Does Geisinger Health Plan Cover Orlistat (Xenical, Alli)

Explore Geisinger Health Plan's coverage for Orlistat and learn how to secure it, along with costs without insurance and answers to common questions.
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Geisinger Health Plan Coverage for Orlistat

 

  • Geisinger Health Plan generally covers Orlistat (Xenical, Alli) under specific conditions. Coverage for weight management medications like Orlistat is usually contingent on medical necessity and prior authorization.
  •  

  • To qualify for coverage, patients may need to demonstrate a certain body mass index (BMI) threshold or comorbid conditions related to obesity, such as hypertension or diabetes.
  •  

  • Patients often must have documented attempts at non-pharmacological weight management methods, including diet and exercise, before coverage approval.
  •  

  • Prior authorization involves a healthcare provider submitting a request justifying the need for Orlistat based on individual health circumstances.
  •  

  • It's essential for patients to consult with their healthcare provider and insurance representative for specific details and documentation required for coverage under Geisinger Health Plan.

 

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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 Orlistat (Xenical, Alli) Coverage with Geisinger Health Plan

 

Contact Geisinger Health Plan

 

  • Reach out to Geisinger Health Plan's customer service for detailed information regarding your specific plan's coverage benefits for prescription medications, including Orlistat.
  •  

  • Ask specifically if Orlistat (Xenical, Alli) is covered under your plan. Ensure you understand any conditions, such as prior authorization or step therapy requirements.

 

Consult with Your Healthcare Provider

 

  • Discuss your intention to use Orlistat with your healthcare provider. Ensure it's appropriate for your weight management plan and overall health condition.
  •  

  • If Geisinger Health Plan requires a prescription for coverage, obtain one from your healthcare provider.

 

Verify Prescription Drug Formulary

 

  • Check Geisinger Health Plan's prescription drug formulary, either online through their member portal or through a hard copy obtained from customer service, to confirm Orlistat is listed and to understand any specific requirements or limitations.
  •  

  • Note any special tiers for Orlistat that might affect your copay or out-of-pocket costs.

 

Submit Required Documentation

 

  • If required, submit any necessary documentation or forms for prior authorization. Your healthcare provider can assist in providing medical necessity information that Geisinger Health Plan may require.
  •  

  • Follow up with both your healthcare provider and Geisinger Health Plan to ensure all required documents have been received and processed correctly.

 

Visit a Participating Pharmacy

 

  • Fill your Orlistat prescription at a pharmacy that participates with Geisinger Health Plan to maximize your plan benefits.
  •  

  • Use your Geisinger Health Plan insurance card at the pharmacy to apply your coverage benefits and reduce out-of-pocket costs for Orlistat.

 

Monitor Your Plan Benefits

 

  • Review your explanation of benefits (EOB) statements from Geisinger Health Plan to ensure your claims for Orlistat are processed correctly and understand any denials or adjustments.
  •  

  • Remain informed about any future changes to your plan that may affect coverage for Orlistat. Regularly check for updates to the formulary or plan details.

 

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FAQs

Does Geisinger Health Plan Cover Orlistat (Xenical, Alli)

Explore Geisinger Health Plan's coverage for Orlistat and learn how to secure it, along with costs without insurance and answers to common questions.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Geisinger Health Plan

 

Geisinger Health Plan Coverage for Orlistat

 

  • Geisinger Health Plan generally covers Orlistat (Xenical, Alli) under specific conditions. Coverage for weight management medications like Orlistat is usually contingent on medical necessity and prior authorization.
  •  

  • To qualify for coverage, patients may need to demonstrate a certain body mass index (BMI) threshold or comorbid conditions related to obesity, such as hypertension or diabetes.
  •  

  • Patients often must have documented attempts at non-pharmacological weight management methods, including diet and exercise, before coverage approval.
  •  

  • Prior authorization involves a healthcare provider submitting a request justifying the need for Orlistat based on individual health circumstances.
  •  

  • It's essential for patients to consult with their healthcare provider and insurance representative for specific details and documentation required for coverage under Geisinger Health Plan.

 

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Geisinger Health Plan's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Coverage Criteria for Orlistat (Xenical, Alli)

 

  • **Body Mass Index (BMI) Requirement:** Members must have a BMI of 30 or greater, or a BMI of 27 or greater with accompanying risk factors such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Lifestyle Modification Program Participation:** There must be documented participation in a physician-supervised weight loss program for at least 6 months, which includes diet, exercise, and behavioral changes.
  •  

  • **Previous Weight Loss Attempts:** Documentation showing inadequate weight loss response with diet and exercise alone, as determined by the supervising healthcare provider.
  •  

  • **Age Restrictions:** Coverage is provided for adult members who are 18 years of age or older.
  •  

  • **Provider Authorization:** Orlistat prescription must be authorized by the member's primary care physician or a qualified specialist involved in the member's weight management program.
  •  

  • **Monitoring and Follow-Up:** Continued eligibility for coverage requires regular follow-up visits with the prescribing physician to monitor weight loss progress and any side effects.
  •  

 

Why Geisinger Health Plan Might Deny Orlistat (Xenical, Alli) Coverage

 

Situations Where Coverage is Denied

 

  • Geisinger Health Plan may deny coverage for Orlistat (Xenical, Alli) if the medication is not deemed medically necessary based on the individual’s specific health condition and medical history.
  •  

  • Coverage may be denied if the patient fails to meet the clinical criteria set forth by the plan, such as a required minimum body mass index (BMI) threshold not being met.
  •  

  • Orlistat may not be covered if there is a lack of documentation or evidence of previous unsuccessful weight management attempts using other interventions.
  •  

  • Denial of coverage can occur if the patient has not participated in a comprehensive weight management program, which may include diet, exercise, and behavior modification, prior to being prescribed Orlistat.
  •  

  • Geisinger Health Plan may refuse coverage if the prescription is for cosmetic weight loss rather than for the treatment of obesity-related health issues.
  •  

  • If a patient is not of eligible age as specified by the plan's guidelines, Orlistat may not be covered.
  •  

  • Orlistat may not be covered under Geisinger Health Plan if it is prescribed outside of the approved dosage guidelines or for an off-label use not supported by the plan.

 

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How Much Does Orlistat (Xenical, Alli) Cost without Insurance?

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

  • Xenical: The brand-name Orlistat, Xenical, can be quite expensive without insurance. Typically, the cost is around $800 to $1,000 for a supply of 90 capsules, with each capsule being 120 mg.
  •  

  • Alli: The over-the-counter version, Alli, is generally less expensive than its prescription counterpart. The price for Alli ranges from $50 to $100 for a supply of 120 capsules, with each capsule being 60 mg.
  •  

  • Generic Orlistat: While generic options may be available, they usually do not offer significant savings over the brand-name versions. The prices for generic Orlistat are often comparable to those of Alli, varying from $50 to $100 for a similar quantity.
  •  

  • Shopping Tips: Prices can vary depending on the pharmacy, location, and availability. Consider using pharmacy discount cards, online coupons, or comparing prices at different pharmacies to obtain the best deal.
  •  

  • Considerations: Always consult a healthcare provider before starting Orlistat, and discuss any potential insurance coverage or assistance programs they might recommend.

 

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 Orlistat (Xenical, Alli) Coverage with Geisinger Health Plan

 

Contact Geisinger Health Plan

 

  • Reach out to Geisinger Health Plan's customer service for detailed information regarding your specific plan's coverage benefits for prescription medications, including Orlistat.
  •  

  • Ask specifically if Orlistat (Xenical, Alli) is covered under your plan. Ensure you understand any conditions, such as prior authorization or step therapy requirements.

 

Consult with Your Healthcare Provider

 

  • Discuss your intention to use Orlistat with your healthcare provider. Ensure it's appropriate for your weight management plan and overall health condition.
  •  

  • If Geisinger Health Plan requires a prescription for coverage, obtain one from your healthcare provider.

 

Verify Prescription Drug Formulary

 

  • Check Geisinger Health Plan's prescription drug formulary, either online through their member portal or through a hard copy obtained from customer service, to confirm Orlistat is listed and to understand any specific requirements or limitations.
  •  

  • Note any special tiers for Orlistat that might affect your copay or out-of-pocket costs.

 

Submit Required Documentation

 

  • If required, submit any necessary documentation or forms for prior authorization. Your healthcare provider can assist in providing medical necessity information that Geisinger Health Plan may require.
  •  

  • Follow up with both your healthcare provider and Geisinger Health Plan to ensure all required documents have been received and processed correctly.

 

Visit a Participating Pharmacy

 

  • Fill your Orlistat prescription at a pharmacy that participates with Geisinger Health Plan to maximize your plan benefits.
  •  

  • Use your Geisinger Health Plan insurance card at the pharmacy to apply your coverage benefits and reduce out-of-pocket costs for Orlistat.

 

Monitor Your Plan Benefits

 

  • Review your explanation of benefits (EOB) statements from Geisinger Health Plan to ensure your claims for Orlistat are processed correctly and understand any denials or adjustments.
  •  

  • Remain informed about any future changes to your plan that may affect coverage for Orlistat. Regularly check for updates to the formulary or plan details.

 

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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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

  • Gastrointestinal issues: Common effects include oily or fatty stools, increased defecation, and the urgent or difficult need to control bowel movements.
  •  

  • Abdominal discomfort: Some users experience pain or discomfort in the abdomen region.
  •  

  • Reduced absorption of fat-soluble vitamins: Orlistat can interfere with the absorption of vitamins A, D, E, and K. A multivitamin supplement is often recommended.
  •  

  • Allergic reactions: Though rare, symptoms may include itching, rash, or swelling, especially of the face, tongue, or throat.
  •  

  • Others: Some users report headaches, back pain, or flu-like symptoms.

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

  • Orlistat aids weight loss by blocking the absorption of fats from the diet, reducing caloric intake. It can block approximately 25-30% of dietary fat.
  •  

  • Clinical studies suggest that Orlistat use for one year can result in an average weight loss of about 5-10% of initial body weight, when combined with a calorie-reduced diet.
  •  

  • It promotes modest weight loss over time and helps maintain weight loss. The effectiveness can improve with lifestyle changes such as increased physical activity and diet modifications.
  •  

  • Orlistat also has beneficial effects on cholesterol levels and may help reduce blood pressure.

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

  • Orlistat is available in two forms: prescription strength (Xenical) and over-the-counter (Alli).
  •  

  • **Xenical**: This is the 120 mg version and requires a doctor's prescription. It's typically used for patients with a higher body mass index (BMI) or more specific medical conditions.
  •  

  • **Alli**: The 60 mg variant can be purchased over the counter in many countries, including the United States and the UK.
  •  

  • Even though Alli is accessible without a prescription, it is advised to consult with a healthcare professional before starting, to discuss its suitability and ensure proper usage.
  •  

 

Considerations Before Using Orlistat

 

  • Proper dietary changes are necessary when taking Orlistat to maximize effectiveness and reduce side effects.
  •  

  • Discuss your complete medical history and any other medications you are taking with your healthcare provider.

 

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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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