Does Cigna Cover Phentermine/Topiramate ER (Qsymia)

Explore Cigna's coverage for Phentermine/Topiramate ER (Qsymia), costs without insurance, reasons for denial, and tips to secure approval.
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Does Cigna Cover Phentermine/Topiramate ER (Qsymia)?

 

  • Cigna may cover Phentermine/Topiramate ER (Qsymia) under certain conditions, primarily for weight management when prescribed for obesity treatment.
  •  

  • Coverage is typically subject to Cigna's prior authorization and medical necessity criteria.
  •  

  • Patients generally need to have a BMI of 30 or greater, or a BMI of 27 or greater with weight-related comorbidities such as hypertension or type 2 diabetes.
  •  

  • Documentation showing previous attempts at weight loss through lifestyle modifications, such as diet and exercise, may be required.
  •  

  • Coverage may vary based on specific plans, so it is crucial to verify benefits with Cigna directly.

 

Basic Steps to Get Covered

 

  • Consult with a healthcare provider to evaluate the need for Qsymia.
  •  

  • Have the provider submit a prior authorization request to Cigna with detailed medical records and weight-loss history.
  •  

  • Ensure compliance with Cigna’s policy criteria outlined in the plan details.
  •  

  • Follow up frequently until a coverage determination is made.

 

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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 Phentermine/Topiramate ER (Qsymia) Coverage with Cigna

 

Verify Your Coverage Plan

 

  • Login to your Cigna account online or check your policy documents to determine if Phentermine/Topiramate ER (Qsymia) is included in your plan's formulary.
  •  

  • Contact Cigna's customer service to confirm if your insurance plan covers the prescription and what requirements must be met.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Phentermine/Topiramate ER (Qsymia) and ask if it's the right option for you.
  •  

  • Ensure that your healthcare provider can provide any necessary documentation to justify the prescription for insurance purposes.

 

Obtain a Prescription

 

  • If your healthcare provider agrees to prescribe Phentermine/Topiramate ER (Qsymia), make sure you get a prescription that includes all necessary information for the pharmacy and insurance.
  •  

  • Ensure that the prescription clearly indicates that it is for medical necessity, as this might be required by Cigna for coverage.

 

Request Prior Authorization (if required)

 

  • Check if your plan requires prior authorization for Phentermine/Topiramate ER (Qsymia). This step is often necessary with specialty medications.
  •  

  • Work with your healthcare provider’s office to submit a prior authorization request to Cigna. Ensure that all required information, such as medical records and the rationale for the medication, is included.

 

Follow Up on Authorization Request

 

  • After submitting the request, follow up with both your healthcare provider and Cigna to ensure the prior authorization is being processed.
  •  

  • Check the status of your prior authorization by contacting Cigna, and be prepared to provide any additional information they may request.

 

Utilize Cigna's Resources

 

  • Take advantage of online resources or speak with a Cigna representative to clarify any doubts or complex steps you encounter in the process.
  •  

  • Review any guides or information Cigna provides specifically for obtaining prescriptions that require special authorization.

 

Fill Your Prescription

 

  • Once authorized, take your prescription to a participating pharmacy or use Cigna's home delivery service if applicable.
  •  

  • Make sure to confirm the co-pay or any out-of-pocket costs with the pharmacy to avoid unexpected expenses.

 

Appeal if Denied

 

  • If coverage for Phentermine/Topiramate ER (Qsymia) is denied, review the denial letter from Cigna to understand the reason for denial.
  •  

  • Work with your healthcare provider to gather additional supporting documents and submit an appeal through Cigna's specified process.

 

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FAQs

Does Cigna Cover Phentermine/Topiramate ER (Qsymia)

Explore Cigna's coverage for Phentermine/Topiramate ER (Qsymia), costs without insurance, reasons for denial, and tips to secure approval.
Curex allergy drops unboxing

Is Phentermine/Topiramate ER (Qsymia) Covered by Cigna

 

Does Cigna Cover Phentermine/Topiramate ER (Qsymia)?

 

  • Cigna may cover Phentermine/Topiramate ER (Qsymia) under certain conditions, primarily for weight management when prescribed for obesity treatment.
  •  

  • Coverage is typically subject to Cigna's prior authorization and medical necessity criteria.
  •  

  • Patients generally need to have a BMI of 30 or greater, or a BMI of 27 or greater with weight-related comorbidities such as hypertension or type 2 diabetes.
  •  

  • Documentation showing previous attempts at weight loss through lifestyle modifications, such as diet and exercise, may be required.
  •  

  • Coverage may vary based on specific plans, so it is crucial to verify benefits with Cigna directly.

 

Basic Steps to Get Covered

 

  • Consult with a healthcare provider to evaluate the need for Qsymia.
  •  

  • Have the provider submit a prior authorization request to Cigna with detailed medical records and weight-loss history.
  •  

  • Ensure compliance with Cigna’s policy criteria outlined in the plan details.
  •  

  • Follow up frequently until a coverage determination is made.

 

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Cigna's Approved Criteria for Phentermine/Topiramate ER (Qsymia) Coverage

 

Criteria for Coverage of Phentermine/Topiramate ER (Qsymia)

 

  • **Body Mass Index (BMI) Requirement**: The patient must have a BMI of 30 kg/m² or greater, which indicates obesity. Alternatively, coverage is considered for patients with a BMI of 27 kg/m² or greater if they have at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

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

  • **Trial of Weight Management Program**: The patient should have participated in a weight management program that includes diet, exercise, and behavioral therapy prior to requesting coverage for Qsymia. Documentation of participation may be required.
  •  

  • **Absence of Contraindications**: The patient must not have any contraindications to using Phentermine/Topiramate ER, such as pregnancy, glaucoma, hyperthyroidism, or recent MAOI use.
  •  

  • **Monitoring for Program Continuation**: Continued coverage will be based on demonstrated weight loss effectiveness. Patients should achieve a minimum percentage of weight loss after a specified treatment duration, often three months, to continue receiving coverage.
  •  

  • **Adherence to Dosing Recommendations**: Coverage is provided when the prescribed dosage falls within FDA-approved labeling recommendations. Providers may be asked to confirm dosage adherence for coverage verification.
  •  

  • **Requirements for Long-Term Use**: For longer-term use beyond a predefined period, usually 12 months, patients may need to demonstrate continued benefit or renewed assessment to justify ongoing coverage.
  •  

  • **Use in Conjunction with Lifestyle Modifications**: Insurance coverage will favor patients utilizing the medication alongside consistent lifestyle changes focused on long-term weight management.

 

Why Cigna Might Deny Phentermine/Topiramate ER (Qsymia) Coverage

 

Reasons Cigna Might Deny Phentermine/Topiramate ER (Qsymia) Coverage

 

  • **Non-Medical Necessity**: Coverage may be denied if the prescription of Phentermine/Topiramate ER (Qsymia) is not deemed medically necessary based on Cigna’s clinical guidelines.
  •  

  • **Lack of Prior Authorization**: If prior authorization is required and not obtained, Cigna may deny coverage.
  •  

  • **Non-Compliance with BMI Requirements**: Coverage might not be granted if the patient does not meet specific body mass index (BMI) criteria established by Cigna for weight management medications.
  •  

  • **Exclusion of Weight Management Drugs**: Some insurance plans explicitly exclude coverage for medications prescribed for obesity or weight management, including Phentermine/Topiramate ER (Qsymia).
  •  

  • **Failure to Meet Lifestyle Modification Conditions**: Cigna might require documentation of attempted lifestyle modifications, such as diet and exercise, before approving coverage. Failure to provide evidence may result in denial.
  •  

  • **Age Restrictions**: Phentermine/Topiramate ER (Qsymia) coverage might be denied if the patient does not fall within the age range Cigna specifies for this treatment.
  •  

  • **Lack of Required Diagnoses**: The absence of specific diagnoses, like obesity or other related comorbid conditions, may lead to a denial of coverage.
  •  

  • **Incomplete or Inaccurate Documentation**: Submitting claims with incomplete or inaccurate information can result in denial of coverage.
  •  

 

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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 Cigna

 

Verify Your Coverage Plan

 

  • Login to your Cigna account online or check your policy documents to determine if Phentermine/Topiramate ER (Qsymia) is included in your plan's formulary.
  •  

  • Contact Cigna's customer service to confirm if your insurance plan covers the prescription and what requirements must be met.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Phentermine/Topiramate ER (Qsymia) and ask if it's the right option for you.
  •  

  • Ensure that your healthcare provider can provide any necessary documentation to justify the prescription for insurance purposes.

 

Obtain a Prescription

 

  • If your healthcare provider agrees to prescribe Phentermine/Topiramate ER (Qsymia), make sure you get a prescription that includes all necessary information for the pharmacy and insurance.
  •  

  • Ensure that the prescription clearly indicates that it is for medical necessity, as this might be required by Cigna for coverage.

 

Request Prior Authorization (if required)

 

  • Check if your plan requires prior authorization for Phentermine/Topiramate ER (Qsymia). This step is often necessary with specialty medications.
  •  

  • Work with your healthcare provider’s office to submit a prior authorization request to Cigna. Ensure that all required information, such as medical records and the rationale for the medication, is included.

 

Follow Up on Authorization Request

 

  • After submitting the request, follow up with both your healthcare provider and Cigna to ensure the prior authorization is being processed.
  •  

  • Check the status of your prior authorization by contacting Cigna, and be prepared to provide any additional information they may request.

 

Utilize Cigna's Resources

 

  • Take advantage of online resources or speak with a Cigna representative to clarify any doubts or complex steps you encounter in the process.
  •  

  • Review any guides or information Cigna provides specifically for obtaining prescriptions that require special authorization.

 

Fill Your Prescription

 

  • Once authorized, take your prescription to a participating pharmacy or use Cigna's home delivery service if applicable.
  •  

  • Make sure to confirm the co-pay or any out-of-pocket costs with the pharmacy to avoid unexpected expenses.

 

Appeal if Denied

 

  • If coverage for Phentermine/Topiramate ER (Qsymia) is denied, review the denial letter from Cigna to understand the reason for denial.
  •  

  • Work with your healthcare provider to gather additional supporting documents and submit an appeal through Cigna's specified process.

 

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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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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.

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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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