Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Phentermine (Adipex-P, Lomaira)

Explore Florida Blue's coverage of Phentermine, reasons for denial, how to gain coverage, costs without insurance, and FAQs in this informative guide.
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Coverage for Phentermine

 

  • Florida Blue may cover Phentermine (Adipex-P, Lomaira) in specific situations, generally under a prescription drug benefit.
  •  

  • The coverage is typically provided for medically necessary cases, such as when prescribed for weight loss in conjunction with diet and exercise in patients with obesity-related risk factors.

 

Criteria for Coverage

 

  • Prior authorization is usually required to ensure that the medication is necessary for the patient’s health condition.
  •  

  • You may need to meet specific BMI (Body Mass Index) criteria to qualify for coverage.
  •  

  • Documentation from your healthcare provider supporting the necessity of Phentermine for weight management is often needed.

 

General Rules

 

  • Verify with Florida Blue for specific policy details, as coverage may vary based on your plan and any updates in policy terms.
  •  

  • Consult with your healthcare provider to assist with the authorization process by providing the required medical justification.

 

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Phentermine (Adipex-P, Lomaira) Coverage with Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Your Plan Details

 

  • Log into your Florida Blue account or contact customer service to confirm the specific benefits and requirements related to prescription drug coverage.
  •  

  • Ensure that your specific plan includes prescription drug benefits and determine if there are any restrictions on weight loss medications.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the necessity of Phentermine for your health condition. Ensure that your doctor understands your health history and can justify the need for Phentermine.
  •  

  • Have your healthcare provider check if you meet the clinical criteria required by Florida Blue to approve coverage for weight management medications.

 

Obtain a Prescription

 

  • If your healthcare provider deems it necessary, they will write a prescription for Phentermine (Adipex-P, Lomaira).
  •  

  • Ensure the prescription is detailed, highlighting the medical necessity, potential benefits, and any previous attempts at weight management.

 

Submit a Prior Authorization Request

 

  • Your healthcare provider should submit a prior authorization request to Florida Blue, explaining why Phentermine is necessary and detailing how it fits within the plan’s medical policy.
  •  

  • Make sure all required documentation is included, as missing information can delay processing. This might include a letter of medical necessity.

 

Follow Up with Florida Blue

 

  • After submission, regularly check the status of your prior authorization request by logging into your account or contacting customer service.
  •  

  • Be prepared to provide any additional information or clarification Florida Blue may request to expedite the approval process.

 

Appeal a Denial if Necessary

 

  • If initial coverage is denied, review the denial letter for specific reasons and obtain support from your healthcare provider to address these issues.
  •  

  • Submit an appeal with any additional documentation or arguments supporting the need for Phentermine. Be detailed in explaining how it is medically necessary.

 

Consider Alternative Options

 

  • If coverage remains difficult, consult with your healthcare provider about alternative medications or treatments that might be similarly effective and coverable under your plan.
  •  

  • Explore potential discounts or pharmaceutical assistance programs as a temporary solution.

 

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FAQs

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Phentermine (Adipex-P, Lomaira)

Explore Florida Blue's coverage of Phentermine, reasons for denial, how to gain coverage, costs without insurance, and FAQs in this informative guide.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Florida Blue (Blue Cross Blue Shield of Florida)

 

Coverage for Phentermine

 

  • Florida Blue may cover Phentermine (Adipex-P, Lomaira) in specific situations, generally under a prescription drug benefit.
  •  

  • The coverage is typically provided for medically necessary cases, such as when prescribed for weight loss in conjunction with diet and exercise in patients with obesity-related risk factors.

 

Criteria for Coverage

 

  • Prior authorization is usually required to ensure that the medication is necessary for the patient’s health condition.
  •  

  • You may need to meet specific BMI (Body Mass Index) criteria to qualify for coverage.
  •  

  • Documentation from your healthcare provider supporting the necessity of Phentermine for weight management is often needed.

 

General Rules

 

  • Verify with Florida Blue for specific policy details, as coverage may vary based on your plan and any updates in policy terms.
  •  

  • Consult with your healthcare provider to assist with the authorization process by providing the required medical justification.

 

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Florida Blue (Blue Cross Blue Shield of Florida)'s Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Criteria for Phentermine Coverage

 

  • **Eligible Diagnosis**: The patient must have an established diagnosis of obesity, defined as a Body Mass Index (BMI) of 30 kg/m² or higher, or a BMI of 27 kg/m² or higher with at least one obesity-related comorbidity such as hypertension, diabetes, or dyslipidemia.
  •  

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

  • **Physician Prescription**: A written prescription from a licensed healthcare provider must be presented, indicating the use of Phentermine as part of a comprehensive weight management program.
  •  

  • **Comprehensive Weight Management Plan**: The patient must be enrolled in a structured weight loss program that includes dietary adjustments, increased physical activity, and behavioral therapy. The use of Phentermine should be as an adjunct to this plan.
  •  

  • **Documentation of Prior Weight Management Efforts**: The patient should provide documentation of prior weight loss attempts, including diet and exercise regimens, to demonstrate the necessity of pharmacotherapy.
  •  

  • **Duration of Coverage**: Approval for Phentermine is usually limited to a short-term duration, typically alluded to be up to 12 weeks, consistent with the short-term indication of the medication.
  •  

  • **Monitoring and Evaluation**: Continuous monitoring by the healthcare provider is required, with regular assessments of the patient's progress towards weight loss goals and any side effects experienced with the medication.
  •  

  • **Absence of Contraindications**: The prescribing physician must confirm that the patient has no cardiovascular diseases, hyperthyroidism, glaucoma, history of drug abuse, or hypersensitivity to sympathomimetic amines that would contraindicate the use of Phentermine.
  •  

  • **Compliance with Legal and Regulatory Requirements**: All prescriptions must comply with DEA regulations, given Phentermine's classification as a Controlled Schedule IV medication.

 

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons for Denial of Phentermine Coverage by Florida Blue

 

  • Florida Blue may deny coverage for Phentermine if the prescription is intended for cosmetic or non-medical weight loss purposes, as these do not meet the criteria for medical necessity.
  •  

  • Requests for Phentermine coverage may be denied if the patient does not meet the Body Mass Index (BMI) requirements specified by Florida Blue's guidelines, which typically mandate a BMI of 30 or higher, or 27 with accompanying risk factors.
  •  

  • Coverage may be denied if there is insufficient documentation of previous weight loss attempts under a physician-supervised program, as demonstrating prior efforts to manage weight is often required.
  •  

  • If the patient has a history of cardiovascular conditions, such as coronary artery disease or uncontrolled hypertension, Florida Blue may reject coverage due to the increased risk of adverse effects.
  •  

  • Florida Blue might deny coverage if the prescription exceeds the maximum dosage or duration as defined by their policy, which typically emphasizes short-term use only.
  •  

  • Phentermine may not be covered if the patient has a history of drug abuse, given the potential for misuse and dependency associated with stimulant medications.
  •  

  • Denial might occur if the prescription is for a patient under the age of 18, as Phentermine is generally not approved for use in pediatric populations according to Florida Blue’s policy guidelines.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Phentermine (Adipex-P, Lomaira) Coverage with Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Your Plan Details

 

  • Log into your Florida Blue account or contact customer service to confirm the specific benefits and requirements related to prescription drug coverage.
  •  

  • Ensure that your specific plan includes prescription drug benefits and determine if there are any restrictions on weight loss medications.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the necessity of Phentermine for your health condition. Ensure that your doctor understands your health history and can justify the need for Phentermine.
  •  

  • Have your healthcare provider check if you meet the clinical criteria required by Florida Blue to approve coverage for weight management medications.

 

Obtain a Prescription

 

  • If your healthcare provider deems it necessary, they will write a prescription for Phentermine (Adipex-P, Lomaira).
  •  

  • Ensure the prescription is detailed, highlighting the medical necessity, potential benefits, and any previous attempts at weight management.

 

Submit a Prior Authorization Request

 

  • Your healthcare provider should submit a prior authorization request to Florida Blue, explaining why Phentermine is necessary and detailing how it fits within the plan’s medical policy.
  •  

  • Make sure all required documentation is included, as missing information can delay processing. This might include a letter of medical necessity.

 

Follow Up with Florida Blue

 

  • After submission, regularly check the status of your prior authorization request by logging into your account or contacting customer service.
  •  

  • Be prepared to provide any additional information or clarification Florida Blue may request to expedite the approval process.

 

Appeal a Denial if Necessary

 

  • If initial coverage is denied, review the denial letter for specific reasons and obtain support from your healthcare provider to address these issues.
  •  

  • Submit an appeal with any additional documentation or arguments supporting the need for Phentermine. Be detailed in explaining how it is medically necessary.

 

Consider Alternative Options

 

  • If coverage remains difficult, consult with your healthcare provider about alternative medications or treatments that might be similarly effective and coverable under your plan.
  •  

  • Explore potential discounts or pharmaceutical assistance programs as a temporary solution.

 

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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.

Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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