Does Geisinger Health Plan Cover Phendimetrazine

Learn about Geisinger Health Plan's coverage for Phendimetrazine, potential reasons for denial, how to secure coverage, costs, and FAQs.
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Coverage of Phendimetrazine

 

  • Geisinger Health Plan may cover Phendimetrazine under specific conditions typically related to weight loss treatment.
  •  

  • Coverage depends on medical necessity, which is assessed by a healthcare provider.
  •  

 

Criteria for Coverage

 

  • Patients must meet certain body mass index (BMI) requirements, often 30 or higher, or 27 with related medical conditions.
  •  

  • A healthcare provider must prescribe Phendimetrazine as part of a comprehensive weight management program.
  •  

 

General Rules

 

  • Pre-authorization might be required, meaning the healthcare provider must justify the medical need before approval.
  •  

  • Regular follow-ups to monitor progress and possible side effects are often mandated.
  •  

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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 Phendimetrazine Coverage with Geisinger Health Plan

 

Verify Phendimetrazine Coverage

 

  • Contact Geisinger Health Plan Member Services to confirm if Phendimetrazine is included in your specific plan's formulary. You can do this through their website or by calling their customer service number found on your insurance card.
  •  

  • Review the plan documents that were provided to you, either electronically or via mail, to see if Phendimetrazine is listed under covered medications.

 

Obtain a Prescription

 

  • Visit your healthcare provider to discuss your need for Phendimetrazine. Ensure they understand your medical history and any weight management objectives you have.
  •  

  • If Phendimetrazine is deemed appropriate, ask your healthcare provider to write you a prescription.

 

Ensure Preauthorization

 

  • Some medications require prior authorization from your insurance company. Check if Phendimetrazine requires this step by consulting the Geisinger Health Plan formulary or speaking with Member Services again.
  •  

  • If prior authorization is necessary, have your healthcare provider complete and submit a preauthorization form to Geisinger Health Plan on your behalf.

 

Select a Participating Pharmacy

 

  • Identify a network pharmacy covered by Geisinger Health Plan. Using an in-network pharmacy can help reduce out-of-pocket costs.
  •  

  • Check the Geisinger Health Plan network pharmacy list, available on their website or by contacting customer service directly.

 

Fill Your Prescription

 

  • Go to the chosen participating pharmacy with your Phendimetrazine prescription. Present your Geisinger Health Plan insurance card to ensure that any coverage is applied correctly.
  •  

  • If there are issues, request the pharmacist to check with Geisinger Health Plan Member Services for verification of benefits specific to Phendimetrazine.

 

Monitor Coverage and Benefits

 

  • Once the prescription is processed, review the Explanation of Benefits (EOB) provided by Geisinger Health Plan to verify that Phendimetrazine was covered as expected.
  •  

  • Keep track of any copayments or additional costs in case you need to budget for future refills or adjust coverage options during enrollment periods.

 

Seek Assistance if Needed

 

  • If you encounter any problems with getting Phendimetrazine covered, contact Geisinger Health Plan Member Services for assistance.
  •  

  • Consider reaching out to your healthcare provider for documentation of medical necessity if required by the insurance plan.

 

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FAQs

Does Geisinger Health Plan Cover Phendimetrazine

Learn about Geisinger Health Plan's coverage for Phendimetrazine, potential reasons for denial, how to secure coverage, costs, and FAQs.
Curex allergy drops unboxing

Is Phendimetrazine Covered by Geisinger Health Plan

 

Coverage of Phendimetrazine

 

  • Geisinger Health Plan may cover Phendimetrazine under specific conditions typically related to weight loss treatment.
  •  

  • Coverage depends on medical necessity, which is assessed by a healthcare provider.
  •  

 

Criteria for Coverage

 

  • Patients must meet certain body mass index (BMI) requirements, often 30 or higher, or 27 with related medical conditions.
  •  

  • A healthcare provider must prescribe Phendimetrazine as part of a comprehensive weight management program.
  •  

 

General Rules

 

  • Pre-authorization might be required, meaning the healthcare provider must justify the medical need before approval.
  •  

  • Regular follow-ups to monitor progress and possible side effects are often mandated.
  •  

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Geisinger Health Plan's Approved Criteria for Phendimetrazine Coverage

 

Prescription Criteria for Phendimetrazine Coverage

 

  • Patients must have a Body Mass Index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² with concurrent obesity-related risk factors such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Documentation must indicate that the patient has attempted weight loss through diet and exercise but has not achieved satisfactory weight reduction.
  •  

  • A thorough medical evaluation and a comprehensive history assessment are required to ensure that the patient is an appropriate candidate for pharmacotherapy.

 

Age Restrictions and Monitoring

 

  • Patients must be at least 16 years of age to qualify for Phendimetrazine coverage under the Geisinger Health Plan.
  •  

  • Regular follow-up consultations with healthcare providers are mandatory to monitor weight, vital signs, and potential side effects.

 

Duration of Coverage and Usage Guidelines

 

  • Phendimetrazine is approved for short-term use only, generally up to 12 weeks, as an adjunct to a reduced-calorie diet and increased physical activity.
  •  

  • Continuation of therapy beyond 12 weeks requires a documented clinical review and justification for extended use.

 

Additional Considerations

 

  • Clinical documentation must demonstrate no contraindications such as cardiovascular disease, hyperthyroidism, or a history of drug abuse.
  •  

  • Patients must not be pregnant or breastfeeding during Phendimetrazine therapy.

 

Why Geisinger Health Plan Might Deny Phendimetrazine Coverage

 

Criteria and Situations Where Geisinger Health Plan Does Not Cover Phendimetrazine

 

  • Usage for Cosmetic Weight Loss: Geisinger Health Plan does not cover Phendimetrazine when it is used solely for cosmetic weight loss purposes, without a diagnosed medical necessity for obesity management.
  •  

  • Lack of Supporting Medical Documentation: Coverage is denied if there is insufficient medical documentation supporting the need for Phendimetrazine for the treatment of obesity or related conditions.
  •  

  • Non-compliance with Plan Guidelines: If the prescription of Phendimetrazine does not comply with the specific guidelines and protocols set forth by Geisinger Health Plan, coverage might be denied.
  •  

  • Non-Approved FDA Indications: Phendimetrazine prescribed for uses not approved by the FDA, which are considered experimental or investigational, are not covered by the plan.
  •  

  • Exceeding Prescribed Duration: Coverage may be denied if the usage duration of Phendimetrazine exceeds the limits established by the health plan based on safety and efficacy standards.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Geisinger Health Plan

 

Verify Phendimetrazine Coverage

 

  • Contact Geisinger Health Plan Member Services to confirm if Phendimetrazine is included in your specific plan's formulary. You can do this through their website or by calling their customer service number found on your insurance card.
  •  

  • Review the plan documents that were provided to you, either electronically or via mail, to see if Phendimetrazine is listed under covered medications.

 

Obtain a Prescription

 

  • Visit your healthcare provider to discuss your need for Phendimetrazine. Ensure they understand your medical history and any weight management objectives you have.
  •  

  • If Phendimetrazine is deemed appropriate, ask your healthcare provider to write you a prescription.

 

Ensure Preauthorization

 

  • Some medications require prior authorization from your insurance company. Check if Phendimetrazine requires this step by consulting the Geisinger Health Plan formulary or speaking with Member Services again.
  •  

  • If prior authorization is necessary, have your healthcare provider complete and submit a preauthorization form to Geisinger Health Plan on your behalf.

 

Select a Participating Pharmacy

 

  • Identify a network pharmacy covered by Geisinger Health Plan. Using an in-network pharmacy can help reduce out-of-pocket costs.
  •  

  • Check the Geisinger Health Plan network pharmacy list, available on their website or by contacting customer service directly.

 

Fill Your Prescription

 

  • Go to the chosen participating pharmacy with your Phendimetrazine prescription. Present your Geisinger Health Plan insurance card to ensure that any coverage is applied correctly.
  •  

  • If there are issues, request the pharmacist to check with Geisinger Health Plan Member Services for verification of benefits specific to Phendimetrazine.

 

Monitor Coverage and Benefits

 

  • Once the prescription is processed, review the Explanation of Benefits (EOB) provided by Geisinger Health Plan to verify that Phendimetrazine was covered as expected.
  •  

  • Keep track of any copayments or additional costs in case you need to budget for future refills or adjust coverage options during enrollment periods.

 

Seek Assistance if Needed

 

  • If you encounter any problems with getting Phendimetrazine covered, contact Geisinger Health Plan Member Services for assistance.
  •  

  • Consider reaching out to your healthcare provider for documentation of medical necessity if required by the insurance plan.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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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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