Does Group Health Cooperative (GHC) Cover Phentermine (Adipex-P, Lomaira)

Explore GHC's coverage for Phentermine, reasons for denial, ways to secure coverage, costs without insurance, and get answers to common questions.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage of Phentermine

 

  • Group Health Cooperative (GHC) may cover Phentermine (Adipex-P, Lomaira) under certain circumstances, primarily as part of an obesity treatment plan.
  •  

  • Coverage often requires documented proof of obesity-related health issues or comorbid conditions, like hypertension or diabetes, that necessitate weight loss interventions.

 

Criteria for Approval

 

  • Patients typically need to demonstrate that other weight loss efforts such as lifestyle modifications or behavioral therapy have been tried without success.
  •  

  • A healthcare provider must evaluate and prescribe Phentermine, ensuring it’s part of a comprehensive weight management program.
  •  

  • The medication might only be approved for short-term use, aligning with FDA guidelines.

 

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 (Adipex-P, Lomaira) Coverage with Group Health Cooperative (GHC)

 

Determine Prescription Requirements

 

  • Discuss your weight management goals with your healthcare provider to see if Phentermine (Adipex-P, Lomaira) is an appropriate option for you.
  • <li>Ensure your healthcare provider is aware of your health history and any other medications you are taking.</li>
    
    <li>Your provider will need to write a prescription for Phentermine if it's deemed suitable for your condition.</li>
    

 

Check Group Health Cooperative (GHC) Coverage

 

  • Contact GHC customer service to inquire about the coverage of Phentermine under your current health plan.
  • <li>Ask for any specific requirements or criteria needed for Phentermine coverage, such as prior authorization.</li>
    
    <li>Review your pharmacy benefits documentation to confirm if Phentermine is included or excluded from your medication formulary.</li>
    

 

Submit Prior Authorization Request

 

  • If prior authorization is required, work with your healthcare provider to complete the necessary forms.
  • <li>Provide any additional documentation or information as requested by GHC to support the need for Phentermine.</li>
    
    <li>Submit the completed prior authorization request to GHC for review.</li>
    

 

Wait for Approval

 

  • Allow time for GHC to review and process the prior authorization request.
  • <li>Contact GHC periodically to check the status of your request.</li>
    
    <li>Once approved, confirm with your pharmacy that they have received authorization to dispense Phentermine.</li>
    

 

Appeal if Necessary

 

  • If your prior authorization is denied, work with your healthcare provider to understand the reasons for denial.
  • <li>Submit an appeal to GHC, providing any additional information or documentation needed to support your case.</li>
    
    <li>Follow up regularly to track the status of your appeal.</li>
    

 

Fill Your Prescription

 

  • Once coverage is approved, take your prescription to a participating pharmacy affiliated with GHC.
  • <li>Verify that the pharmacy processes your insurance correctly to apply any available coverage benefits to your purchase.</li>
    
    <li>Discuss any copayments or out-of-pocket expenses with the pharmacy before filling your prescription.</li>
    

 

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 Group Health Cooperative (GHC) Cover Phentermine (Adipex-P, Lomaira)

Explore GHC's coverage for Phentermine, reasons for denial, ways to secure coverage, costs without insurance, and get answers to common questions.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Group Health Cooperative (GHC)

 

Coverage of Phentermine

 

  • Group Health Cooperative (GHC) may cover Phentermine (Adipex-P, Lomaira) under certain circumstances, primarily as part of an obesity treatment plan.
  •  

  • Coverage often requires documented proof of obesity-related health issues or comorbid conditions, like hypertension or diabetes, that necessitate weight loss interventions.

 

Criteria for Approval

 

  • Patients typically need to demonstrate that other weight loss efforts such as lifestyle modifications or behavioral therapy have been tried without success.
  •  

  • A healthcare provider must evaluate and prescribe Phentermine, ensuring it’s part of a comprehensive weight management program.
  •  

  • The medication might only be approved for short-term use, aligning with FDA guidelines.

 

A weight management program tailored to you

Start with Curex

Group Health Cooperative (GHC)'s Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Criteria for Phentermine Coverage

 

  • Individuals must have a diagnosis of obesity, characterized by a body mass index (BMI) of 30 kg/m² or higher.
  •  

  • Alternatively, if patients have a BMI of 27 kg/m² or greater, they may be eligible if they have comorbid conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • A comprehensive evaluation by a healthcare provider is required to determine the patient's need for pharmacological intervention alongside lifestyle modifications for weight management.

 

Treatment Plan Requirements

 

  • Patients must be actively participating in a weight management program that includes dietary, exercise, and behavioral components.
  •  

  • The treatment plan should be individualized and documented by a healthcare professional, outlining the expected outcomes and monitoring plans.

 

Monitoring and Follow-up

 

  • Ongoing weight reduction goals must be set and progress should be monitored regularly by the prescribing healthcare provider.
  •  

  • The effectiveness of the treatment should be reassessed at frequent intervals, and adjustments to the treatment plan should be made as necessary.

 

Duration and Authorization of Coverage

 

  • Initial coverage is typically approved for a limited duration, such as 12 weeks, with the possibility of renewal based on demonstrated therapeutic benefit and patient adherence to the treatment plan.
  •  

  • Continued coverage approval may require documentation showing significant weight loss progress and health improvement.

 

Why Group Health Cooperative (GHC) Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Situations Where GHC Does Not Cover Phentermine

 

  • **Non-FDA-Approved Uses:** GHC does not cover Phentermine for any uses that are not approved by the FDA. This includes any off-label uses.
  •  

  • **Cosmetic Weight Loss:** The medication will not be covered for individuals seeking weight loss purely for cosmetic purposes without a documented medical necessity.
  •  

  • **Lack of Medical Documentation:** Insurance coverage will be denied if there is insufficient medical documentation supporting the need for Phentermine as part of a weight management plan.
  •  

  • **Non-Compliance with Lifestyle Changes:** If there is evidence that the patient is not adhering to recommended lifestyle changes such as diet and exercise, GHC may deny coverage for Phentermine.
  •  

  • **Inadequate Involvement of a Healthcare Provider:** GHC requires that the prescription of Phentermine involves a healthcare provider specializing in weight management. Prescriptions issued without proper provider involvement can be denied.
  •  

  • **No Presence of Underlying Conditions:** Patients without conditions such as hypertension, diabetes, or other comorbidities that complicate obesity may not receive coverage.
  •  

  • **Short-Term Use Beyond Limits:** If the prescription is intended for long-term use or exceeds the recommended short-term duration of treatment, GHC may not cover it.
  •  

  • **Duplicate Therapy:** Coverage may be denied if the patient is already on another medication for obesity management unless a switch is medically necessary and adequately justified.
  •  

  • **Age Restrictions:** Phentermine may not be covered for individuals outside of the specified age range, typically for those under the age of 16 or over a certain age without medical justification.

 

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

How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 (Adipex-P, Lomaira) Coverage with Group Health Cooperative (GHC)

 

Determine Prescription Requirements

 

  • Discuss your weight management goals with your healthcare provider to see if Phentermine (Adipex-P, Lomaira) is an appropriate option for you.
  • <li>Ensure your healthcare provider is aware of your health history and any other medications you are taking.</li>
    
    <li>Your provider will need to write a prescription for Phentermine if it's deemed suitable for your condition.</li>
    

 

Check Group Health Cooperative (GHC) Coverage

 

  • Contact GHC customer service to inquire about the coverage of Phentermine under your current health plan.
  • <li>Ask for any specific requirements or criteria needed for Phentermine coverage, such as prior authorization.</li>
    
    <li>Review your pharmacy benefits documentation to confirm if Phentermine is included or excluded from your medication formulary.</li>
    

 

Submit Prior Authorization Request

 

  • If prior authorization is required, work with your healthcare provider to complete the necessary forms.
  • <li>Provide any additional documentation or information as requested by GHC to support the need for Phentermine.</li>
    
    <li>Submit the completed prior authorization request to GHC for review.</li>
    

 

Wait for Approval

 

  • Allow time for GHC to review and process the prior authorization request.
  • <li>Contact GHC periodically to check the status of your request.</li>
    
    <li>Once approved, confirm with your pharmacy that they have received authorization to dispense Phentermine.</li>
    

 

Appeal if Necessary

 

  • If your prior authorization is denied, work with your healthcare provider to understand the reasons for denial.
  • <li>Submit an appeal to GHC, providing any additional information or documentation needed to support your case.</li>
    
    <li>Follow up regularly to track the status of your appeal.</li>
    

 

Fill Your Prescription

 

  • Once coverage is approved, take your prescription to a participating pharmacy affiliated with GHC.
  • <li>Verify that the pharmacy processes your insurance correctly to apply any available coverage benefits to your purchase.</li>
    
    <li>Discuss any copayments or out-of-pocket expenses with the pharmacy before filling your prescription.</li>
    

 

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 (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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