Does Harvard Pilgrim Health Care Cover Prozac

Explore Prozac coverage under Harvard Pilgrim. Learn why you might be denied, how to secure coverage, and costs without insurance. FAQ included.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Prozac

 

  • Harvard Pilgrim Health Care typically includes coverage for Prozac, a medication used for treating depression and other mental health conditions, under its prescription drug plans.
  •  

  • Coverage is subject to plan specifics, and enrollees should refer to their individual plan documents for details.

 

Criteria for Coverage

 

  • A prescription from a licensed healthcare provider is required.
  • Prozac must be deemed medically necessary by the prescribing provider.
  • Depending on the plan, prior authorization may be necessary, especially for off-label uses or if alternative treatments have not been tried.

 

Basic Rules

 

  • Copayments or coinsurance may apply, and these will vary based on the specific prescription drug plan.
  • There might be quantity limits, which could restrict the amount you can receive in one prescription fill.
  • Enrollees should verify whether Prozac is on the preferred drug list, which can affect out-of-pocket costs.

 

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 Prozac Coverage with Harvard Pilgrim Health Care

 

Begin with Harvard Pilgrim Health Care Enrollment

 

  • Verify that you have an active plan with Harvard Pilgrim Health Care, as having an active plan is essential for any prescription coverage.
  • Review your policy documents or log into your Harvard Pilgrim member account to ensure your specific plan covers prescription medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Prozac. Your physician will evaluate whether Prozac is the appropriate medication for your condition.
  • If Prozac is prescribed, ensure that your healthcare provider provides a precise prescription with the correct dosage and quantity for insurance filing.

 

Check Drug Formulary

 

  • Visit the Harvard Pilgrim Health Care website to access the drug formulary list. This list identifies which medications are covered and under what terms.
  • Use the search function to confirm if Prozac is included in the formulary and understand any specific requirements, like dosage limitations or prior authorization needs.

 

Understand the Tier and Co-Pay Information

 

  • Refer to your plan details to determine what tier Prozac falls under, as different tiers may have varying co-pay amounts.
  • Take note of your specific co-pay for Prozac if it is under a tier with an associated cost. This will help you understand your out-of-pocket expenses.

 

Check for Prior Authorization Requirements

 

  • Determine if Prozac requires prior authorization as part of your plan coverage. The formulary list or your plan details should indicate if this is necessary.
  • If needed, have your healthcare provider submit the necessary paperwork for prior authorization to Harvard Pilgrim Health Care.

 

Fill Your Prescription at a Network Pharmacy

 

  • Locate a pharmacy within the Harvard Pilgrim Health Care network. Using a network pharmacy often reduces out-of-pocket costs for medications.
  • Present your insurance card and Prozac prescription at the pharmacy. Ensure that the network pharmacy receives all necessary insurance information to process the claim accurately.

 

Contact Harvard Pilgrim Customer Service if Issues Arise

 

  • If you encounter any issues obtaining coverage for Prozac, contact Harvard Pilgrim Health Care customer service for assistance.
  • Have your membership details, the prescription information, and any prior authorization details on hand when you call to facilitate a smooth resolution.

 

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 Harvard Pilgrim Health Care Cover Prozac

Explore Prozac coverage under Harvard Pilgrim. Learn why you might be denied, how to secure coverage, and costs without insurance. FAQ included.
Curex allergy drops unboxing

Is Prozac Covered by Harvard Pilgrim Health Care

 

Coverage for Prozac

 

  • Harvard Pilgrim Health Care typically includes coverage for Prozac, a medication used for treating depression and other mental health conditions, under its prescription drug plans.
  •  

  • Coverage is subject to plan specifics, and enrollees should refer to their individual plan documents for details.

 

Criteria for Coverage

 

  • A prescription from a licensed healthcare provider is required.
  • Prozac must be deemed medically necessary by the prescribing provider.
  • Depending on the plan, prior authorization may be necessary, especially for off-label uses or if alternative treatments have not been tried.

 

Basic Rules

 

  • Copayments or coinsurance may apply, and these will vary based on the specific prescription drug plan.
  • There might be quantity limits, which could restrict the amount you can receive in one prescription fill.
  • Enrollees should verify whether Prozac is on the preferred drug list, which can affect out-of-pocket costs.

 

A weight management program tailored to you

Start with Curex

Harvard Pilgrim Health Care's Approved Criteria for Prozac Coverage

 

Criteria for Prozac Coverage by Harvard Pilgrim Health Care

 

  • Prozac is covered for the treatment of major depressive disorder (MDD) when the diagnosis is confirmed by a licensed healthcare provider and documented in the patient's medical records.
  •  

  • Coverage is available for the treatment of obsessive-compulsive disorder (OCD) when there is evidence of behavioral interventions or prior medication trials that justify the need for Prozac.
  •  

  • Harvard Pilgrim Health Care covers Prozac for panic disorder, including panic attacks, when prescribed by a psychiatrist or a qualified mental health specialist.
  •  

  • Prozac is approved for treating bulimia nervosa with clear documentation of an official diagnosis based on the DSM-5 criteria and when previous treatment options have been insufficient.
  •  

  • Certain anxiety disorders may qualify for Prozac coverage if other first-line treatments have failed or the patient exhibits severe symptoms adverse to daily functioning.
  •  

  • Pediatric patients with an official diagnosis of major depressive disorder or obsessive-compulsive disorder are eligible for Prozac coverage when prescribed by a pediatric psychiatrist.
  •  

  • Long-term coverage for Prozac is available upon periodic review and documented evidence of ongoing benefit and management of adverse effects, as part of a comprehensive treatment plan.

 

Documentation and Prescription Requirements

 

  • The prescriber must provide adequate documentation including initial diagnosis, treatment plan, and rationale for prescribing Prozac over alternative therapies.
  •  

  • A valid prescription from a licensed healthcare provider with appropriate credentials to treat psychiatric disorders is required for coverage eligibility.
  •  

  • Ongoing coverage requires collaborative care plans with regular follow-up assessments to monitor patient progress and adjust treatment as necessary.

 

Patient Eligibility and Treatment Criteria

 

  • Patients must demonstrate a documented history of either primary or co-morbid mental health conditions warranting Prozac therapy.
  •  

  • Evidence of previous unsuccessful therapeutic interventions or the presence of severe symptoms that compromise patient safety or functioning.
  •  

  • For continuation of therapy, evidence of positive response or maintenance of symptom control with Prozac must be documented.

 

Why Harvard Pilgrim Health Care Might Deny Prozac Coverage

 

Criteria for Denying Prozac Coverage by Harvard Pilgrim Health Care

 

  • Prozac is being prescribed off-label for a use that is not approved by the FDA and not supported by reputable clinical evidence.
  •  

  • The patient does not meet the specific diagnostic criteria or medical necessity requirements established by Harvard Pilgrim Health Care for Prozac.
  •  

  • There is a lack of prior authorization if required by the specific health plan, meaning that the necessary approval process was not completed before prescribing Prozac.
  •  

  • A generic alternative is considered equally effective and less expensive, and the patient has not tried or failed treatment with this alternative unless there is a documented medical reason.
  •  

  • Prozac is being prescribed at a dosage that exceeds the maximum recommended level according to established guidelines without proper justification.
  •  

  • The plan prohibits coverage for medications prescribed by healthcare providers outside of the approved network, and no exception process has been undertaken.

 

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

How Much Does Prozac Cost without Insurance?

 

Approximate Cost of Prozac Without Insurance

 

  • The cost of Prozac (fluoxetine), a medication commonly used to treat depression and anxiety disorders, can vary based on the dosage, quantity, and location.
  •  

  • For a 30-day supply of generic fluoxetine, the average cost can range from $4 to $20 for the commonly prescribed dosages like 10mg, 20mg, or 40mg.
  •  

  • The branded version, Prozac, can be more expensive, with prices ranging from $120 to $150 or more without insurance for a similar 30-day supply.
  •  

  • Prices may vary between different pharmacies, and discount programs or pharmacy membership plans can potentially reduce the out-of-pocket 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 Prozac Coverage with Harvard Pilgrim Health Care

 

Begin with Harvard Pilgrim Health Care Enrollment

 

  • Verify that you have an active plan with Harvard Pilgrim Health Care, as having an active plan is essential for any prescription coverage.
  • Review your policy documents or log into your Harvard Pilgrim member account to ensure your specific plan covers prescription medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Prozac. Your physician will evaluate whether Prozac is the appropriate medication for your condition.
  • If Prozac is prescribed, ensure that your healthcare provider provides a precise prescription with the correct dosage and quantity for insurance filing.

 

Check Drug Formulary

 

  • Visit the Harvard Pilgrim Health Care website to access the drug formulary list. This list identifies which medications are covered and under what terms.
  • Use the search function to confirm if Prozac is included in the formulary and understand any specific requirements, like dosage limitations or prior authorization needs.

 

Understand the Tier and Co-Pay Information

 

  • Refer to your plan details to determine what tier Prozac falls under, as different tiers may have varying co-pay amounts.
  • Take note of your specific co-pay for Prozac if it is under a tier with an associated cost. This will help you understand your out-of-pocket expenses.

 

Check for Prior Authorization Requirements

 

  • Determine if Prozac requires prior authorization as part of your plan coverage. The formulary list or your plan details should indicate if this is necessary.
  • If needed, have your healthcare provider submit the necessary paperwork for prior authorization to Harvard Pilgrim Health Care.

 

Fill Your Prescription at a Network Pharmacy

 

  • Locate a pharmacy within the Harvard Pilgrim Health Care network. Using a network pharmacy often reduces out-of-pocket costs for medications.
  • Present your insurance card and Prozac prescription at the pharmacy. Ensure that the network pharmacy receives all necessary insurance information to process the claim accurately.

 

Contact Harvard Pilgrim Customer Service if Issues Arise

 

  • If you encounter any issues obtaining coverage for Prozac, contact Harvard Pilgrim Health Care customer service for assistance.
  • Have your membership details, the prescription information, and any prior authorization details on hand when you call to facilitate a smooth resolution.

 

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.

Prozac FAQ

1. What are the common side effects of Prozac?

 

Common Side Effects of Prozac

 

  • Nausea: Often occurs during initial treatment or after dose increases.
  •  

  • Headache: Can vary in intensity and duration among users.
  •  

  • Sleep disturbances: Includes insomnia or unusual dreams.
  •  

  • Sexual dysfunction: Includes decreased libido, delayed ejaculation, or orgasmic issues.
  •  

  • Dry mouth: May lead to increased thirst or discomfort.
  •  

  • Drowsiness: Some users experience fatigue or lethargy.
  •  

  • Anxiety: Agitation or nervousness may occur, especially early in treatment.
  •  

  • Diarrhea: Varying consistency and frequency may be noted.

2. How long does it take for Prozac to start working?

 

How Prozac Works

 

  • Prozac, an SSRI, increases serotonin levels in the brain by inhibiting reuptake. Improved serotonin availability helps stabilize mood.

 

Onset of Effects

 

  • Initial physical effects, such as improved energy, may be noted within 1-2 weeks.
  •  

  • Significant mood improvement typically requires 4-6 weeks, varying between individuals.

 

Factors Influencing Efficacy

 

  • Dosage and individual metabolism play crucial roles in response time.
  •  

  • Concurrent medication and underlying health conditions can influence onset and effectiveness.
  •  

  • Adherence to prescribed dosing schedule is essential for optimal results.

3. Can Prozac cause weight gain or loss?

 

Prozac and Weight Changes

 

  • **Weight Gain**: Some users may experience weight gain. This can be due to changes in metabolism, increased appetite, or changes in energy levels. It's important to monitor your weight and discuss changes with your doctor.
  •  

  • **Weight Loss**: Others might experience weight loss, possibly due to decreased appetite or improved mood leading to more physical activity. Again, tracking weight changes and discussing them with your healthcare provider is essential.
  •  

  • **Individual Response**: Weight changes are often individual. Some people might not experience any change. Knowing your body’s response and maintaining a balanced diet and exercise routine is crucial.

 

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