Does Highmark Cover Diethylpropion (Tenuate)

Explore Highmark coverage for Diethylpropion. Learn reasons for denials, coverage tips, costs without insurance, and FAQ insights in this comprehensive guide.
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Coverage of Diethylpropion (Tenuate)

 

  • Highmark may cover Diethylpropion (Tenuate) as part of its prescription drug benefits for obesity treatment, but coverage specifics like availability and co-pays depend on your plan.
  •  

  • Coverage typically requires a documented diagnosis of obesity and a BMI over a prescribed threshold, usually 27 or 30 with associated risk factors.
  •  

  • Prior authorization may be needed, requiring your healthcare provider to submit documentation of medical necessity and previous weight loss attempts.

 

Criteria for Coverage

 

  • Ensure your healthcare provider documents all efforts and reasons for prescribing Diethylpropion.
  •  

  • Consult your policy specific benefit details or contact Highmark customer support for the most accurate information tailored to your individual plan.
  •  

  • Check if there are any step therapy requirements, where lower-cost alternatives need to be tried first.

 

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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 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 Highmark

 

Check Your Plan Benefits

 

  • Visit Highmark's official website and log into your member account to review your pharmacy benefits.
  •  

  • Contact Highmark customer service via phone or online chat to confirm if Diethylpropion (Tenuate) is covered under your current plan.
  •  

  • Examine your Explanation of Benefits (EOB) documents to determine past coverage and copay amounts for similar medications.

 

Get a Prescription from Your Doctor

 

  • Discuss your condition and need for Diethylpropion (Tenuate) with your healthcare provider to obtain a prescription.
  •  

  • Ensure your doctor is aware of any specific documentation Highmark may require, such as a prior authorization form, to facilitate the approval process.

 

Submit a Prior Authorization Request

 

  • Obtain the necessary forms from Highmark’s website or customer service that are required for medication coverage requests.
  •  

  • Work with your healthcare provider to complete the prior authorization request, providing detailed information on your medical necessity for Diethylpropion (Tenuate).
  •  

  • Submit the completed forms to Highmark via the specified method, such as fax or online submission.

 

Follow Up on Your Request

 

  • Contact Highmark to confirm receipt of your prior authorization request and ask about the expected timeline for a decision.
  •  

  • Monitor your mail and email for any official notifications from Highmark regarding the status of your request.
  •  

  • Prepare to provide additional information if requested by Highmark to support your need for Diethylpropion (Tenuate).

 

Appeal a Denied Request

 

  • If your coverage request is denied, review the denial letter from Highmark to understand the reasons for denial.
  •  

  • Work with your healthcare provider to gather additional supporting evidence that addresses the concerns raised by Highmark.
  •  

  • Submit an appeal to Highmark, including any new documentation, following the instructions provided in the denial letter.

 

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FAQs

Does Highmark Cover Diethylpropion (Tenuate)

Explore Highmark coverage for Diethylpropion. Learn reasons for denials, coverage tips, costs without insurance, and FAQ insights in this comprehensive guide.
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Is Diethylpropion (Tenuate) Covered by Highmark

 

Coverage of Diethylpropion (Tenuate)

 

  • Highmark may cover Diethylpropion (Tenuate) as part of its prescription drug benefits for obesity treatment, but coverage specifics like availability and co-pays depend on your plan.
  •  

  • Coverage typically requires a documented diagnosis of obesity and a BMI over a prescribed threshold, usually 27 or 30 with associated risk factors.
  •  

  • Prior authorization may be needed, requiring your healthcare provider to submit documentation of medical necessity and previous weight loss attempts.

 

Criteria for Coverage

 

  • Ensure your healthcare provider documents all efforts and reasons for prescribing Diethylpropion.
  •  

  • Consult your policy specific benefit details or contact Highmark customer support for the most accurate information tailored to your individual plan.
  •  

  • Check if there are any step therapy requirements, where lower-cost alternatives need to be tried first.

 

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Highmark's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Coverage Criteria for Diethylpropion (Tenuate)

 

  • Patient must have a body mass index (BMI) of 30 kg/m² or greater. Coverage also applies if the patient has a BMI of 27 kg/m² or greater accompanied by at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient should have tried and failed to achieve weight reduction through a structured diet and exercise program for at least 6 months before the request for Diethylpropion.
  •  

  • The prescription for Diethylpropion must be written by a licensed healthcare professional who specializes in or has credentials in weight management or obesity treatment.
  •  

  • Continuity of care should be a focus, with the prescribing healthcare professional monitoring the patient's progress with scheduled follow-up visits at least every three months.
  •  

  • The patient must not have a history of substance abuse, as Diethylpropion has the potential for abuse.
  •  

  • The treatment plan should include a comprehensive approach to weight management, integrating medication along with lifestyle changes in diet and physical activity.
  •  

  • Reauthorization for continued use of Diethylpropion will require documentation showing that the patient has met weight loss objectives or is maintaining weight loss achieved with the aid of the medication.
  •  

 

Why Highmark Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons Highmark Might Deny Diethylpropion (Tenuate) Coverage

 

  • Highmark does not cover Diethylpropion (Tenuate) for patients who do not meet the medical necessity criteria as outlined in their policy guidelines. This includes inadequate documentation of body mass index (BMI).
  •  

  • Coverage is denied if Diethylpropion (Tenuate) is prescribed for weight loss in individuals who do not meet the required threshold of obesity, such as a BMI under what is stipulated by Highmark's policy.
  •  

  • If the patient has a history of cardiovascular disease, Highmark may not cover Diethylpropion (Tenuate) due to the increased risk of adverse cardiovascular events.
  •  

  • Highmark does not cover Diethylpropion (Tenuate) for long-term weight management, as its use is only approved for short-term adjunctive therapy.
  •  

  • The medication will not be covered if there is a lack of documented lifestyle interventions, such as diet or exercise programs, accompanying the prescription.
  •  

  • Diethylpropion (Tenuate) is not covered if used in combination with other weight loss medications or supplements that are not approved by Highmark.
  •  

  • Highmark denies coverage for patients with a history of drug abuse or dependency, considering the potential for diethylpropion abuse.
  •  

  • The medication is not covered if prescribed for conditions other than obesity, such as for cosmetic weight loss purposes or to treat depression.
  •  

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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 Highmark

 

Check Your Plan Benefits

 

  • Visit Highmark's official website and log into your member account to review your pharmacy benefits.
  •  

  • Contact Highmark customer service via phone or online chat to confirm if Diethylpropion (Tenuate) is covered under your current plan.
  •  

  • Examine your Explanation of Benefits (EOB) documents to determine past coverage and copay amounts for similar medications.

 

Get a Prescription from Your Doctor

 

  • Discuss your condition and need for Diethylpropion (Tenuate) with your healthcare provider to obtain a prescription.
  •  

  • Ensure your doctor is aware of any specific documentation Highmark may require, such as a prior authorization form, to facilitate the approval process.

 

Submit a Prior Authorization Request

 

  • Obtain the necessary forms from Highmark’s website or customer service that are required for medication coverage requests.
  •  

  • Work with your healthcare provider to complete the prior authorization request, providing detailed information on your medical necessity for Diethylpropion (Tenuate).
  •  

  • Submit the completed forms to Highmark via the specified method, such as fax or online submission.

 

Follow Up on Your Request

 

  • Contact Highmark to confirm receipt of your prior authorization request and ask about the expected timeline for a decision.
  •  

  • Monitor your mail and email for any official notifications from Highmark regarding the status of your request.
  •  

  • Prepare to provide additional information if requested by Highmark to support your need for Diethylpropion (Tenuate).

 

Appeal a Denied Request

 

  • If your coverage request is denied, review the denial letter from Highmark to understand the reasons for denial.
  •  

  • Work with your healthcare provider to gather additional supporting evidence that addresses the concerns raised by Highmark.
  •  

  • Submit an appeal to Highmark, including any new documentation, following the instructions provided in the denial letter.

 

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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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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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.

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Do your plans include prescriptions and medications?

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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.

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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