Does Gateway Health Plan Cover Diethylpropion (Tenuate)

Explore Gateway Health Plan's coverage for Diethylpropion, learn why denial happens, find alternatives, costs, and answers to common questions.
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Gateway Health Plan Coverage of Diethylpropion (Tenuate)

 

  • Diethylpropion (Tenuate) may be covered under Gateway Health Plan, depending on the specific plan details and medical necessity.
  •  

  • Coverage often requires a prior authorization, which means your physician must demonstrate that this medication is necessary for your treatment and that other weight-loss methods have been unsuccessful.
  •  

  • Typically, the coverage is considered for patients with a diagnosis of obesity where the body mass index (BMI) exceeds a certain threshold.
  •  

  • Gateway Health Plan may have specific criteria, such as requiring documented lifestyle changes or consultations with a dietitian.
  •  

  • Patients might need to provide a history of past attempts at weight management before approval.
  •  

  • It’s essential to consult directly with Gateway Health Plan or your healthcare provider to verify specific criteria and ensure compliance with the plan's requirements.

 

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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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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 Diethylpropion (Tenuate) Coverage with Gateway Health Plan

 

Check Eligibility for Prescription Coverage

 

  • Log into the Gateway Health Plan member portal using your health plan credentials to view your coverage details.
  •  

  • Contact Gateway Health Plan customer service to confirm if Diethylpropion (Tenuate) is included in your prescription drug coverage.
  •  

  • Review your plan’s formulary, which lists approved medications and their corresponding tiers.

 

Consult with Your Healthcare Provider

 

  • Meet with your healthcare provider to discuss the necessity of Diethylpropion (Tenuate) for your medical condition.
  •  

  • Ensure your healthcare provider documents the medical necessity and provides a prescription that meets Gateway Health Plan's criteria.
  •  

  • Request your healthcare provider to write a letter of medical necessity if Diethylpropion (Tenuate) is not on the preferred drug list.

 

Submit a Prior Authorization Request

 

  • Download or request a Prior Authorization (PA) form from Gateway Health Plan’s website or customer service.
  •  

  • Fill out the PA form with your healthcare provider, ensuring all required information is complete and accurate.
  •  

  • Submit the completed PA form along with any supporting documentation, such as the letter of medical necessity, to Gateway Health Plan.

 

Follow Up on the Request

 

  • Monitor the status of your Prior Authorization request through the Gateway Health Plan portal or by contacting their customer service.
  •  

  • If your request is approved, coordinate with your pharmacy to fill the prescription under Gateway Health Plan coverage.
  •  

  • In case of denial, review the denial letter for specific reasons and work with your healthcare provider to address any issues.

 

Appeal Denial if Necessary

 

  • Prepare an appeal by gathering all relevant documentation and information to support the necessity of Diethylpropion (Tenuate).
  •  

  • Submit the appeal to Gateway Health Plan following their specified procedures, often outlined in your denial letter.
  •  

  • Engage with your healthcare provider during the appeal process for additional support and documentation.

 

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FAQs

Does Gateway Health Plan Cover Diethylpropion (Tenuate)

Explore Gateway Health Plan's coverage for Diethylpropion, learn why denial happens, find alternatives, costs, and answers to common questions.
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Is Diethylpropion (Tenuate) Covered by Gateway Health Plan

 

Gateway Health Plan Coverage of Diethylpropion (Tenuate)

 

  • Diethylpropion (Tenuate) may be covered under Gateway Health Plan, depending on the specific plan details and medical necessity.
  •  

  • Coverage often requires a prior authorization, which means your physician must demonstrate that this medication is necessary for your treatment and that other weight-loss methods have been unsuccessful.
  •  

  • Typically, the coverage is considered for patients with a diagnosis of obesity where the body mass index (BMI) exceeds a certain threshold.
  •  

  • Gateway Health Plan may have specific criteria, such as requiring documented lifestyle changes or consultations with a dietitian.
  •  

  • Patients might need to provide a history of past attempts at weight management before approval.
  •  

  • It’s essential to consult directly with Gateway Health Plan or your healthcare provider to verify specific criteria and ensure compliance with the plan's requirements.

 

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Gateway Health Plan's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility for Coverage

 

  • Patient must be enrolled in Gateway Health Plan and have active coverage at the time of the prescription request.
  •  

  • Coverage is available for patients age 16 and older.

 

Medical Necessity Requirements

 

  • Diethylpropion must be prescribed by a healthcare provider qualified in obesity management or weight loss treatment.
  •  

  • A documented diagnosis of obesity, defined as a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² with comorbid conditions such as hypertension, diabetes, or hyperlipidemia, is required.

 

Previous Treatment Criteria

 

  • Patient must have demonstrated unsuccessful weight loss with lifestyle modifications such as diet and exercise prior to medication request.
  •  

  • Provider documentation of previous interventions, including behavioral therapy or other pharmacotherapy, if applicable, must be included.

 

Duration and Monitoring

 

  • Coverage is typically approved for an initial 12-week period. Continuation of therapy may require documentation of weight loss or clinical improvement.
  •  

  • Regular follow-up visits with the prescribing provider are required to monitor effectiveness and any potential side effects.

 

Dosage

 

  • The medication should be taken as prescribed, typically 25 mg up to three times daily, or 75 mg of the extended-release version once daily.
  •  

  • Provider must confirm that the dosage aligns with guidelines and patient's health status for approval.

 

Exclusions

 

  • Diethylpropion should not be used in combination with other weight loss medications unless approved by Gateway Health Plan.
  •  

  • Patient must not have contraindications such as severe cardiovascular disease, hyperthyroidism, or uncontrolled hypertension.

 

Documentation and Authorization

 

  • Provider must submit a detailed medical history and justification for the use of diethylpropion including lab results and BMI calculations.
  •  

  • A prior authorization form may be required to be submitted for initial and subsequent coverage approval.

 

Why Gateway Health Plan Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Diethylpropion (Tenuate) Coverage Denial by Gateway Health Plan

 

  • Gateway Health Plan does not cover Diethylpropion if it deems the medication as non-essential or not medically necessary for the patient’s treatment plan.
  •  

  • Coverage may be denied if the prescribing doctor fails to provide sufficient documentation of the medical necessity of Diethylpropion.
  •  

  • Diethylpropion is not covered if the patient does not meet the BMI or health criteria set forth by the health plan for obesity treatments.
  •  

  • The health plan rejects coverage if the patient has a history of substance abuse or the medication poses a significant risk for abuse or addiction.
  •  

  • Gateway Health Plan will not cover the medication if it is prescribed in dosages exceeding the recommended amounts, or if it is used for off-label purposes not approved by the FDA.
  •  

  • Diethylpropion is not covered if the medication is prescribed by a non-network provider, unless previously authorized by the plan.
  •  

  • Coverage is denied if the patient fails to comply with other components of a weight management program, such as diet and exercise plans, as required by the health plan.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Gateway Health Plan

 

Check Eligibility for Prescription Coverage

 

  • Log into the Gateway Health Plan member portal using your health plan credentials to view your coverage details.
  •  

  • Contact Gateway Health Plan customer service to confirm if Diethylpropion (Tenuate) is included in your prescription drug coverage.
  •  

  • Review your plan’s formulary, which lists approved medications and their corresponding tiers.

 

Consult with Your Healthcare Provider

 

  • Meet with your healthcare provider to discuss the necessity of Diethylpropion (Tenuate) for your medical condition.
  •  

  • Ensure your healthcare provider documents the medical necessity and provides a prescription that meets Gateway Health Plan's criteria.
  •  

  • Request your healthcare provider to write a letter of medical necessity if Diethylpropion (Tenuate) is not on the preferred drug list.

 

Submit a Prior Authorization Request

 

  • Download or request a Prior Authorization (PA) form from Gateway Health Plan’s website or customer service.
  •  

  • Fill out the PA form with your healthcare provider, ensuring all required information is complete and accurate.
  •  

  • Submit the completed PA form along with any supporting documentation, such as the letter of medical necessity, to Gateway Health Plan.

 

Follow Up on the Request

 

  • Monitor the status of your Prior Authorization request through the Gateway Health Plan portal or by contacting their customer service.
  •  

  • If your request is approved, coordinate with your pharmacy to fill the prescription under Gateway Health Plan coverage.
  •  

  • In case of denial, review the denial letter for specific reasons and work with your healthcare provider to address any issues.

 

Appeal Denial if Necessary

 

  • Prepare an appeal by gathering all relevant documentation and information to support the necessity of Diethylpropion (Tenuate).
  •  

  • Submit the appeal to Gateway Health Plan following their specified procedures, often outlined in your denial letter.
  •  

  • Engage with your healthcare provider during the appeal process for additional support and documentation.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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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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.

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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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