Does Fallon Community Health Plan (FCHP) Cover Semaglutide (Wegovy)

Explore if FCHP covers Semaglutide (Wegovy), reasons for denial, coverage tips, costs without insurance, and FAQs.
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Coverage for Semaglutide (Wegovy) with FCHP

 

  • Semaglutide (Wegovy) may be covered under Fallon Community Health Plan (FCHP) for individuals meeting specific criteria related to obesity management.
  •  

  • Patients generally need to have a BMI of 30 or higher, or 27 with comorbid conditions such as hypertension or type 2 diabetes.
  •  

  • Prior authorization is typically required, meaning a healthcare provider must demonstrate medical necessity before the medication is approved.
  •  

  • Coverage might require documented failure or contraindication of prior weight management therapies.
  •  

  • Regular follow-ups to assess effectiveness and adherence may be needed to maintain coverage.

 

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

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

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Semaglutide (Wegovy) Coverage with Fallon Community Health Plan (FCHP)

 

Verify Eligibility

 

  • Contact Fallon Community Health Plan (FCHP) directly by calling the customer service number on your insurance card to confirm that Semaglutide (Wegovy) is covered under your plan.
  •  

  • Review your policy documents or login to the FCHP member portal to check for any specific criteria that might be required for weight management medications.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your eligibility for Semaglutide (Wegovy). Your provider can help assess the medical necessity based on your health condition.
  •  

  • Request that your provider prepare any necessary documentation that explains the need for Semaglutide (Wegovy) as a part of your treatment plan.

 

Obtain Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to FCHP. This request should include your medical history, treatment rationale, and any other supporting documents.
  •  

  • Monitor the status of your prior authorization by contacting FCHP or checking the member portal regularly for updates.

 

Understand Cost-Sharing Requirements

 

  • Once approved, review your plan’s cost-sharing terms to determine your out-of-pocket costs, such as co-pays or coinsurance, for Semaglutide (Wegovy).
  •  

  • Consider reaching out to FCHP’s customer service if you have any questions about how the medication is priced under your plan.

 

Fill the Prescription

 

  • Use a pharmacy in your plan’s network to fill your prescription for Semaglutide (Wegovy). Double-check with the pharmacy to ensure the prior authorization has been processed.
  •  

  • Consult your pharmacist if you have any questions regarding medication administration or potential side effects.

 

Explore Financial Assistance Programs

 

  • If your out-of-pocket costs are significant, inquire about manufacturer assistance programs or discounts that might be available for Semaglutide (Wegovy).
  •  

  • Consider reaching out to nonprofit organizations for potential financial aid if manufacturer assistance is insufficient.

 

Follow Up Regularly

 

  • Schedule regular follow-up appointments with your healthcare provider to monitor the effectiveness of the medication and discuss any necessary treatment adjustments.
  •  

  • Keep records of all communications with FCHP, your healthcare provider, and the pharmacy for future reference if any issues arise.

 

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Does Fallon Community Health Plan (FCHP) Cover Semaglutide (Wegovy)

Explore if FCHP covers Semaglutide (Wegovy), reasons for denial, coverage tips, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Semaglutide (Wegovy) Covered by Fallon Community Health Plan (FCHP)

 

Coverage for Semaglutide (Wegovy) with FCHP

 

  • Semaglutide (Wegovy) may be covered under Fallon Community Health Plan (FCHP) for individuals meeting specific criteria related to obesity management.
  •  

  • Patients generally need to have a BMI of 30 or higher, or 27 with comorbid conditions such as hypertension or type 2 diabetes.
  •  

  • Prior authorization is typically required, meaning a healthcare provider must demonstrate medical necessity before the medication is approved.
  •  

  • Coverage might require documented failure or contraindication of prior weight management therapies.
  •  

  • Regular follow-ups to assess effectiveness and adherence may be needed to maintain coverage.

 

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Fallon Community Health Plan (FCHP)'s Approved Criteria for Semaglutide (Wegovy) Coverage

 

Fallon Community Health Plan (FCHP) Coverage Criteria for Semaglutide (Wegovy)

 

  • Membership with Fallon Community Health Plan: The patient must be a current member of FCHP to qualify for coverage of Semaglutide (Wegovy).
  •  

  • Diagnosis of Obesity: The patient should have a diagnosis of obesity defined as a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • Failure of Previous Weight Loss Attempts: The patient must have documented unsuccessful attempts to manage their weight through diet, exercise, and behavioral modification interventions.
  •  

  • Medical Assessment: A comprehensive medical examination must be conducted, confirming that the use of Semaglutide (Wegovy) is clinically appropriate as part of a weight management program.
  •  

  • Prescription by a Specialist: The medication must be prescribed by an endocrinologist, bariatric specialist, or other healthcare provider specializing in weight management.
  •  

  • Monitoring and Follow-Up: Ongoing patient monitoring should be conducted to evaluate weight loss progress and any potential side effects.
  •  

  • Adherence to Treatment Plan: The patient must commit to adherence to the prescribed treatment regimen, including lifestyle changes such as dietary adjustments and physical activity.
  •  

  • Age Requirement: Patient must be 18 years of age or older.
  •  

 

Why Fallon Community Health Plan (FCHP) Might Deny Semaglutide (Wegovy) Coverage

 

Situations Where Fallon Community Health Plan (FCHP) Might Deny Wegovy Coverage

 

  • FCHP may deny coverage if the medication is not approved by the FDA for the individual's specific medical condition.
  •  

  • Coverage could be denied if the individual does not meet FCHP's medical necessity criteria, which might include specific BMI thresholds or documented weight-related health conditions.
  •  

  • If there is evidence that the individual did not comply with previous weight management programs or treatments, FCHP might refuse coverage.
  •  

  • The plan might deny coverage if Semaglutide (Wegovy) is prescribed as an off-label treatment not recognized within their policy guidelines.
  •  

  • FCHP may require prior authorization, and failure to obtain this before starting the medication can result in denial of coverage.
  •  

  • Coverage could be denied if there is a more cost-effective alternative available, as determined by the plan's formulary guidelines.
  •  

  • If the prescribed dosage is inconsistent with FCHP's approved prescribing guidelines or exceeds their maximum allowed quantity, coverage may be denied.
  •  

 

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How Much Does Semaglutide (Wegovy) Cost without Insurance?

 

Approximate Cost of Semaglutide (Wegovy) Without Insurance

 

  • The price of Semaglutide, commonly known as Wegovy, without insurance can be substantial, typically ranging between $1,200 and $1,400 for a supply that lasts approximately one month.
  •  

  • This medication is designed for long-term weight management, thus planning financially for sustained use is important if paying out of pocket.
  •  

  • It's important to note that prices can vary based on the pharmacy, geographic location, and available discounts or pharmacy loyalty programs.
  •  

  • Patients are encouraged to seek patient assistance programs or discounts to help mitigate costs. Some pharmaceutical manufacturers offer discount cards or assistance programs to help with the cost of prescription medications like Wegovy.

 

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 Semaglutide (Wegovy) Coverage with Fallon Community Health Plan (FCHP)

 

Verify Eligibility

 

  • Contact Fallon Community Health Plan (FCHP) directly by calling the customer service number on your insurance card to confirm that Semaglutide (Wegovy) is covered under your plan.
  •  

  • Review your policy documents or login to the FCHP member portal to check for any specific criteria that might be required for weight management medications.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your eligibility for Semaglutide (Wegovy). Your provider can help assess the medical necessity based on your health condition.
  •  

  • Request that your provider prepare any necessary documentation that explains the need for Semaglutide (Wegovy) as a part of your treatment plan.

 

Obtain Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to FCHP. This request should include your medical history, treatment rationale, and any other supporting documents.
  •  

  • Monitor the status of your prior authorization by contacting FCHP or checking the member portal regularly for updates.

 

Understand Cost-Sharing Requirements

 

  • Once approved, review your plan’s cost-sharing terms to determine your out-of-pocket costs, such as co-pays or coinsurance, for Semaglutide (Wegovy).
  •  

  • Consider reaching out to FCHP’s customer service if you have any questions about how the medication is priced under your plan.

 

Fill the Prescription

 

  • Use a pharmacy in your plan’s network to fill your prescription for Semaglutide (Wegovy). Double-check with the pharmacy to ensure the prior authorization has been processed.
  •  

  • Consult your pharmacist if you have any questions regarding medication administration or potential side effects.

 

Explore Financial Assistance Programs

 

  • If your out-of-pocket costs are significant, inquire about manufacturer assistance programs or discounts that might be available for Semaglutide (Wegovy).
  •  

  • Consider reaching out to nonprofit organizations for potential financial aid if manufacturer assistance is insufficient.

 

Follow Up Regularly

 

  • Schedule regular follow-up appointments with your healthcare provider to monitor the effectiveness of the medication and discuss any necessary treatment adjustments.
  •  

  • Keep records of all communications with FCHP, your healthcare provider, and the pharmacy for future reference if any issues arise.

 

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.

Semaglutide (Wegovy) FAQ

1. What are the common side effects of Semaglutide (Wegovy)?

 

Common Side Effects of Semaglutide (Wegovy)

 

  • Nausea  — Often occurs at the start of treatment and may decrease over time.
  •  

  • Vomiting  — Related to gastrointestinal upset; usually temporary.
  •  

  • Diarrhea  — Common and may vary in intensity.
  •  

  • Constipation  — It can occur alongside other digestive issues.
  •  

  • Abdominal Pain  — Includes discomfort or cramping sensation.
  •  

  • Headache  — Typically mild but can be persistent.
  •  

  • Dizziness  — May affect balance or result in vertigo-like symptoms.
  •  

  • Fatigue  — Some patients report general tiredness or lack of energy.

 

2. How much weight can I lose with Semaglutide (Wegovy)?

 

Potential Weight Loss with Semaglutide (Wegovy)

 

  • Clinical trials demonstrate that Semaglutide (Wegovy) helps individuals lose a significant amount of weight. On average, participants experienced a weight loss of about 15% of their initial body weight over 68 weeks.
  •  

  • Results vary, with some losing more and others less. Factors include adherence to medication, lifestyle changes, and individual metabolic responses.
  •  

  • Semaglutide should be part of a comprehensive weight management program, including a reduced-calorie diet and increased physical activity.
  •  

  • Consult with a healthcare professional for personalized advice and to discuss possible side effects like nausea or gastrointestinal issues.

 

3. Is Wegovy the same as Ozempic?

 

Differences Between Wegovy and Ozempic

 

  • Formulation: Both contain semaglutide, a GLP-1 receptor agonist, but are formulated for different purposes.
  •  

  • Indication: Wegovy is primarily for weight management in adults with obesity. Ozempic is prescribed for type 2 diabetes management.
  •  

  • Dosage: While both are weekly injections, Wegovy generally has higher dosing than Ozempic (up to 2.4mg vs. 1mg for Ozempic).
  •  

  • Side Effects: Common side effects overlap, including nausea, but may vary in intensity due to different dosages.

 

Conclusion

 

  • Though similar, they serve distinct medical purposes. Always consult your healthcare provider for personalized advice.

 

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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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