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Does Highmark Cover Benzphetamine (Didrex)

Explore Highmark's coverage for Benzphetamine, reasons for denial, tips to obtain coverage, costs without insurance, and FAQs in this comprehensive guide.
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Does Highmark Cover Benzphetamine (Didrex)

 

  • Highmark may cover Benzphetamine (Didrex) as a prescription medication for treating obesity by decreasing appetite. Coverage often depends on your specific plan and medical necessity.

    •  

  • Typically, coverage requires a demonstrated unsuccessful attempt at weight loss through diet and exercise alone.

    •  

  • Obtaining coverage might require prior authorization, where your healthcare provider submits documentation justifying the need for Benzphetamine based on your medical condition and history.

    •  

  • It's important to check with Highmark directly or through your healthcare provider to confirm if Benzphetamine is covered under your plan and the specific requirements needed for coverage.

 

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Clinical Support

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 Benzphetamine (Didrex) Coverage with Highmark

 

Contact Highmark Customer Service

 

  • Reach out to Highmark for clarification on their coverage policy for Benzphetamine (Didrex). Their customer service team can assist you with understanding the specifics of your plan.

    •  

  • Use the member services phone number on the back of your insurance card, or access their contact information through the Highmark website.

    •  

  • Ask directly about any prior authorization requirements or documentation needed for Benzphetamine (Didrex) coverage.

 

Review Your Plan Details

 

  • Log in to your Highmark online account to review your specific insurance plan details. This will help you verify if Benzphetamine (Didrex) is included under your prescription drug coverage.

    •  

  • Check for any exclusions related to weight management drugs or similar categories that might affect coverage for Benzphetamine.

 

Consult with Your Healthcare Provider

 

  • Discuss with your physician about the medical necessity of Benzphetamine (Didrex) and obtain a valid prescription.

    •  

  • Make sure your healthcare provider is aware of the insurance process and any potential steps needed, such as providing a letter of medical necessity or filling out specific forms required by Highmark.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization (PA) request if required by Highmark. Many insurance plans need PA for medications like Benzphetamine.

    •  

  • Ensure all necessary information and documentation, including the prescription and any supporting clinical data, are included in the PA request.

 

Follow Up with Highmark

 

  • After submitting the prior authorization, follow up with Highmark to confirm receipt and inquire about the status of your request.

    •  

  • If additional information is needed or if the initial request is denied, ask for guidance on how to proceed or appeal the decision.

 

Use Preferred Pharmacies

 

  • Once approved, filling your prescription at a Highmark network or preferred pharmacy may ensure a smoother process and potentially lower out-of-pocket costs.

    •  

  • Check Highmark's list of in-network pharmacies through their website or customer service for potential savings and convenience.

 

Stay Informed

 

  • Keep records of all communications, submissions, and approvals regarding Benzphetamine to manage your coverage effectively.

    •  

  • Stay updated on Highmark’s policies, as they can change and may affect your coverage for Benzphetamine in the future.

 

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FAQs

Does Highmark Cover Benzphetamine (Didrex)

Explore Highmark's coverage for Benzphetamine, reasons for denial, tips to obtain coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Benzphetamine (Didrex) Covered by Highmark

 

Does Highmark Cover Benzphetamine (Didrex)

 

  • Highmark may cover Benzphetamine (Didrex) as a prescription medication for treating obesity by decreasing appetite. Coverage often depends on your specific plan and medical necessity.

    •  

  • Typically, coverage requires a demonstrated unsuccessful attempt at weight loss through diet and exercise alone.

    •  

  • Obtaining coverage might require prior authorization, where your healthcare provider submits documentation justifying the need for Benzphetamine based on your medical condition and history.

    •  

  • It's important to check with Highmark directly or through your healthcare provider to confirm if Benzphetamine is covered under your plan and the specific requirements needed for coverage.

 

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Start with Curex

Highmark's Approved Criteria for Benzphetamine (Didrex) Coverage

 

Benzphetamine (Didrex) Coverage Criteria by Highmark

 

  • Patient must have a body mass index (BMI) of at least 30 kg/m², indicating clinical obesity, or a BMI of 27 kg/m² or higher with the presence of comorbid conditions such as hypertension, type 2 diabetes, or dyslipidemia that necessitate weight reduction interventions.

    •  

  • There must be documented evidence of unsuccessful weight loss using non-pharmacological interventions, including structured dietary modifications and a comprehensive physical exercise regimen, over a period of at least 6 months.

    •  

  • The prescribing physician should provide a detailed treatment plan that communicates the integration of Benzphetamine with ongoing lifestyle modification efforts designed to achieve and maintain weight loss.

    •  

  • The patient’s medical history should reflect an absence of hypersensitivity to Benzphetamine or any components of Didrex, and there should be no history of misuse or abuse of controlled substances.

    •  

  • The prescriber must ensure that the patient has no contraindicated medical conditions such as severe cardiovascular diseases, uncontrolled hypertension, hyperthyroidism, glaucoma, or is in a state of agitation or intoxication.

    •  

  • Individuals covered should not be pregnant, planning to become pregnant, or breastfeeding. A documented negative pregnancy test is required prior to initiation in women of childbearing potential, along with confirmation of adherence to effective contraception methods during treatment.

 

Why Highmark Might Deny Benzphetamine (Didrex) Coverage

 

Reasons for Denial of Benzphetamine Coverage

 

  • Highmark may deny coverage for Benzphetamine (Didrex) if the request does not meet the required medical necessity criteria, which often involves demonstrating that other weight loss treatments have been ineffective or inappropriate for the patient.

    •  

  • Coverage may be denied if there is a lack of appropriate documentation from the prescribing physician, including an absence of detailed medical history and the rationale for prescribing Benzphetamine.

    •  

  • If Benzphetamine is prescribed for off-label uses that Highmark does not recognize or approve, coverage could be denied.

    •  

  • Highmark may not cover Benzphetamine if it is prescribed in dosages that fall outside the recommended guidelines, as this can raise safety and efficacy concerns.

    •  

  • Cases where the patient has a history of medication abuse or addiction can lead to denial, as Benzphetamine can be habit-forming and may pose a risk for misuse.

    •  

  • Denial may occur if the patient has certain contraindications or medical conditions listed in Highmark's policy guidelines that preclude the safe use of Benzphetamine.

    •  

  • If Benzphetamine is not included in Highmark's formulary list or is considered a non-preferred prescription, coverage might be denied unless prior authorization or an exception is approved.

    •  

  • Claims could be denied due to administrative errors, such as incorrect or incomplete insurance information provided at the time of the coverage request.

 

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How Much Does Benzphetamine (Didrex) Cost without Insurance?

 

Understanding Benzphetamine (Didrex) Cost

 

  • Benzphetamine, commonly known by the brand name Didrex, is a prescription medication used as a short-term adjunct in weight reduction therapy.

    •  

  • The cost of Benzphetamine without insurance can vary significantly depending on the pharmacy and the dosage prescribed.

    •  

  • On average, the cost for a 30-day supply of Benzphetamine (50 mg tablets) can range from $40 to $70.

    •  

  • Prices may be higher or lower, depending on location, pharmacy pricing policies, and available discounts or coupons.

    •  

  • Pharmacy discount programs and generic versions of the drug may offer cost savings.
Clinical Support

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 Benzphetamine (Didrex) Coverage with Highmark

 

Contact Highmark Customer Service

 

  • Reach out to Highmark for clarification on their coverage policy for Benzphetamine (Didrex). Their customer service team can assist you with understanding the specifics of your plan.

    •  

  • Use the member services phone number on the back of your insurance card, or access their contact information through the Highmark website.

    •  

  • Ask directly about any prior authorization requirements or documentation needed for Benzphetamine (Didrex) coverage.

 

Review Your Plan Details

 

  • Log in to your Highmark online account to review your specific insurance plan details. This will help you verify if Benzphetamine (Didrex) is included under your prescription drug coverage.

    •  

  • Check for any exclusions related to weight management drugs or similar categories that might affect coverage for Benzphetamine.

 

Consult with Your Healthcare Provider

 

  • Discuss with your physician about the medical necessity of Benzphetamine (Didrex) and obtain a valid prescription.

    •  

  • Make sure your healthcare provider is aware of the insurance process and any potential steps needed, such as providing a letter of medical necessity or filling out specific forms required by Highmark.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization (PA) request if required by Highmark. Many insurance plans need PA for medications like Benzphetamine.

    •  

  • Ensure all necessary information and documentation, including the prescription and any supporting clinical data, are included in the PA request.

 

Follow Up with Highmark

 

  • After submitting the prior authorization, follow up with Highmark to confirm receipt and inquire about the status of your request.

    •  

  • If additional information is needed or if the initial request is denied, ask for guidance on how to proceed or appeal the decision.

 

Use Preferred Pharmacies

 

  • Once approved, filling your prescription at a Highmark network or preferred pharmacy may ensure a smoother process and potentially lower out-of-pocket costs.

    •  

  • Check Highmark's list of in-network pharmacies through their website or customer service for potential savings and convenience.

 

Stay Informed

 

  • Keep records of all communications, submissions, and approvals regarding Benzphetamine to manage your coverage effectively.

    •  

  • Stay updated on Highmark’s policies, as they can change and may affect your coverage for Benzphetamine in the future.

 

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.

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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.

Benzphetamine (Didrex) FAQ

What are the side effects of Benzphetamine (Didrex)?

 

Common Side Effects

 

  • Insomnia
  • Nervousness
  • Dizziness
  • Dry Mouth
  • Headache
  • Constipation

 

Severe Side Effects

 

  • Increased Blood Pressure
  • Heart Palpitations
  • Seizures
  • Severe Mood Changes
  • Chest Pain
  • Breathing Difficulties

 

Important Considerations

 

  • If you experience severe side effects, seek medical attention immediately.
  • Use cautiously if you have a history of cardiovascular conditions.
  • Avoid usage in individuals with a history of drug abuse.
  • Always follow the prescribed dosage to minimize risks.
  • Inform your doctor of any existing health conditions or medications.

 

How does Benzphetamine help with weight loss?

 

Mechanism of Action

 

  • Benzphetamine is an appetite suppressant. It stimulates the central nervous system, which increases heart rate and blood pressure.
    •  
  • This leads to a reduced appetite and a feeling of fullness, helping individuals to control their caloric intake.

 

Usage Guidelines

 

  • It should be used as part of a comprehensive weight loss plan, including diet, exercise, and behavioral modification.
    •  
  • Typically prescribed for short-term use to jump-start weight loss efforts.

 

Precautions

 

  • Not suitable for individuals with a history of cardiovascular diseases, hyperthyroidism, or glaucoma.
    •  
  • It may cause side effects such as insomnia, dizziness, and dry mouth.

Is Benzphetamine similar to Phentermine?

 

Similarity between Benzphetamine and Phentermine

 

  • Benzphetamine (Didrex) and Phentermine are both stimulant medications primarily used to treat obesity.

    •  

  • They function as appetite suppressants by affecting the central nervous system.

    •  

  • Both are chemically related to amphetamines but are not classified as amphetamines themselves.

 

Differences

 

  • Benzphetamine is a prodrug and metabolizes into amphetamine and methamphetamine, while Phentermine does not convert into amphetamine derivatives.

    •  

  • Phentermine is generally preferred due to a more established safety profile and fewer side effects compared to Benzphetamine.

    •  

  • Phentermine is typically dosed once daily, whereas Benzphetamine might require multiple doses.

Have questions left?

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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.

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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
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Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

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