Does Geisinger Health Plan Cover Phentermine/Topiramate ER (Qsymia)

Explore Geisinger Health Plan's coverage for Phentermine/Topiramate ER (Qsymia) and learn about costs, reasons for denial, and how to secure approval.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Geisinger Health Plan Coverage for Qsymia

 

  • Geisinger Health Plan may cover Phentermine/Topiramate ER (Qsymia) as part of its medication management for obesity. This coverage often requires a prescription from a healthcare provider.
  •  

  • Eligibility for coverage typically necessitates that the patient has a BMI of 30 or greater, or 27 with at least one weight-related comorbidity such as hypertension or type 2 diabetes.
  •  

  • Authorization commonly requires documentation showing the patient's previous attempts at weight loss through lifestyle changes and other medications if applicable.
  •  

  • Patients might be required to participate in a weight management program offered or endorsed by Geisinger Health Plan, which can include regular medical consultations.
  •  

  • Coverage terms, including cost-sharing and prior authorization, vary based on specific plan details and state regulations. Patients should consult their plan documents or contact Geisinger directly for precise information.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 Phentermine/Topiramate ER (Qsymia) Coverage with Geisinger Health Plan

 

Verify Your Coverage

 

  • Contact Geisinger Health Plan customer service to confirm that your specific plan includes coverage for weight loss medications such as Phentermine/Topiramate ER (Qsymia).
  •  

  • Review the terms of your plan in the documentation provided by Geisinger or available on their member portal to understand your coverage.
  •  

  • Consider consulting with your healthcare provider about whether this medication is necessary for your health condition and appropriate under your current plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the potential benefits and risks of taking Phentermine/Topiramate ER (Qsymia) for weight management.
  •  

  • Ensure your provider documents the medical necessity for the medication in your health records, which will be essential for insurance purposes.

 

Obtain a Prescription

 

  • Once your healthcare provider determines that Phentermine/Topiramate ER (Qsymia) is suitable for you, obtain a written prescription.
  •  

  • Ensure the prescription specifies the dosage and any other relevant details necessary for the pharmacy and insurance processing.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request to Geisinger Health Plan. This process often involves completing a form that details the medical necessity for the medication.
  •  

  • Include any supporting documentation, such as health records and your provider’s note on the necessity of the medication, with the authorization request.
  • nbsp;

  • Follow up with Geisinger regularly to check on the status of your prior authorization request, as they may require additional information or clarification.

 

Visit a Network Pharmacy

 

  • Once authorization is obtained, fill your prescription at a pharmacy within Geisinger's network to ensure that it is covered under your plan.
  •  

  • Present your insurance card and any authorization documents provided by Geisinger when you fill the prescription.
  • Ask the pharmacist to confirm that the medication is covered under your insurance before finalizing the purchase.

 

Monitor Your Coverage and Costs

 

  • Keep track of any changes to your health plan that may affect your coverage for Phentermine/Topiramate ER (Qsymia).
  •  

  • Review your explanation of benefits (EOB) statements to ensure that the medication is being covered according to the terms of your plan.
  •  

  • If you encounter issues with coverage or costs, contact Geisinger customer service for assistance and clarification.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Geisinger Health Plan Cover Phentermine/Topiramate ER (Qsymia)

Explore Geisinger Health Plan's coverage for Phentermine/Topiramate ER (Qsymia) and learn about costs, reasons for denial, and how to secure approval.
Curex allergy drops unboxing

Is Phentermine/Topiramate ER (Qsymia) Covered by Geisinger Health Plan

 

Geisinger Health Plan Coverage for Qsymia

 

  • Geisinger Health Plan may cover Phentermine/Topiramate ER (Qsymia) as part of its medication management for obesity. This coverage often requires a prescription from a healthcare provider.
  •  

  • Eligibility for coverage typically necessitates that the patient has a BMI of 30 or greater, or 27 with at least one weight-related comorbidity such as hypertension or type 2 diabetes.
  •  

  • Authorization commonly requires documentation showing the patient's previous attempts at weight loss through lifestyle changes and other medications if applicable.
  •  

  • Patients might be required to participate in a weight management program offered or endorsed by Geisinger Health Plan, which can include regular medical consultations.
  •  

  • Coverage terms, including cost-sharing and prior authorization, vary based on specific plan details and state regulations. Patients should consult their plan documents or contact Geisinger directly for precise information.

 

A weight management program tailored to you

Start with Curex

Geisinger Health Plan's Approved Criteria for Phentermine/Topiramate ER (Qsymia) Coverage

 

Criteria for Initial Approval

 

  • Member is 18 years of age or older.
  • Diagnosis of obesity with a body mass index (BMI) of 30 kg/m² or greater, or overweight with a BMI of 27 kg/m² or greater in the presence of at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes, dyslipidemia).
  • Documentation of failure or inability to achieve adequate weight loss through a structured weight reduction program consisting of diet, exercise, and behavioral modifications for at least six months prior to requesting coverage.
  • No history of hypersensitivity to sympathomimetic amines or topiramate.
  • No history of hyperthyroidism or glaucoma.
  • Member is not pregnant or nursing.
  • Willingness to use effective contraception if the member is of childbearing potential.

 

Criteria for Continued Coverage

 

  • Initial approval period goals have been met, including a clinically significant weight reduction as defined by the health plan (typically at least 3% of initial body weight within the first 12 weeks).
  • Member continues to be at risk for weight-related comorbidities as indicated by current health evaluation.
  • Documented ongoing participation in a comprehensive weight management program (including diet, exercise, and behavioral therapy).
  • No significant adverse effects or contraindications have emerged during the treatment.

 

Required Documentation

 

  • Recent medical records displaying BMI calculations from within the past 3 months.
  • Assessment reports from previous weight management program participation.
  • Current medication list to rule out contraindicated drugs.
  • Argument substantiating continued risk of weight-related comorbidities if treatment is ceased.

 

Duration of Authorization

 

  • Initial approval duration: 12 weeks.
  • Subsequent re-authorization: 6 months, contingent upon meeting continued coverage criteria.

 

Why Geisinger Health Plan Might Deny Phentermine/Topiramate ER (Qsymia) Coverage

 

Geisinger Health Plan Denial of Phentermine/Topiramate ER (Qsymia) Coverage

 

  • Phentermine/Topiramate ER (Qsymia) may be denied if not approved through a prior authorization process.
  •  

  • Coverage is not provided for members who do not meet the required Body Mass Index (BMI) criteria for initiation of therapy.
  •  

  • The medication is denied if utilized for purposes other than FDA-approved indications related to weight management.
  •  

  • Geisinger excludes coverage if the member has a history of substance misuse or addiction, considering the potential for misuse.
  •  

  • If the member has not demonstrated unsuccessful weight loss through diet and exercise alone, prior to consideration of pharmacotherapy, coverage may be denied.
  •  

  • No coverage is offered if there are contraindications present with the patient's medical history, such as glaucoma or hyperthyroidism.
  •  

  • Members who are pregnant or planning to become pregnant are excluded from coverage due to potential risks to the fetus.
  •  

  • Medication is not covered if used concurrently with other weight loss products or anorectics, to prevent potential drug interactions or enhanced effects.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Phentermine/Topiramate ER (Qsymia) Cost without Insurance?

 

Cost of Phentermine/Topiramate ER (Qsymia) Without Insurance

 

  • The average retail price for Phentermine/Topiramate ER (Qsymia), a medication typically prescribed for weight loss, ranges from $120 to $240 for a 30-day supply, depending on the pharmacy and location.
  •  

  • Prices may vary slightly due to specific factors such as dosage strength, with differing costs for varying dosages like 3.75 mg/23 mg, 7.5 mg/46 mg, 11.25 mg/69 mg, and 15 mg/92 mg.
  •  

  • Discount programs or pharmacy coupons might offer lower prices, potentially reducing the cost to as low as $100 for a monthly supply. It is advisable for patients to explore these options for financial relief.
  •  

  • Some pharmacies provide price matching, which can be helpful in securing the best available price without insurance.
  •  

  • Patients should check for any available manufacturer's savings programs or patient assistance plans that might further aid in reducing out-of-pocket 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 Phentermine/Topiramate ER (Qsymia) Coverage with Geisinger Health Plan

 

Verify Your Coverage

 

  • Contact Geisinger Health Plan customer service to confirm that your specific plan includes coverage for weight loss medications such as Phentermine/Topiramate ER (Qsymia).
  •  

  • Review the terms of your plan in the documentation provided by Geisinger or available on their member portal to understand your coverage.
  •  

  • Consider consulting with your healthcare provider about whether this medication is necessary for your health condition and appropriate under your current plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the potential benefits and risks of taking Phentermine/Topiramate ER (Qsymia) for weight management.
  •  

  • Ensure your provider documents the medical necessity for the medication in your health records, which will be essential for insurance purposes.

 

Obtain a Prescription

 

  • Once your healthcare provider determines that Phentermine/Topiramate ER (Qsymia) is suitable for you, obtain a written prescription.
  •  

  • Ensure the prescription specifies the dosage and any other relevant details necessary for the pharmacy and insurance processing.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request to Geisinger Health Plan. This process often involves completing a form that details the medical necessity for the medication.
  •  

  • Include any supporting documentation, such as health records and your provider’s note on the necessity of the medication, with the authorization request.
  • nbsp;

  • Follow up with Geisinger regularly to check on the status of your prior authorization request, as they may require additional information or clarification.

 

Visit a Network Pharmacy

 

  • Once authorization is obtained, fill your prescription at a pharmacy within Geisinger's network to ensure that it is covered under your plan.
  •  

  • Present your insurance card and any authorization documents provided by Geisinger when you fill the prescription.
  • Ask the pharmacist to confirm that the medication is covered under your insurance before finalizing the purchase.

 

Monitor Your Coverage and Costs

 

  • Keep track of any changes to your health plan that may affect your coverage for Phentermine/Topiramate ER (Qsymia).
  •  

  • Review your explanation of benefits (EOB) statements to ensure that the medication is being covered according to the terms of your plan.
  •  

  • If you encounter issues with coverage or costs, contact Geisinger customer service for assistance and clarification.

 

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.

Phentermine/Topiramate ER (Qsymia) FAQ

What are the common side effects of Phentermine/Topiramate ER (Qsymia)?

 

Common Side Effects of Qsymia

 

  • **Paraesthesia:** Often described as a tingling sensation, typically in the hands and feet.
  •  

  • **Dizziness and lightheadedness:** These sensations may occur, especially when standing up quickly.
  •  

  • **Dry mouth:** Increased thirst or the feeling of not having enough saliva can be common with Qsymia use.
  •  

  • **Insomnia:** Difficulty falling asleep or staying asleep may be experienced.
  •  

  • **Constipation:** A common digestive side effect, characterized by infrequent bowel movements.
  •  

  • **Taste alteration:** Some users report a change in taste perception or a metallic taste.

How effective is Qsymia for weight loss?

 

Effectiveness of Qsymia

 

  • Qsymia combines phentermine and topiramate ER, proven effective for weight loss by enhancing satiety and reducing appetite.
  •  

  • Clinical trials report an average weight loss of about 5%–10% of initial body weight over a year, higher than diet and exercise alone.
  •  

  • Study results can vary based on individual factors such as diet adherence and lifestyle changes.
  •  

 

Considerations

 

  • Best results occur alongside a reduced-calorie diet and increased physical activity.
  •  

  • Assess for potential side effects, including increased heart rate, mood changes, and birth defects if used during pregnancy.
  •  

  • Long-term efficacy beyond one year is less established, requiring ongoing lifestyle modifications for sustained weight management.

 

Can Qsymia be taken long-term for weight management?

 

Long-term Use of Qsymia

 

  • Qsymia is an obesity medication combining phentermine and topiramate. It's approved for long-term use along with a reduced-calorie diet and increased physical activity.
  •  

  • Potential benefits include sustainable weight loss, improved metabolic health, and reduced risk of obesity-related conditions.

 

Monitoring and Safety

 

  • Regular follow-ups with a healthcare provider are essential to monitor side effects and effectiveness.
  •  

  • Common side effects include numbness, dizziness, taste changes, and insomnia. More severe risks include mood alterations and birth defects.

 

Continuing Treatment

 

  • Periodic assessment is crucial to decide if continued treatment is appropriate based on weight loss progress and side effect profile.
  •  

  • Should significant weight loss not occur within 12 weeks, alternative therapies might be considered.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

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.

Made in Webflow