Does EmblemHealth Cover Contrave

Explore if EmblemHealth covers Contrave, reasons for denial, tips for approval, costs without insurance, and FAQs to guide your medication journey.
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Contrave Coverage by EmblemHealth

 

  • Contrave, a medication used for weight management, may be covered by EmblemHealth, but specifics depend on your health plan.
  •  

  • Typically, it is covered under the pharmacy benefits, but preauthorization is required to confirm medical necessity.
  •  

  • The patient might need to demonstrate previous attempts with other weight loss methods for eligibility.
  •  

  • Insurance criteria often includes BMI thresholds, usually a BMI of 30 or greater, or a BMI of 27 with comorbid conditions such as hypertension or diabetes.
  •  

  • Consult the EmblemHealth formulary for specific plan details and steps for obtaining coverage.
  •  

  • It's advisable to verify with EmblemHealth customer service or your healthcare provider for tailored advice and coverage options.

 

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Contrave Coverage with EmblemHealth

 

Verify Coverage Information

 

  • Visit the EmblemHealth website and log in to your member account.
  •  

  • Navigate to the prescription drug coverage section under your specific health plan.
  •  

  • Check if Contrave is listed under covered medications.
  •  

  • If additional clarification is needed, contact EmblemHealth’s customer service for information on Contrave coverage.

 

Obtain Prescription

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave.
  •  

  • Ensure your healthcare provider writes a prescription detailing the medication dosage and frequency.
  •  

  • Ask your healthcare provider if they can provide any supporting documentation that EmblemHealth might require for coverage approval.

 

Contact EmblemHealth

 

  • Call the EmblemHealth customer service line to confirm the exact procedure for obtaining pre-authorization for Contrave, if required.
  •  

  • Ask if there are any specific forms or documents needed from your healthcare provider to process the request.
  •  

  • Request information on whether any step therapy or prior authorization is required for Contrave.

 

Submit Prior Authorization Request

 

  • Work with your healthcare provider to complete any necessary forms for prior authorization.
  •  

  • Collect supporting documentation such as medical records or doctor’s notes justifying the need for Contrave.
  •  

  • Submit the prior authorization request form and supporting documents to EmblemHealth, either via fax, mail, or through an online portal if available.

 

Follow Up on Request

 

  • Contact EmblemHealth to confirm they have received your prior authorization request.
  •  

  • Inquire about the timeline for processing and approval of the request.
  •  

  • Be prepared to provide any additional information that might be requested by EmblemHealth.
  •  

  • If denied, ask for details on the appeals process to contest the decision.

 

Fill Your Prescription

 

  • Once approved, take your prescription and coverage approval to a participating pharmacy.
  •  

  • Inform the pharmacist that your plan covers Contrave through EmblemHealth.
  •  

  • Pay any applicable co-payment and follow the pharmacist’s instructions for medication use.

 

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FAQs

Does EmblemHealth Cover Contrave

Explore if EmblemHealth covers Contrave, reasons for denial, tips for approval, costs without insurance, and FAQs to guide your medication journey.
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Is Contrave Covered by EmblemHealth

 

Contrave Coverage by EmblemHealth

 

  • Contrave, a medication used for weight management, may be covered by EmblemHealth, but specifics depend on your health plan.
  •  

  • Typically, it is covered under the pharmacy benefits, but preauthorization is required to confirm medical necessity.
  •  

  • The patient might need to demonstrate previous attempts with other weight loss methods for eligibility.
  •  

  • Insurance criteria often includes BMI thresholds, usually a BMI of 30 or greater, or a BMI of 27 with comorbid conditions such as hypertension or diabetes.
  •  

  • Consult the EmblemHealth formulary for specific plan details and steps for obtaining coverage.
  •  

  • It's advisable to verify with EmblemHealth customer service or your healthcare provider for tailored advice and coverage options.

 

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EmblemHealth's Approved Criteria for Contrave Coverage

 

Criteria for Contrave Coverage by EmblemHealth

 

  • **FDA Approval**: Contrave must be FDA-approved for the specific indication being requested.
  •  

  • **Age Requirement**: The patient must be 18 years or older.
  •  

  • **Body Mass Index (BMI)**:
    • A BMI of 30 kg/m² or greater, OR
    • A BMI of 27 kg/m² or greater with at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes, or dyslipidemia).
  •  

  • **Previous Weight Loss Efforts**: Documentation of previous weight loss attempts, including lifestyle interventions such as diet, exercise, and behavior modification, for at least 6 months.
  •  

  • **Consultation and Prescription**: A prescription from a licensed healthcare professional emphasizing the patient’s need for pharmacotherapy as part of a comprehensive weight management plan.
  •  

  • **Exclusion of Primary Eating Disorders**: The patient should not have any history of primary eating disorders such as anorexia nervosa or bulimia.
  •  

  • **Concurrent Medication and Interaction Review**: Assessment of potential drug interactions with current medications to ensure Contrave is a safe option.
  •  

  • **Initial Coverage Duration**: Initial coverage is often given for a specified trial period (e.g., 12 weeks) to assess effective weight loss, defined as a 5% reduction in baseline body weight.
  •  

  • **Continued Coverage Criteria**: Continued use may be reassessed to ensure sustained weight loss benefits, often requiring documentation of ongoing weight loss and adherence to therapy.

Why EmblemHealth Might Deny Contrave Coverage

 

Non-Coverage Criteria for Contrave by EmblemHealth

 

  • **Off-label Use:** EmblemHealth does not cover Contrave if it is prescribed for conditions other than obesity or weight loss management approved by the FDA.
  •  

  • **Non-compliance with Prior Authorization Requirements:** Coverage may be denied if the patient fails to obtain prior authorization for Contrave as required by EmblemHealth protocols.
  •  

  • **Failure to Meet Medical Necessity Criteria:** If the patient does not meet specified medical necessity criteria, such as a threshold Body Mass Index (BMI) or the presence of obesity-related conditions, coverage may be denied.
  •  

  • **Limitations on Duration of Use:** EmblemHealth may not cover Contrave beyond a certain period if the patient does not demonstrate weight loss progress or failure to achieve intended outcomes as specified by the plan.
  •  

  • **Use of Alternative Therapy:** Coverage might be denied if there is a requirement to try and fail alternative weight loss therapies before approving Contrave.
  •  

  • **Plan Exclusions:** Contrave may not be covered if it falls under specific plan exclusions or if the medication is explicitly excluded from the formulary.
  •  

  • **Age Restrictions:** EmblemHealth might not cover Contrave for patients who do not fall within the age range specified for use according to their policies or clinical guidelines.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with EmblemHealth

 

Verify Coverage Information

 

  • Visit the EmblemHealth website and log in to your member account.
  •  

  • Navigate to the prescription drug coverage section under your specific health plan.
  •  

  • Check if Contrave is listed under covered medications.
  •  

  • If additional clarification is needed, contact EmblemHealth’s customer service for information on Contrave coverage.

 

Obtain Prescription

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave.
  •  

  • Ensure your healthcare provider writes a prescription detailing the medication dosage and frequency.
  •  

  • Ask your healthcare provider if they can provide any supporting documentation that EmblemHealth might require for coverage approval.

 

Contact EmblemHealth

 

  • Call the EmblemHealth customer service line to confirm the exact procedure for obtaining pre-authorization for Contrave, if required.
  •  

  • Ask if there are any specific forms or documents needed from your healthcare provider to process the request.
  •  

  • Request information on whether any step therapy or prior authorization is required for Contrave.

 

Submit Prior Authorization Request

 

  • Work with your healthcare provider to complete any necessary forms for prior authorization.
  •  

  • Collect supporting documentation such as medical records or doctor’s notes justifying the need for Contrave.
  •  

  • Submit the prior authorization request form and supporting documents to EmblemHealth, either via fax, mail, or through an online portal if available.

 

Follow Up on Request

 

  • Contact EmblemHealth to confirm they have received your prior authorization request.
  •  

  • Inquire about the timeline for processing and approval of the request.
  •  

  • Be prepared to provide any additional information that might be requested by EmblemHealth.
  •  

  • If denied, ask for details on the appeals process to contest the decision.

 

Fill Your Prescription

 

  • Once approved, take your prescription and coverage approval to a participating pharmacy.
  •  

  • Inform the pharmacist that your plan covers Contrave through EmblemHealth.
  •  

  • Pay any applicable co-payment and follow the pharmacist’s instructions for medication use.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

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

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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