Does Gateway Health Plan Cover Benzphetamine (Didrex)

Explore Gateway Health Plan's coverage on Benzphetamine. Learn why coverage might be denied, how to secure it, costs without insurance, and FAQs.
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Gateway Health Plan Coverage for Benzphetamine (Didrex)

 

  • Coverage for Benzphetamine (Didrex) typically involves specific criteria such as prior authorization. You must demonstrate medical necessity, often confirmed by a healthcare provider.
  •  

  • Patients may need documentation proving they have tried and not benefited from alternative medications for weight management.
  •  

  • To initiate coverage, contact Gateway Health Plan for pre-approval, ensuring you provide comprehensive information regarding your condition and previous treatments.
  •  

  • Policy terms can vary, so reviewing your specific insurance plan's formulary and consulting with customer service representatives is crucial for understanding coverage limits 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.

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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 Benzphetamine (Didrex) Coverage with Gateway Health Plan

 

Verify Benzphetamine Coverage

 

  • Contact Gateway Health Plan's customer service to confirm if Benzphetamine (Didrex) is included in their pharmacy benefit coverage.
  •  

  • Review the summary of benefits and coverage document that you received when enrolling for detailed information regarding drug coverage.
  •  

  • Check Gateway Health Plan's formulary list on their website to see if Benzphetamine is covered and if any restrictions apply.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about prescribing Benzphetamine and ensure they are aware of Gateway Health Plan's requirements, if any.
  •  

  • Request your healthcare provider to provide necessary medical documentation that justifies the need for Benzphetamine if required by the insurance plan.

 

Obtain a Prescription

 

  • If Benzphetamine is covered, have your healthcare provider issue a prescription in accordance with the plan's guidelines.
  •  

  • Ensure the prescribed dosage and quantity comply with any limits set by Gateway Health Plan.

 

Submit Prior Authorization, if Needed

 

  • In case Benzphetamine requires prior authorization, your healthcare provider will need to submit a prior authorization request to Gateway Health Plan.
  •  

  • Provide any additional documentation or information as requested by Gateway Health Plan to facilitate the authorization process.

 

Fill Your Prescription

 

  • Once the prescription is authorized, take it to a pharmacy in the Gateway Health Plan network to have it filled.
  •  

  • Verify that the pharmacy processes the prescription according to your coverage benefits to avoid unexpected costs.

 

Appeal a Denial, if Applicable

 

  • If your request for Benzphetamine coverage is denied, review the denial letter to understand the reason and gather the necessary information to appeal the decision.
  •  

  • Work with your healthcare provider to provide any additional information required to strengthen your appeal.

 

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FAQs

Does Gateway Health Plan Cover Benzphetamine (Didrex)

Explore Gateway Health Plan's coverage on Benzphetamine. Learn why coverage might be denied, how to secure it, costs without insurance, and FAQs.
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Is Benzphetamine (Didrex) Covered by Gateway Health Plan

 

Gateway Health Plan Coverage for Benzphetamine (Didrex)

 

  • Coverage for Benzphetamine (Didrex) typically involves specific criteria such as prior authorization. You must demonstrate medical necessity, often confirmed by a healthcare provider.
  •  

  • Patients may need documentation proving they have tried and not benefited from alternative medications for weight management.
  •  

  • To initiate coverage, contact Gateway Health Plan for pre-approval, ensuring you provide comprehensive information regarding your condition and previous treatments.
  •  

  • Policy terms can vary, so reviewing your specific insurance plan's formulary and consulting with customer service representatives is crucial for understanding coverage limits and requirements.

 

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Gateway Health Plan's Approved Criteria for Benzphetamine (Didrex) Coverage

 

Approved Criteria for Benzphetamine (Didrex) Coverage

 

  • The member must be diagnosed with obesity, for which conventional measures like dietary management and increased physical activity have proven insufficient.
  •  

  • Weight-related comorbid conditions such as hypertension, type 2 diabetes, or dyslipidemia should be present, showcasing a recognized need for pharmacological intervention.
  •  

  • A documented attempt of weight loss through pharmacologic therapy with an alternative agent should be noted as unsuccessful, indicating the necessity for Benzphetamine prescription.
  •  

  • The member must be aged 12 years or older, as per guidelines ensuring safety and efficacy standards tailored to this age group.
  •  

  • Proper documentation from a healthcare provider recommending Benzphetamine as an adjunct therapy to a comprehensive weight management program is required.
  •  

  • Demonstrated commitment from the member to adhere to a supervised weight loss program synchronized with the use of Benzphetamine, ensuring all therapeutic avenues are aligned for optimal outcomes.
  •  

  • Annual evaluation and approval are mandated, requiring documentation of significant clinical improvement or weight loss to continue coverage, thus ensuring ongoing therapeutic effectiveness and safety.

 

Why Gateway Health Plan Might Deny Benzphetamine (Didrex) Coverage

 

Non-Covered Criteria for Benzphetamine (Didrex) by Gateway Health Plan

 

  • Benzphetamine is not covered when prescribed for weight loss in situations considered cosmetic or non-essential for overall health improvement.
  •  

  • The medication is not approved for use in individuals who do not meet Body Mass Index (BMI) criteria or weight-related health conditions as defined by Gateway Health Plan's policies.
  •  

  • Prescriptions for Benzphetamine without documented evidence of comprehensive lifestyle changes, including diet and exercise plans, are not covered.
  •  

  • Coverage is denied if Benzphetamine is prescribed alongside contraindicated medications or for individuals with certain pre-existing health conditions such as cardiovascular diseases.
  •  

  • Gateway Health Plan does not cover cases where Benzphetamine is prescribed for longer durations than approved, or if there's inadequate documentation of periodic patient evaluations to assess the drug's effectiveness and safety.
  •  

  • The plan excludes coverage for Benzphetamine if it is used without following FDA-approved indications or dosages.
  •  

  • Usage intended for populations outside the approved age range specified by the health plan's guidelines is not covered.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Benzphetamine (Didrex) Cost without Insurance?

 

Understanding Benzphetamine (Didrex) Cost

 

  • Benzphetamine, commonly known by the brand name Didrex, is a prescription medication used as a short-term adjunct in weight reduction therapy.
  •  

  • The cost of Benzphetamine without insurance can vary significantly depending on the pharmacy and the dosage prescribed.
  •  

  • On average, the cost for a 30-day supply of Benzphetamine (50 mg tablets) can range from $40 to $70.
  •  

  • Prices may be higher or lower, depending on location, pharmacy pricing policies, and available discounts or coupons.
  •  

  • Pharmacy discount programs and generic versions of the drug may offer cost savings.

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 Benzphetamine (Didrex) Coverage with Gateway Health Plan

 

Verify Benzphetamine Coverage

 

  • Contact Gateway Health Plan's customer service to confirm if Benzphetamine (Didrex) is included in their pharmacy benefit coverage.
  •  

  • Review the summary of benefits and coverage document that you received when enrolling for detailed information regarding drug coverage.
  •  

  • Check Gateway Health Plan's formulary list on their website to see if Benzphetamine is covered and if any restrictions apply.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about prescribing Benzphetamine and ensure they are aware of Gateway Health Plan's requirements, if any.
  •  

  • Request your healthcare provider to provide necessary medical documentation that justifies the need for Benzphetamine if required by the insurance plan.

 

Obtain a Prescription

 

  • If Benzphetamine is covered, have your healthcare provider issue a prescription in accordance with the plan's guidelines.
  •  

  • Ensure the prescribed dosage and quantity comply with any limits set by Gateway Health Plan.

 

Submit Prior Authorization, if Needed

 

  • In case Benzphetamine requires prior authorization, your healthcare provider will need to submit a prior authorization request to Gateway Health Plan.
  •  

  • Provide any additional documentation or information as requested by Gateway Health Plan to facilitate the authorization process.

 

Fill Your Prescription

 

  • Once the prescription is authorized, take it to a pharmacy in the Gateway Health Plan network to have it filled.
  •  

  • Verify that the pharmacy processes the prescription according to your coverage benefits to avoid unexpected costs.

 

Appeal a Denial, if Applicable

 

  • If your request for Benzphetamine coverage is denied, review the denial letter to understand the reason and gather the necessary information to appeal the decision.
  •  

  • Work with your healthcare provider to provide any additional information required to strengthen your appeal.

 

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Benzphetamine (Didrex) FAQ

What are the side effects of Benzphetamine (Didrex)?

 

Common Side Effects

 

  • Insomnia
  • Nervousness
  • Dizziness
  • Dry Mouth
  • Headache
  • Constipation

 

Severe Side Effects

 

  • Increased Blood Pressure
  • Heart Palpitations
  • Seizures
  • Severe Mood Changes
  • Chest Pain
  • Breathing Difficulties

 

Important Considerations

 

  • If you experience severe side effects, seek medical attention immediately.
  • Use cautiously if you have a history of cardiovascular conditions.
  • Avoid usage in individuals with a history of drug abuse.
  • Always follow the prescribed dosage to minimize risks.
  • Inform your doctor of any existing health conditions or medications.

 

How does Benzphetamine help with weight loss?

 

Mechanism of Action

 

  • Benzphetamine is an appetite suppressant. It stimulates the central nervous system, which increases heart rate and blood pressure.
  •  
  • This leads to a reduced appetite and a feeling of fullness, helping individuals to control their caloric intake.

 

Usage Guidelines

 

  • It should be used as part of a comprehensive weight loss plan, including diet, exercise, and behavioral modification.
  •  
  • Typically prescribed for short-term use to jump-start weight loss efforts.

 

Precautions

 

  • Not suitable for individuals with a history of cardiovascular diseases, hyperthyroidism, or glaucoma.
  •  
  • It may cause side effects such as insomnia, dizziness, and dry mouth.

Is Benzphetamine similar to Phentermine?

 

Similarity between Benzphetamine and Phentermine

 

  • Benzphetamine (Didrex) and Phentermine are both stimulant medications primarily used to treat obesity.
  •  

  • They function as appetite suppressants by affecting the central nervous system.
  •  

  • Both are chemically related to amphetamines but are not classified as amphetamines themselves.

 

Differences

 

  • Benzphetamine is a prodrug and metabolizes into amphetamine and methamphetamine, while Phentermine does not convert into amphetamine derivatives.
  •  

  • Phentermine is generally preferred due to a more established safety profile and fewer side effects compared to Benzphetamine.
  •  

  • Phentermine is typically dosed once daily, whereas Benzphetamine might require multiple doses.

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Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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