Does Cigna Cover Phentermine (Adipex-P, Lomaira)

Discover if Cigna covers Phentermine, reasons for denial, ways to secure coverage, costs without insurance, and answers to common FAQs in our comprehensive article.
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Does Cigna Cover Phentermine?

 

  • Cigna may cover Phentermine (Adipex-P, Lomaira) under specific conditions, primarily when it is deemed medically necessary.
  •  

  • Cigna typically requires that the patient be diagnosed with obesity or a related condition, with a body mass index (BMI) above a certain threshold.
  •  

  • Coverage often requires prior authorization to demonstrate that Phentermine is part of a comprehensive weight-loss program that includes diet, exercise, and behavioral changes.
  •  

  • Physicians must provide documentation supporting the necessity of Phentermine as part of the treatment plan.
  •  

  • Patients might need to prove failure to lose weight with lifestyle changes alone before coverage is approved.
  •  

  • Cigna's specific criteria and coverage may vary based on policy type and individual circumstances, so it’s advised to directly consult with Cigna or review plan details.

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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 Phentermine (Adipex-P, Lomaira) Coverage with Cigna

 

Verify Medication Coverage

 

  • Access your Cigna account through their online portal or app to review your specific plan details.
  •  

  • Locate the section on prescription drug coverage to check if Phentermine (Adipex-P, Lomaira) is included.
  •  

  • If you cannot find information online, call Cigna's customer service to ask about the coverage for Phentermine under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Phentermine with your healthcare provider to ensure it is medically necessary and eligible for insurance coverage.
  •  

  • Request that your healthcare provider submits a pre-authorization request to Cigna if necessary, explaining the medical necessity.

 

Understand Pre-Authorization Requirements

 

  • Contact Cigna to understand the pre-authorization requirements for Phentermine, as some plans might require it before covering the medication.
  •  

  • Request a list of documentation needed for the pre-authorization process from your healthcare provider.

 

Submit Necessary Documentation

 

  • Gather all required documentation from your healthcare provider, including any medical records that justify the need for Phentermine.
  •  

  • Ensure your healthcare provider submits the pre-authorization documents to Cigna promptly to avoid delays.

 

Follow Up with Cigna

 

  • Check the status of your pre-authorization request by contacting Cigna or monitoring it through their online portal.
  •  

  • If the request is approved, ensure that you understand the coverage details, including co-pays or any limitations on the medication.
  •  

  • If denied, ask for the specific reason and work with your healthcare provider to address any issues or submit an appeal if necessary.

 

Visit the Pharmacy

 

  • Once coverage is confirmed, fill your prescription at a pharmacy within Cigna’s network to ensure you receive the benefit of the coverage.
  •  

  • Provide your insurance details at the pharmacy to process the claim directly with Cigna.
  •  

  • Verify the cost with the pharmacist to ensure it aligns with your plan's coverage terms.

 

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FAQs

Does Cigna Cover Phentermine (Adipex-P, Lomaira)

Discover if Cigna covers Phentermine, reasons for denial, ways to secure coverage, costs without insurance, and answers to common FAQs in our comprehensive article.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Cigna

 

Does Cigna Cover Phentermine?

 

  • Cigna may cover Phentermine (Adipex-P, Lomaira) under specific conditions, primarily when it is deemed medically necessary.
  •  

  • Cigna typically requires that the patient be diagnosed with obesity or a related condition, with a body mass index (BMI) above a certain threshold.
  •  

  • Coverage often requires prior authorization to demonstrate that Phentermine is part of a comprehensive weight-loss program that includes diet, exercise, and behavioral changes.
  •  

  • Physicians must provide documentation supporting the necessity of Phentermine as part of the treatment plan.
  •  

  • Patients might need to prove failure to lose weight with lifestyle changes alone before coverage is approved.
  •  

  • Cigna's specific criteria and coverage may vary based on policy type and individual circumstances, so it’s advised to directly consult with Cigna or review plan details.

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Cigna's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Criteria for Cigna Coverage for Phentermine

 

  • The patient must have a documented clinical diagnosis of obesity. This is defined by a Body Mass Index (BMI) of 30 kg/m² or greater.
  •  

  • If the patient’s BMI is between 27 kg/m² and 29.9 kg/m², they must have at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must have attempted a documented weight-loss program, which includes experience with lifestyle modification, such as diet and exercise, with limited success.
  •  

  • The healthcare provider must show that the patient has been adherent to the weight-loss program and actively engaged in it for a minimum of six months without adequate weight reduction.
  •  

  • The prescription must be written by a healthcare provider with specialized training in the management of obesity or a related field.
  •  

  • The provider must document a comprehensive assessment including the patient’s weight history and dietary habits in the medical record as part of the request for coverage.
  •  

  • Ongoing use past the initial approved duration requires documentation of clinically significant weight loss as a result of using Phentermine, and ongoing participation in lifestyle interventions.
  •  

  • Renewal requests must include recent documentation indicating the patient's BMI and any improvements in the obesity-related comorbid conditions.

 

Why Cigna Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Cigna Exclusions for Phentermine (Adipex-P, Lomaira)

 

  • Cigna does not cover Phentermine if it is prescribed for cosmetic weight loss rather than treating obesity-related health conditions.
  •  

  • The coverage is denied if Phentermine is requested without documentation of previous efforts at weight reduction through diet and exercise programs.
  •  

  • Phentermine is not covered when prescribed as a maintenance medication, as it is intended for short-term use only according to Cigna's guidelines.
  •  

  • Coverage is excluded if the patient does not meet the Body Mass Index (BMI) criteria set by Cigna, typically a BMI of 30 or higher, or 27 with additional comorbidities.
  •  

  • Cigna may deny claims if Phentermine is used in combination with other weight-loss medications not approved by the FDA for combination use.
  •  

  • The insurance provider may refuse to cover Phentermine in cases where the patient has a history of substance abuse, as the medication has a potential for dependency.
  •  

  • Phentermine prescriptions are not covered if there is a lack of sufficient medical documentation justifying its necessity for the patient's treatment plan.
  •  

  • Cigna will not cover Phentermine if it is prescribed beyond the maximum allowable treatment duration, which is generally a few weeks.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 (Adipex-P, Lomaira) Coverage with Cigna

 

Verify Medication Coverage

 

  • Access your Cigna account through their online portal or app to review your specific plan details.
  •  

  • Locate the section on prescription drug coverage to check if Phentermine (Adipex-P, Lomaira) is included.
  •  

  • If you cannot find information online, call Cigna's customer service to ask about the coverage for Phentermine under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Phentermine with your healthcare provider to ensure it is medically necessary and eligible for insurance coverage.
  •  

  • Request that your healthcare provider submits a pre-authorization request to Cigna if necessary, explaining the medical necessity.

 

Understand Pre-Authorization Requirements

 

  • Contact Cigna to understand the pre-authorization requirements for Phentermine, as some plans might require it before covering the medication.
  •  

  • Request a list of documentation needed for the pre-authorization process from your healthcare provider.

 

Submit Necessary Documentation

 

  • Gather all required documentation from your healthcare provider, including any medical records that justify the need for Phentermine.
  •  

  • Ensure your healthcare provider submits the pre-authorization documents to Cigna promptly to avoid delays.

 

Follow Up with Cigna

 

  • Check the status of your pre-authorization request by contacting Cigna or monitoring it through their online portal.
  •  

  • If the request is approved, ensure that you understand the coverage details, including co-pays or any limitations on the medication.
  •  

  • If denied, ask for the specific reason and work with your healthcare provider to address any issues or submit an appeal if necessary.

 

Visit the Pharmacy

 

  • Once coverage is confirmed, fill your prescription at a pharmacy within Cigna’s network to ensure you receive the benefit of the coverage.
  •  

  • Provide your insurance details at the pharmacy to process the claim directly with Cigna.
  •  

  • Verify the cost with the pharmacist to ensure it aligns with your plan's coverage terms.

 

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Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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