Does Harvard Pilgrim Health Care Cover Diethylpropion (Tenuate)

Explore Harvard Pilgrim Health Care's Diethylpropion coverage, costs, and steps to secure it, plus find answers to common questions in this detailed guide.
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Coverage for Diethylpropion (Tenuate)

 

  • Harvard Pilgrim Health Care generally provides coverage for Diethylpropion (Tenuate) when it is deemed medically necessary. This typically involves the medication being prescribed for the treatment of obesity as part of a comprehensive weight loss plan.
  •  

  • Coverage criteria often require documentation of the patient's BMI and evidence of trial and failure of a lifestyle modification program that includes diet and exercise before considering pharmacotherapy.
  •  

  • The prescriber must also confirm that the patient does not have contraindications such as history of cardiovascular disease, hyperthyroidism, or glaucoma.
  •  

  • Pre-authorization may be required to validate the necessity of the medication and to ensure that other weight management therapies have been tried without sufficient success.
  •  

  • Members are encouraged to check their specific policy details and contact customer service for precise coverage information as individual plans may vary.

 

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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.

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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 Diethylpropion (Tenuate) Coverage with Harvard Pilgrim Health Care

 

Check Your Harvard Pilgrim Health Care Plan Details

 

  • Review your current Harvard Pilgrim Health Care plan documents to determine what prescription drugs are covered. Look specifically for the section on weight management or obesity medications.
  •  

  • If you don’t have the documents readily available, log into your online member account on the Harvard Pilgrim Health Care website to access plan coverage details.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Diethylpropion (Tenuate) and to confirm that it is medically necessary for your treatment plan.
  •  

  • Ensure that your provider is aware of the specific criteria and documentation required by Harvard Pilgrim Health Care for coverage of this medication.

 

Request Prior Authorization

 

  • If Diethylpropion requires prior authorization, your healthcare provider will need to submit a prior authorization request on your behalf to Harvard Pilgrim Health Care.
  •  

  • Ensure that your provider includes all necessary documentation, such as medical records and any required test results, to support the authorization request.

 

Follow Up on the Authorization Request

 

  • Contact Harvard Pilgrim Health Care to check the status of your prior authorization request, if you have not received a response within a reasonable time frame (usually 1-2 weeks).
  •  

  • Provide any additional information requested by Harvard Pilgrim Health Care promptly to avoid delays in approval.

 

Appeal a Denied Claim

 

  • If Harvard Pilgrim Health Care denies coverage for Diethylpropion, review the denial letter for specific reasons and details on how to appeal the decision.
  •  

  • Work with your healthcare provider to gather any additional required documentation or explanations to support your appeal.
  •  

  • Submit the appeal within the timeframe specified by Harvard Pilgrim Health Care, and consider reaching out to a customer service representative for guidance on the process.

 

Explore Alternative Coverage Options

 

  • If coverage continues to be denied, discuss alternative medications or weight management treatment options with your healthcare provider that may be covered under your plan.
  •  

  • Consider if other weight-loss medication options or lifestyle interventions could be effective in your treatment plan.

 

Contact Customer Service for Assistance

 

  • If you have questions or need further assistance, contact Harvard Pilgrim Health Care’s customer service department via phone or through your online member portal for guidance tailored to your specific situation.
  •  

  • Request help understanding your plan’s coverage policies and options for obtaining Diethylpropion (Tenuate).

 

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FAQs

Does Harvard Pilgrim Health Care Cover Diethylpropion (Tenuate)

Explore Harvard Pilgrim Health Care's Diethylpropion coverage, costs, and steps to secure it, plus find answers to common questions in this detailed guide.
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Is Diethylpropion (Tenuate) Covered by Harvard Pilgrim Health Care

 

Coverage for Diethylpropion (Tenuate)

 

  • Harvard Pilgrim Health Care generally provides coverage for Diethylpropion (Tenuate) when it is deemed medically necessary. This typically involves the medication being prescribed for the treatment of obesity as part of a comprehensive weight loss plan.
  •  

  • Coverage criteria often require documentation of the patient's BMI and evidence of trial and failure of a lifestyle modification program that includes diet and exercise before considering pharmacotherapy.
  •  

  • The prescriber must also confirm that the patient does not have contraindications such as history of cardiovascular disease, hyperthyroidism, or glaucoma.
  •  

  • Pre-authorization may be required to validate the necessity of the medication and to ensure that other weight management therapies have been tried without sufficient success.
  •  

  • Members are encouraged to check their specific policy details and contact customer service for precise coverage information as individual plans may vary.

 

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Harvard Pilgrim Health Care's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Criteria for Diethylpropion (Tenuate) Coverage

 

  • The patient must have a Body Mass Index (BMI) of 30 kg/m² or higher, or 27 kg/m² with at least one obesity-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • Diethylpropion (Tenuate) is approved when it is part of a comprehensive weight management program including behavioral modification and reduced-calorie diet.
  •  

  • The prescribing physician must document the patient's weight history and previous weight loss efforts, indicating an earnest attempt to lose weight through non-drug methods.
  •  

  • There must be documented evidence that the patient has been counseled regarding the risks and benefits of treatment with Diethylpropion (Tenuate), including potential side effects and the importance of adherence to a comprehensive therapeutic lifestyle change program.
  •  

  • The patient should be 16 years of age or older, as Diethylpropion is not approved for pediatric use under the plan.
  •  

  • There should be no history of cardiovascular disease, such as uncontrolled hypertension or history of heart attack or stroke, as Diethylpropion is contraindicated in these conditions.
  •  

  • Harvard Pilgrim Health Care may require a prescription from a specialist in obesity or endocrinology for initial coverage approval, although follow-up prescriptions can be from the patient's primary care provider.
  •  

  • A re-evaluation may be needed after 12 weeks of therapy to assess the efficacy and safety of ongoing treatment with Diethylpropion, looking for a clinically meaningful weight loss of 5% or more from baseline.

 

Why Harvard Pilgrim Health Care Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Denial of Diethylpropion (Tenuate) Coverage

 

  • Patient does not meet the pre-specified medical criteria for excessive weight or obesity, as set by Harvard Pilgrim Health Care.
  •  

  • The prescription lacks comprehensive medical documentation of a requisite weight-loss program, including diet and exercise, which is considered a prerequisite for coverage.
  •  

  • Prescription is intended for off-label usage that is not recognized under the approval guidelines of Harvard Pilgrim Health Care for Diethylpropion.
  •  

  • Lack of compliance with prior authorization requirements, such as failing to provide necessary documentation and evidence of medical necessity.
  •  

  • Request is for a refill or extension of the medication without showing documented, meaningful weight loss or improvement in health metrics initially targeted.
  •  

  • The patient is taking a dosage or formulation of Diethylpropion that is inconsistent with FDA recommendations and does not align with the plan's coverage policy.
  •  

  • Diethylpropion is prescribed for long-term use beyond the maximum duration of coverage allowed by the health plan.
  •  

  • The patient is concurrently prescribed contraindicated medications or has underlying health conditions that may conflict with the usage of Diethylpropion, deemed unsafe by Harvard Pilgrim Health Care medical guidelines.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Harvard Pilgrim Health Care

 

Check Your Harvard Pilgrim Health Care Plan Details

 

  • Review your current Harvard Pilgrim Health Care plan documents to determine what prescription drugs are covered. Look specifically for the section on weight management or obesity medications.
  •  

  • If you don’t have the documents readily available, log into your online member account on the Harvard Pilgrim Health Care website to access plan coverage details.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Diethylpropion (Tenuate) and to confirm that it is medically necessary for your treatment plan.
  •  

  • Ensure that your provider is aware of the specific criteria and documentation required by Harvard Pilgrim Health Care for coverage of this medication.

 

Request Prior Authorization

 

  • If Diethylpropion requires prior authorization, your healthcare provider will need to submit a prior authorization request on your behalf to Harvard Pilgrim Health Care.
  •  

  • Ensure that your provider includes all necessary documentation, such as medical records and any required test results, to support the authorization request.

 

Follow Up on the Authorization Request

 

  • Contact Harvard Pilgrim Health Care to check the status of your prior authorization request, if you have not received a response within a reasonable time frame (usually 1-2 weeks).
  •  

  • Provide any additional information requested by Harvard Pilgrim Health Care promptly to avoid delays in approval.

 

Appeal a Denied Claim

 

  • If Harvard Pilgrim Health Care denies coverage for Diethylpropion, review the denial letter for specific reasons and details on how to appeal the decision.
  •  

  • Work with your healthcare provider to gather any additional required documentation or explanations to support your appeal.
  •  

  • Submit the appeal within the timeframe specified by Harvard Pilgrim Health Care, and consider reaching out to a customer service representative for guidance on the process.

 

Explore Alternative Coverage Options

 

  • If coverage continues to be denied, discuss alternative medications or weight management treatment options with your healthcare provider that may be covered under your plan.
  •  

  • Consider if other weight-loss medication options or lifestyle interventions could be effective in your treatment plan.

 

Contact Customer Service for Assistance

 

  • If you have questions or need further assistance, contact Harvard Pilgrim Health Care’s customer service department via phone or through your online member portal for guidance tailored to your specific situation.
  •  

  • Request help understanding your plan’s coverage policies and options for obtaining Diethylpropion (Tenuate).

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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.

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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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