Does EmblemHealth Cover Diethylpropion (Tenuate)

Explore if EmblemHealth covers Diethylpropion, learn how to secure coverage, understand potential costs, and get answers to FAQs.
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Coverage of Diethylpropion (Tenuate) by EmblemHealth

 

  • Diethylpropion (Tenuate) is a prescription medication used for weight loss. Coverage by EmblemHealth varies based on specific health plans.
  •  

  • Typically, EmblemHealth covers medications deemed medically necessary. A physician must provide documentation indicating that Diethylpropion is required for the patient's weight management, often after other weight loss methods have failed.
  •  

  • Prior authorization may be required, meaning your healthcare provider must obtain approval before the medication is covered.
  •  

  • Some plans might require the patient to meet criteria such as a certain Body Mass Index (BMI) and the presence of weight-related health conditions.
  •  

  • Contact EmblemHealth customer service or review your specific plan's formulary for detailed coverage information.

 

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

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

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

Kayla Mardaga, NP

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

How to Get Diethylpropion (Tenuate) Coverage with EmblemHealth

 

Verify Prescription Coverage with EmblemHealth

 

  • Contact EmblemHealth Customer Service to confirm if Diethylpropion (Tenuate) is included in your plan's formulary. Have your member ID ready for a seamless verification process.
  •  

  • Check the EmblemHealth website or member portal, as they usually offer a list of covered medications and potential preferred alternatives.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Diethylpropion (Tenuate) for your treatment plan. They may offer insights on the need for prior authorization or alternatives that could be more easily covered.
  •  

  • Request documentation or medical records from your provider that justify the need for Diethylpropion, which can aid in strengthening your case during an appeal if required.

 

Request a Prior Authorization

 

  • Determine if a prior authorization is needed for Diethylpropion (Tenuate) by confirming with EmblemHealth. Your healthcare provider should initiate this process on your behalf.
  •  

  • Ensure that your provider submits all necessary forms and documentation promptly to prevent delays in processing your coverage request.

 

Explore Alternative Coverage Options

 

  • If initial coverage is denied, discuss with your provider about submitting an appeal with EmblemHealth, providing any additional supporting documents or medical necessity letters.
  •  

  • Evaluate generic alternatives or different weight-management medications if Diethylpropion is not covered, as these may offer similar benefits with better coverage.

 

Utilize EmblemHealth Resources

 

  • Access the EmblemHealth member portal to track the status of your prior authorization or appeal. This can offer timely updates and allow you to submit additional documents if necessary.
  •  

  • Contact EmblemHealth pharmacy services directly for detailed information about coverage tiers, formularies, and potential out-of-pocket costs associated with Diethylpropion (Tenuate).

 

Stay Informed and Persistent

 

  • Regularly follow up with both EmblemHealth and your healthcare provider to ensure all necessary steps are being taken to secure coverage.
  •  

  • If your request is denied, inquire about the reasons for the denial and explore all options for a successful appeal process.

 

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FAQs

Does EmblemHealth Cover Diethylpropion (Tenuate)

Explore if EmblemHealth covers Diethylpropion, learn how to secure coverage, understand potential costs, and get answers to FAQs.
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Is Diethylpropion (Tenuate) Covered by EmblemHealth

 

Coverage of Diethylpropion (Tenuate) by EmblemHealth

 

  • Diethylpropion (Tenuate) is a prescription medication used for weight loss. Coverage by EmblemHealth varies based on specific health plans.
  •  

  • Typically, EmblemHealth covers medications deemed medically necessary. A physician must provide documentation indicating that Diethylpropion is required for the patient's weight management, often after other weight loss methods have failed.
  •  

  • Prior authorization may be required, meaning your healthcare provider must obtain approval before the medication is covered.
  •  

  • Some plans might require the patient to meet criteria such as a certain Body Mass Index (BMI) and the presence of weight-related health conditions.
  •  

  • Contact EmblemHealth customer service or review your specific plan's formulary for detailed coverage information.

 

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EmblemHealth's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

EmblemHealth Criteria for Diethylpropion (Tenuate) Coverage

 

  • Diethylpropion (Tenuate) may be covered by EmblemHealth when prescribed for the management of exogenous obesity as part of a comprehensive weight management program.
  •  

  • The member must be at least 18 years old and have a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² with the presence of an obesity-related comorbidity such as type 2 diabetes, hypertension, or hyperlipidemia.
  •  

  • Documentation indicating that the member has attempted weight-loss with a comprehensive lifestyle intervention, including diet, physical activity, and behavioral therapies, for at least 3 months, should be provided.
  •  

  • The healthcare provider must confirm that the initiation of Diethylpropion is part of a comprehensive weight management program supervised by the healthcare provider.
  •  

  • The continuation of Diethylpropion treatment beyond an initial 12-week period is considered if the member has achieved a weight loss of at least 5 percent of the initial body weight and no significant adverse effects are present.

 

Continuation Criteria

 

  • EmblemHealth may cover Diethylpropion for extended use if there is documented evidence of continued benefit from the therapy, such as sustained weight reduction or favorable metabolic improvements.
  •  

  • Periodic reassessment by the prescribing healthcare provider to evaluate progress and decide on the continuation of therapy is necessary for continued coverage.
  •  

  • There should be evidence of compliance with a comprehensive weight management plan, including dietary, physical activity, and behavioral strategies.

 

Why EmblemHealth Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons EmblemHealth Might Deny Diethylpropion (Tenuate) Coverage

 

  • Diethylpropion is prescribed for conditions not supported by FDA approval. Coverage may be denied if the drug is used off-label or for weight management not recognized by the FDA.
  •  

  • Patient does not meet Body Mass Index (BMI) requirements. EmblemHealth may require that patients exhibit a BMI of 30 or greater, or 27 with related comorbidities, and coverage may be denied if these criteria are not met.
  •  

  • Insufficient documentation of previous weight loss attempts. Coverage can be denied if there is a lack of evidence of previous weight management efforts through traditional means such as diet and exercise.
  •  

  • Prescription exceeds approved dosage or duration limits. EmblemHealth may impose limits on the quantity and duration of Diethylpropion prescriptions, and exceeding these limits can result in a denial.
  •  

  • Non-compliance with prior authorization requirements. Failing to acquire necessary prior authorization before prescribing Diethylpropion can lead to a denial of coverage.
  •  

  • Policy exclusions related to weight management drugs. Some EmblemHealth plans exclude coverage for weight management medications altogether, which would include Diethylpropion.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with EmblemHealth

 

Verify Prescription Coverage with EmblemHealth

 

  • Contact EmblemHealth Customer Service to confirm if Diethylpropion (Tenuate) is included in your plan's formulary. Have your member ID ready for a seamless verification process.
  •  

  • Check the EmblemHealth website or member portal, as they usually offer a list of covered medications and potential preferred alternatives.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Diethylpropion (Tenuate) for your treatment plan. They may offer insights on the need for prior authorization or alternatives that could be more easily covered.
  •  

  • Request documentation or medical records from your provider that justify the need for Diethylpropion, which can aid in strengthening your case during an appeal if required.

 

Request a Prior Authorization

 

  • Determine if a prior authorization is needed for Diethylpropion (Tenuate) by confirming with EmblemHealth. Your healthcare provider should initiate this process on your behalf.
  •  

  • Ensure that your provider submits all necessary forms and documentation promptly to prevent delays in processing your coverage request.

 

Explore Alternative Coverage Options

 

  • If initial coverage is denied, discuss with your provider about submitting an appeal with EmblemHealth, providing any additional supporting documents or medical necessity letters.
  •  

  • Evaluate generic alternatives or different weight-management medications if Diethylpropion is not covered, as these may offer similar benefits with better coverage.

 

Utilize EmblemHealth Resources

 

  • Access the EmblemHealth member portal to track the status of your prior authorization or appeal. This can offer timely updates and allow you to submit additional documents if necessary.
  •  

  • Contact EmblemHealth pharmacy services directly for detailed information about coverage tiers, formularies, and potential out-of-pocket costs associated with Diethylpropion (Tenuate).

 

Stay Informed and Persistent

 

  • Regularly follow up with both EmblemHealth and your healthcare provider to ensure all necessary steps are being taken to secure coverage.
  •  

  • If your request is denied, inquire about the reasons for the denial and explore all options for a successful appeal process.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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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