Does Geisinger Health Plan Cover Contrave

Explore Geisinger Health Plan's Contrave coverage, denial reasons, how to secure coverage, Contrave costs without insurance, and FAQs.
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Coverage Overview

 

  • Geisinger Health Plan may cover Contrave, a weight management medication, depending on the specific terms of your plan.
  • Coverage is typically subject to prior authorization, meaning approval must be obtained before the insurance will pay for the medication.

 

Situations for Coverage

 

  • Used for chronic weight management in adults who are obese or overweight with an associated weight-related condition, such as hypertension or type 2 diabetes.
  • The medication is intended for use alongside a reduced-calorie diet and increased physical activity.

 

Criteria for Coverage

 

  • A healthcare provider must determine that Contrave is medically necessary for the individual's weight management goals.
  • Patients may need to meet specific body mass index (BMI) criteria to qualify for coverage.
  • Documentation may be required to prove attempts of weight management through diet and exercise before approving the prescription.

 

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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 Geisinger Health Plan

 

Verify Your Coverage

 

  • Contact Geisinger Health Plan's customer service to inquire if Contrave is included in your plan's formulary. Provide them with your plan details or membership ID for accurate information.
  •  

  • Review your policy documents or the online member portal for any coverage details on weight management medications, specifically those related to appetite suppressants or obesity treatment.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your primary care physician or a healthcare provider to discuss your eligibility for Contrave. Ensure they are within the Geisinger network for seamless coordination.
  •  

  • Obtain a prescription from your healthcare provider, as Geisinger Health Plan will require a valid prescription before providing coverage for Contrave.

 

Pre-Authorization Process

 

  • Check if pre-authorization is needed for Contrave. Many insurance plans, including Geisinger Health Plan, may require pre-authorization for certain medications to determine medical necessity.
  •  

  • Work with your physician's office to complete the pre-authorization forms or request this documentation directly from Geisinger Health Plan.

 

Submit Required Documentation

 

  • Compile and submit any required documentation to Geisinger Health Plan, including the prescription, medical history, and relevant pre-authorization forms.
  •  

  • Ensure all submitted forms are filled correctly to prevent delays in the approval process.

 

Follow Up on Approval

 

  • Stay in contact with both your healthcare provider and Geisinger Health Plan to monitor the status of your coverage request for Contrave.
  •  

  • If initially denied, inquire about the appeals process and gather any additional information that may support your case.

 

Fill Your Prescription

 

  • Once approved, visit a Geisinger Health Plan network pharmacy to fill your prescription for Contrave.
  •  

  • Discuss any copays or coverage limits with the pharmacy to ensure you understand your financial responsibility based on your plan's benefits.

 

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FAQs

Does Geisinger Health Plan Cover Contrave

Explore Geisinger Health Plan's Contrave coverage, denial reasons, how to secure coverage, Contrave costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Contrave Covered by Geisinger Health Plan

 

Coverage Overview

 

  • Geisinger Health Plan may cover Contrave, a weight management medication, depending on the specific terms of your plan.
  • Coverage is typically subject to prior authorization, meaning approval must be obtained before the insurance will pay for the medication.

 

Situations for Coverage

 

  • Used for chronic weight management in adults who are obese or overweight with an associated weight-related condition, such as hypertension or type 2 diabetes.
  • The medication is intended for use alongside a reduced-calorie diet and increased physical activity.

 

Criteria for Coverage

 

  • A healthcare provider must determine that Contrave is medically necessary for the individual's weight management goals.
  • Patients may need to meet specific body mass index (BMI) criteria to qualify for coverage.
  • Documentation may be required to prove attempts of weight management through diet and exercise before approving the prescription.

 

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Geisinger Health Plan's Approved Criteria for Contrave Coverage

 

Geisinger Health Plan's Approved Criteria for Contrave Coverage

 

  • **Medical Diagnosis:** The member must have a medical diagnosis of obesity or overweight. Obesity is defined as a Body Mass Index (BMI) of 30 kg/m² or higher. Overweight is a BMI of 27 kg/m² or higher, accompanied by at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

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

  • **Previous Weight Loss Attempts:** Documentation of prior unsuccessful weight loss efforts is required, emphasizing that the member has engaged in a physician-supervised weight loss program involving lifestyle changes such as diet and exercise.
  •  

  • **Medication Use:** The request for Contrave must indicate that the prescription is for adjunctive therapy, meaning it will be used alongside a reduced-calorie diet and increased physical activity.
  •  

  • **Duration of Lifestyle Modification:** There should be a demonstrated adherence to a lifestyle modification program for a minimum of three to six months, illustrating efforts in sustained weight management.
  •  

  • **Contraindications:** The prescribing clinician must attest that the member does not have any contraindications for the use of Contrave, such as uncontrolled hypertension, seizure disorders, or chronic opioid use.
  •  

  • **Initial Approval Duration:** Should all criteria be met, initial approval for coverage is typically granted for a period of twelve weeks, contingent upon ongoing participation in lifestyle modifications and follow-up consultations.
  •  

  • **Continuation of Therapy:** For the continuation of therapy beyond the initial approval, an assessment by the prescribing practitioner must demonstrate clinically meaningful weight loss. This may involve a reduction of at least 5% of initial body weight within this period.
  •  

  • **Regular Monitoring:** Ongoing prescriptions may require periodic follow-ups to verify the member's compliance with treatment and continuous adjustment of lifestyle behaviors, supporting long-term weight management goals.

 

Why Geisinger Health Plan Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage

 

  • Geisinger Health Plan may deny coverage for Contrave if it is not deemed medically necessary for the patient based on their health condition and medical history.
  •  

  • The plan might not cover Contrave if the patient does not meet the body mass index (BMI) criteria or other specific health markers that are required for the approval of this medication.
  •  

  • Coverage may be denied if the patient has not tried and failed with other weight management interventions, such as lifestyle modifications or alternative medications, as required by the health plan's guidelines.
  •  

  • Contrave might not be covered if the patient does not have a documented diagnosis related to obesity or a related medical condition, such as Type 2 diabetes or hypertension, which the medication is approved to treat.
  •  

  • The health plan could refuse to cover if there is no supporting documentation or records from a healthcare provider justifying the need for Contrave as part of the treatment plan.
  •  

  • Contrave coverage might be restricted if the prescribed dosage exceeds the limits established by the Geisinger Health Plan guidelines.
  •  

  • In cases where the medication is deemed experimental or not approved for the patient’s specific condition, the plan may not cover its use.
  •  

  • The health plan might deny coverage if there are contraindications or safety concerns based on the patient's current medication regimen or health status.
  •  

 

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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 Geisinger Health Plan

 

Verify Your Coverage

 

  • Contact Geisinger Health Plan's customer service to inquire if Contrave is included in your plan's formulary. Provide them with your plan details or membership ID for accurate information.
  •  

  • Review your policy documents or the online member portal for any coverage details on weight management medications, specifically those related to appetite suppressants or obesity treatment.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your primary care physician or a healthcare provider to discuss your eligibility for Contrave. Ensure they are within the Geisinger network for seamless coordination.
  •  

  • Obtain a prescription from your healthcare provider, as Geisinger Health Plan will require a valid prescription before providing coverage for Contrave.

 

Pre-Authorization Process

 

  • Check if pre-authorization is needed for Contrave. Many insurance plans, including Geisinger Health Plan, may require pre-authorization for certain medications to determine medical necessity.
  •  

  • Work with your physician's office to complete the pre-authorization forms or request this documentation directly from Geisinger Health Plan.

 

Submit Required Documentation

 

  • Compile and submit any required documentation to Geisinger Health Plan, including the prescription, medical history, and relevant pre-authorization forms.
  •  

  • Ensure all submitted forms are filled correctly to prevent delays in the approval process.

 

Follow Up on Approval

 

  • Stay in contact with both your healthcare provider and Geisinger Health Plan to monitor the status of your coverage request for Contrave.
  •  

  • If initially denied, inquire about the appeals process and gather any additional information that may support your case.

 

Fill Your Prescription

 

  • Once approved, visit a Geisinger Health Plan network pharmacy to fill your prescription for Contrave.
  •  

  • Discuss any copays or coverage limits with the pharmacy to ensure you understand your financial responsibility based on your plan's benefits.

 

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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Everything you need is included:

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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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