Does Gateway Health Plan Cover Contrave

Explore Gateway Health Plan's coverage for Contrave. Learn about possible denial reasons, coverage tips, costs without insurance, and find answers to common questions.
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Does Gateway Health Plan Cover Contrave?

 

  • Gateway Health Plan may cover Contrave, a prescription medication for weight management, depending on the plan's formulary and guidelines.
  •  

  • Coverage often requires trying other weight-loss methods or medications first, indicating that it is not a first-line treatment.
  •  

  • A prior authorization process is usually required, where your healthcare provider must demonstrate medical necessity based on your health history and plan requirements.
  •  

  • Eligibility for coverage might include documented obesity-related conditions, such as hypertension or diabetes, as part of the approval criteria.
  •  

  • Always check with Gateway Health Plan for specific formulary details or consult your healthcare provider to assess potential coverage for Contrave in your situation.

 

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Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Contrave Coverage with Gateway Health Plan

 

Understand Your Coverage

 

  • Review your Gateway Health Plan benefits documentation to determine what is covered under your plan, focusing on prescription drug benefits.
  •  

  • Check for any specific exclusions related to weight loss medications, as this may impact coverage for Contrave.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your desire to use Contrave for weight management.
  •  

  • Request a prescription for Contrave from your provider if they determine it is an appropriate treatment for you.

 

Pre-Authorization Requirement

 

  • Contact Gateway Health Plan’s customer service to inquire about any pre-authorization requirements for Contrave.
  •  

  • Work with your healthcare provider to submit any necessary pre-authorization forms required by Gateway Health Plan.

 

Check the Formulary

 

  • Access Gateway Health Plan's formulary list on their website or through your member handbook to verify if Contrave is included.
  •  

  • If Contrave is not listed, discuss alternatives with your healthcare provider that are covered by your plan.

 

Utilize Pharmacy Benefits

 

  • Visit a network pharmacy that accepts Gateway Health Plan coverage to fill your prescription for Contrave.
  •  

  • Inform the pharmacist of any Gateway Health Plan discounts or special arrangements for medication pricing.

 

Appeal Denials

 

  • If your coverage request for Contrave is denied, file an appeal with Gateway Health Plan. Review the plan’s appeal process and gather necessary documentation.
  •  

  • Include a letter of necessity from your healthcare provider presenting the medical justification for Contrave.

 

Regularly Review Plan Updates

 

  • Keep up to date with any changes in your benefits or formulary that might affect the coverage of Contrave by checking communications from Gateway Health Plan.
  •  

  • Consult with a Gateway Health Plan representative to understand how any updates may influence your medication coverage.

 

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FAQs

Does Gateway Health Plan Cover Contrave

Explore Gateway Health Plan's coverage for Contrave. Learn about possible denial reasons, coverage tips, costs without insurance, and find answers to common questions.
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Is Contrave Covered by Gateway Health Plan

 

Does Gateway Health Plan Cover Contrave?

 

  • Gateway Health Plan may cover Contrave, a prescription medication for weight management, depending on the plan's formulary and guidelines.
  •  

  • Coverage often requires trying other weight-loss methods or medications first, indicating that it is not a first-line treatment.
  •  

  • A prior authorization process is usually required, where your healthcare provider must demonstrate medical necessity based on your health history and plan requirements.
  •  

  • Eligibility for coverage might include documented obesity-related conditions, such as hypertension or diabetes, as part of the approval criteria.
  •  

  • Always check with Gateway Health Plan for specific formulary details or consult your healthcare provider to assess potential coverage for Contrave in your situation.

 

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Gateway Health Plan's Approved Criteria for Contrave Coverage

 

Coverage Criteria for Contrave

 

  • Contrave is covered for patients who are 18 years of age or older.
  •  

  • Patients must have a diagnosis of obesity, which is defined by a body mass index (BMI) of 30 kg/m2 or higher, or a BMI of 27 kg/m2 or higher with at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Coverage is provided for patients who have attempted to lose weight through dietary changes, physical activity, and behavioral strategies but have not achieved or maintained sufficient weight loss.
  •  

  • A prescription for Contrave must be written by a healthcare provider.
  •  

  • Patients must not have a history of seizures or eating disorders, as Contrave is contraindicated for these conditions.
  •  

  • Continued coverage is subject to documentation of significant weight loss (typically at least 5% of baseline weight) within the first 12 weeks of treatment.
  •  

  • Renewal of coverage requires ongoing documentation of weight maintenance or additional weight loss, as well as compliance with the prescribed treatment and lifestyle intervention plans.

 

Why Gateway Health Plan Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage by Gateway Health Plan

 

  • Contrave is not covered for individuals who do not meet the medical necessity criteria, which typically includes specific BMI thresholds or associated comorbidities.
  •  

  • Coverage is denied if the patient has not attempted and documented other weight loss methods prior to prescription, as weight management protocols often require proof of failed alternative interventions.
  •  

  • Gateway Health Plan may deny coverage if there is no prior authorization obtained before the prescription. Pre-approval is usually necessary to ensure the medication is covered.
  •  

  • Coverage may be refused for patients with certain contraindications such as uncontrolled hypertension or a history of seizures, based on the safety profile of Contrave.
  •  

  • Claims are likely to be denied if submitted after the prescription is filled without verification of benefits, leading to potential coverage discrepancies.
  •  

  • The health plan may not cover Contrave if the prescribing physician is out of network, unless specific exceptions are in place allowing for coverage with out-of-network providers.
  •  

  • Contrave may not be covered if it is deemed experimental or investigational for conditions that have not been FDA-approved for this medication's use.
  •  

  • Gateway Health Plan does not cover Contrave for non-prescription use or if intended for off-label purposes other than those approved.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing costs.

 

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 Contrave Coverage with Gateway Health Plan

 

Understand Your Coverage

 

  • Review your Gateway Health Plan benefits documentation to determine what is covered under your plan, focusing on prescription drug benefits.
  •  

  • Check for any specific exclusions related to weight loss medications, as this may impact coverage for Contrave.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your desire to use Contrave for weight management.
  •  

  • Request a prescription for Contrave from your provider if they determine it is an appropriate treatment for you.

 

Pre-Authorization Requirement

 

  • Contact Gateway Health Plan’s customer service to inquire about any pre-authorization requirements for Contrave.
  •  

  • Work with your healthcare provider to submit any necessary pre-authorization forms required by Gateway Health Plan.

 

Check the Formulary

 

  • Access Gateway Health Plan's formulary list on their website or through your member handbook to verify if Contrave is included.
  •  

  • If Contrave is not listed, discuss alternatives with your healthcare provider that are covered by your plan.

 

Utilize Pharmacy Benefits

 

  • Visit a network pharmacy that accepts Gateway Health Plan coverage to fill your prescription for Contrave.
  •  

  • Inform the pharmacist of any Gateway Health Plan discounts or special arrangements for medication pricing.

 

Appeal Denials

 

  • If your coverage request for Contrave is denied, file an appeal with Gateway Health Plan. Review the plan’s appeal process and gather necessary documentation.
  •  

  • Include a letter of necessity from your healthcare provider presenting the medical justification for Contrave.

 

Regularly Review Plan Updates

 

  • Keep up to date with any changes in your benefits or formulary that might affect the coverage of Contrave by checking communications from Gateway Health Plan.
  •  

  • Consult with a Gateway Health Plan representative to understand how any updates may influence your medication coverage.

 

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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A weight management program tailored to you

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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