Does Harvard Pilgrim Health Care Cover Contrave

Explore if Harvard Pilgrim covers Contrave, reasons for denial, steps for coverage, costs without insurance, and answers to common questions.
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Harvard Pilgrim Health Care Coverage for Contrave

 

  • **Prior Authorization Required**: Members must obtain prior authorization to determine medical necessity for Contrave coverage.
  •  

  • **Prescribing Conditions**: Typically covered for adults with a diagnosis of obesity or overweight with weight-related comorbidities such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Documentation Needed**: Physicians may need to provide clinical documentation showing previous weight management prescriptions or efforts, and the member's current BMI.
  •  

  • **Plan Specifics**: Coverage may vary based on the specific health plan, including copayment levels, deductibles, and preferred pharmacy networks.
  •  

  • **Lifestyle Program Engagement**: Often requires participation in a concurrent lifestyle modification program that includes diet, exercise, and behavioral changes to maintain coverage.

 

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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 Contrave Coverage with Harvard Pilgrim Health Care

 

Check Your Insurance Plan

 

  • Log into your Harvard Pilgrim Health Care member account online or contact their customer service to review your specific insurance plan details.
  •  

  • Confirm whether your plan covers prescription medications and check if Contrave is listed in their formulary.

 

Consult with Your Doctor

 

  • Discuss your weight management needs with your healthcare provider and ask them if Contrave is a suitable option for you.
  •  

  • If prescribed, your doctor should provide the necessary documentation, including a prescription for Contrave.

 

Verify Prescription Coverage

 

  • Contact Harvard Pilgrim Health Care to verify if Contrave is covered under your prescription drug benefits.
  •  

  • Request information on any prior authorization requirements or specific criteria you must meet for coverage.

 

Request Prior Authorization

 

  • If prior authorization is necessary, work with your doctor to submit the required paperwork to Harvard Pilgrim Health Care.
  •  

  • Your doctor may need to provide information on medical necessity and previous failed weight loss attempts.

 

Explore Cost Assistance Programs

 

  • If Contrave isn't fully covered, inquire about any patient assistance programs, discounts, or rebates available through the manufacturer.
  •  

  • Ask Harvard Pilgrim Health Care about any available programs to lower your out-of-pocket costs.

 

Appeal Denials if Necessary

 

  • If you receive a denial for coverage, review the denial letter's reasons and gather additional information to support an appeal.
  •  

  • Submit an appeal through Harvard Pilgrim’s appeals process, including all relevant documentation from your doctor.

 

Monitor Prescription Fill

 

  • Once authorization is approved, contact your pharmacy to ensure they have received the necessary paperwork and that the prescription is ready to fill.
  •  

  • Continue to work with your doctor and insurance if there are any issues at the pharmacy counter.

 

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FAQs

Does Harvard Pilgrim Health Care Cover Contrave

Explore if Harvard Pilgrim covers Contrave, reasons for denial, steps for coverage, costs without insurance, and answers to common questions.
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Is Contrave Covered by Harvard Pilgrim Health Care

 

Harvard Pilgrim Health Care Coverage for Contrave

 

  • **Prior Authorization Required**: Members must obtain prior authorization to determine medical necessity for Contrave coverage.
  •  

  • **Prescribing Conditions**: Typically covered for adults with a diagnosis of obesity or overweight with weight-related comorbidities such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Documentation Needed**: Physicians may need to provide clinical documentation showing previous weight management prescriptions or efforts, and the member's current BMI.
  •  

  • **Plan Specifics**: Coverage may vary based on the specific health plan, including copayment levels, deductibles, and preferred pharmacy networks.
  •  

  • **Lifestyle Program Engagement**: Often requires participation in a concurrent lifestyle modification program that includes diet, exercise, and behavioral changes to maintain coverage.

 

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Harvard Pilgrim Health Care's Approved Criteria for Contrave Coverage

 

Criteria for Contrave Coverage

 

  • Members must have a documented body mass index (BMI) of 30 kg/m2 or greater. For members with a BMI between 27 kg/m2 and 30 kg/m2, there must be an obesity-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • Members should have attempted to lose weight through a comprehensive lifestyle intervention, which may include a reduced-calorie diet, increased physical activity, and behavior modification.
  •  

  • The health care provider must document a comprehensive assessment and diagnosis of obesity as a chronic disease state. This should be supported by a treatment plan aimed specifically at tackling obesity.
  •  

  • Continuation of therapy beyond 12 weeks requires documentation that the member has lost at least 5% of the total body weight from baseline. If this goal is not met, ongoing treatment will not be authorized.
  •  

  • Detailed documentation of member adherence to prescribed therapy, including lifestyle interventions, must be maintained as a condition for ongoing coverage.
  •  

  • Provider must confirm that the medication will be used in conjunction with a reduced-calorie diet and increased physical activity.

 

Why Harvard Pilgrim Health Care Might Deny Contrave Coverage

 

Situations When Harvard Pilgrim Health Care Does Not Cover Contrave

 

  • **Off-Label Use:** Harvard Pilgrim Health Care may deny coverage for Contrave if it is prescribed for any condition other than those officially approved by the FDA. Off-label usage typically does not meet the insurance company's coverage policies.
  •  

  • **Non-Compliance with Required Criteria:** If a patient's medical documentation does not align with Harvard Pilgrim Health Care's specific eligibility criteria for Contrave, the medication may not be covered. This includes failure to meet weight-related thresholds or lack of documented lifestyle intervention efforts.
  •  

  • **Prior Authorization Not Obtained:** If the prescribing physician does not obtain the required prior authorization before prescribing Contrave, coverage may be denied. Prior authorization ensures that the medication is medically necessary and adheres to the insurance provider's standards.
  •  

  • **Lack of Documented Weight Management Program:** Harvard Pilgrim Health Care might require participation in a structured weight management program to qualify for Contrave coverage. Without documented evidence of such participation, the claim may be rejected.
  •  

  • **Exceeding Established Dose Limits:** The insurance plan may have specified dosage limitations for coverage. If prescribed dosages exceed these limits, Harvard Pilgrim Health Care may deny the claim for Contrave.

 

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

How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with Harvard Pilgrim Health Care

 

Check Your Insurance Plan

 

  • Log into your Harvard Pilgrim Health Care member account online or contact their customer service to review your specific insurance plan details.
  •  

  • Confirm whether your plan covers prescription medications and check if Contrave is listed in their formulary.

 

Consult with Your Doctor

 

  • Discuss your weight management needs with your healthcare provider and ask them if Contrave is a suitable option for you.
  •  

  • If prescribed, your doctor should provide the necessary documentation, including a prescription for Contrave.

 

Verify Prescription Coverage

 

  • Contact Harvard Pilgrim Health Care to verify if Contrave is covered under your prescription drug benefits.
  •  

  • Request information on any prior authorization requirements or specific criteria you must meet for coverage.

 

Request Prior Authorization

 

  • If prior authorization is necessary, work with your doctor to submit the required paperwork to Harvard Pilgrim Health Care.
  •  

  • Your doctor may need to provide information on medical necessity and previous failed weight loss attempts.

 

Explore Cost Assistance Programs

 

  • If Contrave isn't fully covered, inquire about any patient assistance programs, discounts, or rebates available through the manufacturer.
  •  

  • Ask Harvard Pilgrim Health Care about any available programs to lower your out-of-pocket costs.

 

Appeal Denials if Necessary

 

  • If you receive a denial for coverage, review the denial letter's reasons and gather additional information to support an appeal.
  •  

  • Submit an appeal through Harvard Pilgrim’s appeals process, including all relevant documentation from your doctor.

 

Monitor Prescription Fill

 

  • Once authorization is approved, contact your pharmacy to ensure they have received the necessary paperwork and that the prescription is ready to fill.
  •  

  • Continue to work with your doctor and insurance if there are any issues at the pharmacy counter.

 

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Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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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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