigna. This often involves filling out specific forms and providing justification for the medication.

 

Utilize Cigna's Member Portal

 

  • Create or log into your account on the Cigna member portal to manage your prescription coverage and submit any additional documentation required.
  • Track your prior authorization request status or any other submissions directly through the member portal. This facilitates easier follow-up and ensures everything is on track for approval.

 

Explore Alternative Pharmacies

 

  • Use Cigna’s pharmacy directory in your plan documents or on their website to locate in-network pharmacies, as using preferred pharmacies can help with coverage and cost reduction.
  • Check if a specific pharmacy offers special services or discounts for Cigna members. Some pharmacies may have special arrangements with insurance providers that affect coverage terms favorably.

 

Appeal Denials

 

  • If Cigna denies the coverage for Phendimetrazine, review the denial letter carefully. It typically explains the reason for denial and the steps necessary for appeal.
  • Prepare for an appeal by gathering additional documentation that supports the necessity of Phendimetrazine, such as letters from your healthcare provider.
  • Follow Cigna's specific process for submitting an appeal, making sure to adhere to any deadlines for appeals submission.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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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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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