Does Fallon Community Health Plan (FCHP) Cover Naltrexone/Bupropion (Contrave)

Explore FCHP coverage for Contrave, denial reasons, cost without insurance, FAQs, and tips to secure naltrexone/bupropion through Fallon Community Health Plan.
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Fallon Community Health Plan (FCHP) Coverage for Contrave

 

  • FCHP may cover Naltrexone/Bupropion (Contrave) for the treatment of obesity in specific cases.
  •  

  • Coverage generally applies if the medication is deemed medically necessary for the enrollee and prescribed by a healthcare provider.
  •  

  • The patient typically needs to meet criteria such as a BMI of 30 or above, or a BMI of 27 or above with at least one weight-related comorbidity, such as hypertension or type 2 diabetes.
  •  

  • Prior authorization is often required to ensure that the patient meets all criteria set by FCHP for this medication.
  •  

  • Enrollees may need to provide documentation of previous weight loss attempts over a prescribed period.

 

Criteria for Coverage

 

  • The policyholder must be a member with an active plan under FCHP that includes prescription coverage.
  •  

  • The prescription must be filled at a pharmacy within the FCHP network for documents to be considered.
  •  

  • Continuous evaluation of weight loss progress may influence continued coverage of the regimen.

 

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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 Naltrexone/Bupropion (Contrave) Coverage with Fallon Community Health Plan (FCHP)

 

Verify Plan Coverage

 

  • Contact Fallon Community Health Plan (FCHP) customer service to confirm if your plan includes coverage for Naltrexone/Bupropion (Contrave). You can usually find the contact number on your FCHP insurance card.
  •  

  • Check the FCHP member portal online for any available information on prescription drug coverage. Search the formulary or drug list for Naltrexone/Bupropion.
  •  

  • Review your specific policy documents or benefits summary to see detailed coverage information and any requirements such as prior authorization or step therapy.

 

Consult with Your Healthcare Provider

 

  • Talk to your doctor about your interest in taking Naltrexone/Bupropion (Contrave). Ensure it is medically appropriate for your condition and discuss any potential side effects with them.
  •  

  • Request a prescription for Naltrexone/Bupropion from your healthcare provider.
  •  

  • Ask your doctor whether they have experience obtaining approval for medications like Naltrexone/Bupropion with FCHP. They may provide useful advice or assistance with the process.

 

Initiate Prior Authorization

 

  • If required, your healthcare provider needs to submit a prior authorization request to FCHP. This documentation should outline the medical necessity of the medication.
  •  

  • Your provider may need to fill out specific forms provided by FCHP. Ensure that they include necessary information such as diagnosis, treatment history, and reasons for requesting Naltrexone/Bupropion.
  •  

  • Follow up with your healthcare provider's office to ensure the prior authorization request has been submitted.

 

Follow Up with Fallon Community Health Plan

 

  • Contact FCHP customer service to check on the status of your prior authorization or claims submission.
  •  

  • Ask if any additional information is needed to process your request or if there are any outstanding steps to take.
  •  

  • In case of denial, request a detailed explanation for the decision, and consult your healthcare provider about appealing the decision if necessary.

 

Explore Alternatives

 

  • Ask FCHP if there are other similar medications that are covered under your plan which can be considered as alternatives.
  •  

  • Discuss with your doctor if these alternatives might be appropriate for your treatment.

 

Consider Financial Assistance Options

 

  • Research available manufacturer discounts or patient assistance programs that may help offset the costs of Naltrexone/Bupropion if not covered by FCHP.
  •  

  • Check with your pharmacy for any additional savings programs or discounts they may offer.

 

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FAQs

Does Fallon Community Health Plan (FCHP) Cover Naltrexone/Bupropion (Contrave)

Explore FCHP coverage for Contrave, denial reasons, cost without insurance, FAQs, and tips to secure naltrexone/bupropion through Fallon Community Health Plan.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Fallon Community Health Plan (FCHP)

 

Fallon Community Health Plan (FCHP) Coverage for Contrave

 

  • FCHP may cover Naltrexone/Bupropion (Contrave) for the treatment of obesity in specific cases.
  •  

  • Coverage generally applies if the medication is deemed medically necessary for the enrollee and prescribed by a healthcare provider.
  •  

  • The patient typically needs to meet criteria such as a BMI of 30 or above, or a BMI of 27 or above with at least one weight-related comorbidity, such as hypertension or type 2 diabetes.
  •  

  • Prior authorization is often required to ensure that the patient meets all criteria set by FCHP for this medication.
  •  

  • Enrollees may need to provide documentation of previous weight loss attempts over a prescribed period.

 

Criteria for Coverage

 

  • The policyholder must be a member with an active plan under FCHP that includes prescription coverage.
  •  

  • The prescription must be filled at a pharmacy within the FCHP network for documents to be considered.
  •  

  • Continuous evaluation of weight loss progress may influence continued coverage of the regimen.

 

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Fallon Community Health Plan (FCHP)'s Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Coverage Criteria for Naltrexone/Bupropion (Contrave)

 

  • Members must be 18 years of age or older at the time of the request.
  •  

  • Documentation must confirm a diagnosis of obesity with a Body Mass Index (BMI) of 30 kg/m² or higher, or overweight with a BMI of 27 kg/m² or greater with at least one weight-related medical condition such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • The member has attempted weight loss through diet, exercise, and lifestyle changes for at least six months, and these attempts have been unsuccessful in achieving a significant reduction in weight.
  •  

  • The request for Naltrexone/Bupropion (Contrave) must be written by an endocrinologist, bariatric specialist, or another healthcare provider experienced in managing obesity.
  •  

  • There must be documentation of a consistent monitoring plan for weight loss and side effects with follow-ups scheduled to assess the effectiveness of the medication.
  •  

  • Authorization may be given initially for a 3-month trial period with evidence required of at least a 5% weight loss at the end of this period for continuation of coverage.
  •  

  • Evidence of ongoing compliance with prescribed treatment and lifestyle modifications must be demonstrated for continued authorization of the medication.

 

Why Fallon Community Health Plan (FCHP) Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons Fallon Community Health Plan (FCHP) Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

  • FCHP may deny coverage if Naltrexone/Bupropion is not prescribed for an FDA-approved indication.
  •  

  • Coverage might be denied if prior authorization criteria have not been met. This includes failure to provide necessary documentation or justification for use.
  •  

  • If the member has not met the required health condition criteria, such as minimum Body Mass Index (BMI) requirements, FCHP might not cover the medication.
  •  

  • The plan may deny coverage if the patient has not tried or failed other weight management therapies before using Naltrexone/Bupropion.
  •  

  • Naltrexone/Bupropion may not be covered if there are contraindications based on the patient’s medical history, such as uncontrolled hypertension, seizure disorders, or other contraindicated conditions.
  •  

  • FCHP might deny coverage if the medication is considered experimental, investigational, or not medically necessary according to their policy guidelines.
  •  

  • If the use of Naltrexone/Bupropion is for a condition that can be managed with a covered alternative medication or therapy, FCHP may consider it as a step-therapy or formulary exclusion.
  •  

 

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How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Fallon Community Health Plan (FCHP)

 

Verify Plan Coverage

 

  • Contact Fallon Community Health Plan (FCHP) customer service to confirm if your plan includes coverage for Naltrexone/Bupropion (Contrave). You can usually find the contact number on your FCHP insurance card.
  •  

  • Check the FCHP member portal online for any available information on prescription drug coverage. Search the formulary or drug list for Naltrexone/Bupropion.
  •  

  • Review your specific policy documents or benefits summary to see detailed coverage information and any requirements such as prior authorization or step therapy.

 

Consult with Your Healthcare Provider

 

  • Talk to your doctor about your interest in taking Naltrexone/Bupropion (Contrave). Ensure it is medically appropriate for your condition and discuss any potential side effects with them.
  •  

  • Request a prescription for Naltrexone/Bupropion from your healthcare provider.
  •  

  • Ask your doctor whether they have experience obtaining approval for medications like Naltrexone/Bupropion with FCHP. They may provide useful advice or assistance with the process.

 

Initiate Prior Authorization

 

  • If required, your healthcare provider needs to submit a prior authorization request to FCHP. This documentation should outline the medical necessity of the medication.
  •  

  • Your provider may need to fill out specific forms provided by FCHP. Ensure that they include necessary information such as diagnosis, treatment history, and reasons for requesting Naltrexone/Bupropion.
  •  

  • Follow up with your healthcare provider's office to ensure the prior authorization request has been submitted.

 

Follow Up with Fallon Community Health Plan

 

  • Contact FCHP customer service to check on the status of your prior authorization or claims submission.
  •  

  • Ask if any additional information is needed to process your request or if there are any outstanding steps to take.
  •  

  • In case of denial, request a detailed explanation for the decision, and consult your healthcare provider about appealing the decision if necessary.

 

Explore Alternatives

 

  • Ask FCHP if there are other similar medications that are covered under your plan which can be considered as alternatives.
  •  

  • Discuss with your doctor if these alternatives might be appropriate for your treatment.

 

Consider Financial Assistance Options

 

  • Research available manufacturer discounts or patient assistance programs that may help offset the costs of Naltrexone/Bupropion if not covered by FCHP.
  •  

  • Check with your pharmacy for any additional savings programs or discounts they may offer.

 

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Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

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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.

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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