Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Semaglutide (Wegovy)

Discover if Florida Blue covers Semaglutide, steps to secure approval, and costs without insurance, plus answers to common questions.
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Coverage for Semaglutide (Wegovy)

 

  • Florida Blue may cover Semaglutide (Wegovy) under their pharmacy benefit plan. Coverage often depends on medical necessity and the plan's specific guidelines.

 

Eligibility Criteria

 

  • Generally requires a diagnosis of obesity (BMI ≥30) or overweight (BMI ≥27) with related medical conditions like diabetes or hypertension.
  • Patients might need to show prior weight management attempts through lifestyle changes.

 

Approval Process

 

  • Physicians might need to provide documentation supporting the medical need for Wegovy.
  • Pre-authorization might be required, and documentation should include history of obesity treatment and related health issues.

 

Consult Your Plan

 

  • Always verify the specifics of your coverage with Florida Blue directly, as plans can vary widely in terms of benefits and requirements.

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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 Semaglutide (Wegovy) Coverage with Florida Blue (Blue Cross Blue Shield of Florida)

 

Check Your Insurance Plan Details

 

  • Log in to your Florida Blue Member Portal to access your plan details. Verify what your plan covers in terms of prescription medications.
  • Look for a list of covered medications (formulary) to see if Semaglutide (Wegovy) is listed. This can often be found in the pharmacy benefits section.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Semaglutide (Wegovy).
  • Request that they provide any necessary medical documentation that demonstrates the medical necessity of the medication.

 

Contact Florida Blue Customer Service

 

  • Call the customer service number found on your insurance card to inquire about coverage for Semaglutide (Wegovy).
  • Ask for details regarding prior authorization, co-pays, or any specific conditions for coverage.

 

Initiate Prior Authorization

 

  • If prior authorization is needed, work with your healthcare provider to submit the request to Florida Blue.
  • Ensure that all required documentation, such as medical records and provider notes, are included to demonstrate necessity.

 

Follow Up on Authorization Request

 

  • Monitor the status of your prior authorization request through your Florida Blue Member Portal or by contacting customer service.
  • Be prepared to provide any additional information that may be requested by the insurance company.

 

Understand Your Out-of-Pocket Costs

 

  • Once coverage is granted, review any out-of-pocket costs like copayments or deductibles associated with Semaglutide (Wegovy).
  • Check if there are any savings programs or assistance options through the manufacturer or your pharmacy.

 

Fill Your Prescription

 

  • Proceed to fill the prescription at a pharmacy that accepts Florida Blue insurance plans.
  • Ensure the pharmacy has the medication in stock and is aware of your insurance coverage for the prescription.

 

Stay Informed

 

  • Regularly review any updates or changes to your insurance policy that might affect coverage for medications like Semaglutide (Wegovy).
  • Stay in contact with your healthcare provider and insurance for managing your prescription needs.

 

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FAQs

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Semaglutide (Wegovy)

Discover if Florida Blue covers Semaglutide, steps to secure approval, and costs without insurance, plus answers to common questions.
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Is Semaglutide (Wegovy) Covered by Florida Blue (Blue Cross Blue Shield of Florida)

 

Coverage for Semaglutide (Wegovy)

 

  • Florida Blue may cover Semaglutide (Wegovy) under their pharmacy benefit plan. Coverage often depends on medical necessity and the plan's specific guidelines.

 

Eligibility Criteria

 

  • Generally requires a diagnosis of obesity (BMI ≥30) or overweight (BMI ≥27) with related medical conditions like diabetes or hypertension.
  • Patients might need to show prior weight management attempts through lifestyle changes.

 

Approval Process

 

  • Physicians might need to provide documentation supporting the medical need for Wegovy.
  • Pre-authorization might be required, and documentation should include history of obesity treatment and related health issues.

 

Consult Your Plan

 

  • Always verify the specifics of your coverage with Florida Blue directly, as plans can vary widely in terms of benefits and requirements.

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Florida Blue (Blue Cross Blue Shield of Florida)'s Approved Criteria for Semaglutide (Wegovy) Coverage

 

Eligibility Criteria for Semaglutide (Wegovy) Coverage

 

  • The patient must be 18 years of age or older, as Florida Blue covers Semaglutide (Wegovy) primarily for adult patients.
  •  

  • Patient must have 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, or dyslipidemia.
  •  

  • The patient has documented history of unsuccessful weight management efforts through lifestyle adjustments, including both dietary changes and increased physical activity, for a qualified period as determined by the healthcare provider.

 

Prescription Requirements

 

  • The prescribing healthcare professional must provide a diagnosis of obesity or overweight with the associated comorbidity that meets the criteria specified by Florida Blue.
  •  

  • The prescription must follow the recommended dosing regimen for Wegovy as approved by the U.S. FDA, starting with the initial prescribed dosage and titrating to the maintenance dose as tolerated.

 

Continuous Use Criteria

 

  • Periodic assessments should show that the patient has experienced a clinically meaningful weight loss since the start of therapy, usually defined as a 5% reduction in body weight after three months of treatment, to continue coverage.
  •  

  • The patient should adhere to the comprehensive approach to weight management, including following a reduced-calorie meal plan and increased physical activity in conjunction with Wegovy therapy.

 

Re-evaluation of Coverage

 

  • Continued authorization may require ongoing documentation from the healthcare provider indicating the patient's compliance with the treatment plan and continued weight loss progress at regular intervals specified by Florida Blue.
  •  

  • Insurance coverage re-evaluation may also necessitate confirmation that no contraindications have developed that would impact the safety or efficacy of Semaglutide treatment.

 

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Semaglutide (Wegovy) Coverage

 

Situations Where Florida Blue Might Deny Semaglutide (Wegovy) Coverage

 

  • Non-FDA Approved Uses: Florida Blue may deny coverage if Semaglutide (Wegovy) is prescribed for conditions or purposes not approved by the FDA.
  •  

  • Lack of Documented Medical Necessity: If the provider does not present sufficient evidence or documentation to prove the medical necessity of Semaglutide (Wegovy), coverage might be denied.
  •  

  • Absence of Required Prior Authorization: Coverage could be denied if the necessary prior authorization procedure was not completed by the healthcare provider before prescribing Semaglutide (Wegovy).
  •  

  • Policy Exclusions: Florida Blue might not cover Semaglutide if it falls under specific policy exclusions, which might include treatments considered experimental or investigational.
  •  

  • Non-Compliance with Benefit Plan Guidelines: If the request for Semaglutide (Wegovy) coverage does not align with the benefit plans' guidelines and criteria set by Florida Blue, it may be denied.
  •  

  • Incomplete or Inaccurate Patient Information: Denial can occur if incorrect or insufficient patient information is provided during the coverage request process.

 

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Check Your Insurance Plan Details

 

  • Log in to your Florida Blue Member Portal to access your plan details. Verify what your plan covers in terms of prescription medications.
  • Look for a list of covered medications (formulary) to see if Semaglutide (Wegovy) is listed. This can often be found in the pharmacy benefits section.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Semaglutide (Wegovy).
  • Request that they provide any necessary medical documentation that demonstrates the medical necessity of the medication.

 

Contact Florida Blue Customer Service

 

  • Call the customer service number found on your insurance card to inquire about coverage for Semaglutide (Wegovy).
  • Ask for details regarding prior authorization, co-pays, or any specific conditions for coverage.

 

Initiate Prior Authorization

 

  • If prior authorization is needed, work with your healthcare provider to submit the request to Florida Blue.
  • Ensure that all required documentation, such as medical records and provider notes, are included to demonstrate necessity.

 

Follow Up on Authorization Request

 

  • Monitor the status of your prior authorization request through your Florida Blue Member Portal or by contacting customer service.
  • Be prepared to provide any additional information that may be requested by the insurance company.

 

Understand Your Out-of-Pocket Costs

 

  • Once coverage is granted, review any out-of-pocket costs like copayments or deductibles associated with Semaglutide (Wegovy).
  • Check if there are any savings programs or assistance options through the manufacturer or your pharmacy.

 

Fill Your Prescription

 

  • Proceed to fill the prescription at a pharmacy that accepts Florida Blue insurance plans.
  • Ensure the pharmacy has the medication in stock and is aware of your insurance coverage for the prescription.

 

Stay Informed

 

  • Regularly review any updates or changes to your insurance policy that might affect coverage for medications like Semaglutide (Wegovy).
  • Stay in contact with your healthcare provider and insurance for managing your prescription needs.

 

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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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