Does Group Health Cooperative (GHC) Cover Saxenda

Explore GHC's coverage of Saxenda, learn why it might be denied, how to secure approval, costs without insurance, and answers to common Saxenda questions.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Saxenda by Group Health Cooperative (GHC)

 

  • Group Health Cooperative's (GHC) coverage for Saxenda, a weight management medication, typically depends on the specific health plan and policy rules. Not all plans may include coverage for this medication.
  •  

  • Coverage criteria generally require a prescription from a healthcare provider, detailing a medical necessity for treatment with Saxenda. This usually involves conditions like obesity or weight-related health issues.
  •  

  • Patients may need to demonstrate that previous weight loss interventions were ineffective before Saxenda can be approved.
  •  

  • Some plans might necessitate prior authorization, meaning the provider must justify the need for Saxenda to GHC before a prescription can be covered.
  •  

  • Co-payments or deductibles might apply, and members should check with GHC or their benefit handbook for specifics on their individual plan's coverage and out-of-pocket costs related to Saxenda.

 

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 Saxenda Coverage with Group Health Cooperative (GHC)

 

Check Your Insurance Plan Details

 

  • Review your Group Health Cooperative (GHC) insurance policy to determine if it includes prescription drug coverage, specifically for weight management medications like Saxenda.
  • Look for any specific terms regarding weight loss drugs or related treatments.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Saxenda and whether it is a suitable option for your weight management goals.
  • Request your healthcare provider to write a detailed prescription along with a justification for Saxenda, as insurance companies often require this documentation for prior approval.

 

Contact GHC Member Services

 

  • Call the GHC Member Services number found on your insurance card to ask about coverage for Saxenda.
  • Inquire if Saxenda is on their formulary list and if any prior authorization or additional documentation is required to obtain coverage.

 

Request Prior Authorization

 

  • Work with your doctor to complete any necessary prior authorization forms. This often involves providing medical records and documentation supporting the need for Saxenda.
  • Submit the prior authorization forms to GHC for review.

 

Follow Up on Prior Authorization

 

  • Contact GHC after submission to ensure they received your prior authorization request and to ask about the expected timeline for approval.
  • If necessary, follow up with your healthcare provider to supply any additional information requested by the insurance company.

 

Appeal if Coverage is Denied

 

  • If your request for Saxenda coverage is denied, review the denial letter for specific reasons and any appeal instructions.
  • Collaborate with your doctor to gather additional supporting information to strengthen your appeal.
  • Submit your appeal in accordance with the instructions provided by GHC, and follow up on its status regularly.

 

Consider Alternative Options if Necessary

 

  • If you are unable to secure insurance coverage for Saxenda, discuss alternative weight management medications or strategies with your healthcare provider.
  • Explore patient assistance programs offered by the manufacturer, which may provide Saxenda at a reduced cost or for free based on eligibility.

 

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 Saxenda

Explore GHC's coverage of Saxenda, learn why it might be denied, how to secure approval, costs without insurance, and answers to common Saxenda questions.
Curex allergy drops unboxing

Is Saxenda Covered by Group Health Cooperative (GHC)

 

Coverage for Saxenda by Group Health Cooperative (GHC)

 

  • Group Health Cooperative's (GHC) coverage for Saxenda, a weight management medication, typically depends on the specific health plan and policy rules. Not all plans may include coverage for this medication.
  •  

  • Coverage criteria generally require a prescription from a healthcare provider, detailing a medical necessity for treatment with Saxenda. This usually involves conditions like obesity or weight-related health issues.
  •  

  • Patients may need to demonstrate that previous weight loss interventions were ineffective before Saxenda can be approved.
  •  

  • Some plans might necessitate prior authorization, meaning the provider must justify the need for Saxenda to GHC before a prescription can be covered.
  •  

  • Co-payments or deductibles might apply, and members should check with GHC or their benefit handbook for specifics on their individual plan's coverage and out-of-pocket costs related to Saxenda.

 

A weight management program tailored to you

Start with Curex

Group Health Cooperative (GHC)'s Approved Criteria for Saxenda Coverage

 

Criteria for Saxenda Coverage under Group Health Cooperative (GHC)

 

  • Medical Necessity: Saxenda insurance coverage requires documentation from a healthcare provider indicating that Saxenda is medically necessary for the patient based on their health condition or diagnosis.
  •  

  • Body Mass Index (BMI): The patient must have a documented BMI of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • Previous Weight Management Attempts: The patient must provide evidence of prior attempts to manage weight through lifestyle intervention, including diet and exercise, that did not result in a significant or sustained improvement in weight.
  •  

  • Comprehensive Weight Management Plan: The patient should be enrolled in a comprehensive weight management program that includes lifestyle interventions such as dietary modifications, physical activity, and behavioral therapy alongside Saxenda usage.
  •  

  • Age Criteria: Saxenda coverage usually applies to adult patients 18 years and older. Ensure documentation supports that the patient meets the age requirement.
  •  

  • Approval from Treating Physician: A treating physician must recommend Saxenda as an appropriate part of the patient's weight loss program, supporting this with clinical rationale.
  •  

  • Consistent Monitoring: Patients must agree to regular follow-up visits to assess progress, evaluate Saxenda efficacy, and monitor for any potential adverse reactions.

 

Renewal of Coverage

 

  • Demonstrated Weight Loss: Continued coverage requires documentation of clinically significant weight loss or other health benefit within the initial treatment period.
  •  

  • Compliance with Treatment Plan: Patients should demonstrate adherence to their comprehensive weight management plan, including Saxenda therapy and other lifestyle modifications, as part of renewal criteria.

 

Why Group Health Cooperative (GHC) Might Deny Saxenda Coverage

 

Reasons for GHC Denial of Saxenda Coverage

 

  • The individual does not meet the defined body mass index (BMI) criteria required for Saxenda coverage. Usually, a specific BMI threshold is mandated for consideration.
  •  

  • Saxenda is requested for off-label use, which is not approved by GHC. Coverage is typically restricted to FDA-approved indications only.
  •  

  • There is a lack of sufficient documentation or evidence to demonstrate that previous weight loss attempts, such as lifestyle changes or other weight loss medications, were unsuccessful.
  •  

  • The medication is deemed not medically necessary based on the individual's specific health conditions or risk factors as assessed by GHC.
  •  

  • An alternative, more cost-effective treatment option is available and equally suitable, as determined by GHC's clinical guidelines.
  •  

  • Requests for Saxenda do not comply with GHC's established prior authorization process. Failure to complete necessary paperwork or submit detailed medical records can result in denial.
  •  

  • The individual has a history of non-compliance with prescribed treatments which may impact the effectiveness of Saxenda.
  •  

 

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

How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize 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 Saxenda Coverage with Group Health Cooperative (GHC)

 

Check Your Insurance Plan Details

 

  • Review your Group Health Cooperative (GHC) insurance policy to determine if it includes prescription drug coverage, specifically for weight management medications like Saxenda.
  • Look for any specific terms regarding weight loss drugs or related treatments.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Saxenda and whether it is a suitable option for your weight management goals.
  • Request your healthcare provider to write a detailed prescription along with a justification for Saxenda, as insurance companies often require this documentation for prior approval.

 

Contact GHC Member Services

 

  • Call the GHC Member Services number found on your insurance card to ask about coverage for Saxenda.
  • Inquire if Saxenda is on their formulary list and if any prior authorization or additional documentation is required to obtain coverage.

 

Request Prior Authorization

 

  • Work with your doctor to complete any necessary prior authorization forms. This often involves providing medical records and documentation supporting the need for Saxenda.
  • Submit the prior authorization forms to GHC for review.

 

Follow Up on Prior Authorization

 

  • Contact GHC after submission to ensure they received your prior authorization request and to ask about the expected timeline for approval.
  • If necessary, follow up with your healthcare provider to supply any additional information requested by the insurance company.

 

Appeal if Coverage is Denied

 

  • If your request for Saxenda coverage is denied, review the denial letter for specific reasons and any appeal instructions.
  • Collaborate with your doctor to gather additional supporting information to strengthen your appeal.
  • Submit your appeal in accordance with the instructions provided by GHC, and follow up on its status regularly.

 

Consider Alternative Options if Necessary

 

  • If you are unable to secure insurance coverage for Saxenda, discuss alternative weight management medications or strategies with your healthcare provider.
  • Explore patient assistance programs offered by the manufacturer, which may provide Saxenda at a reduced cost or for free based on eligibility.

 

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.

Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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