Does Highmark Cover Naltrexone/Bupropion (Contrave)

Discover if Highmark covers Naltrexone/Bupropion (Contrave). Learn why coverage might be denied, how to get approval, and costs without insurance.
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Highmark Coverage for Naltrexone/Bupropion (Contrave)

 

  • Highmark may cover Naltrexone/Bupropion (Contrave) under certain conditions, primarily related to weight management.
  •  

  • Candidates typically need a diagnosis of obesity (BMI ≥30) or overweight status (BMI ≥27) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Coverage often requires demonstrated lifestyle changes (e.g., diet and exercise) that have not resulted in significant weight loss.
  •  

  • Pre-authorization from Highmark is usually needed to determine medical necessity and coverage eligibility.

 

Steps to Obtain Coverage

 

  • Consult your healthcare provider to assess eligibility based on medical history and current health status.
  •  

  • Submit a pre-authorization request to Highmark, including medical documentation and a prescription from your doctor.
  •  

  • Check with Highmark directly to verify specific plan coverage, as coverage can vary by plan and location.

 

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Naltrexone/Bupropion (Contrave) Coverage with Highmark

 

Contact Highmark Customer Service

 

  • Begin by calling the Highmark customer service number located on the back of your insurance card to clarify coverage details for Naltrexone/Bupropion (Contrave).
  •  

  • Ask specific questions about whether this medication is covered under your current plan and identify any requirements or restrictions that may apply.

 

Review Your Insurance Policy

 

  • Carefully review your Summary of Benefits and Coverage (SBC) document to see if Naltrexone/Bupropion (Contrave) is listed as a covered medication.
  •  

  • Pay special attention to the details regarding prescription drug coverage and any formulary restrictions or requirements for obtaining coverage.

 

Check the Highmark Formulary

 

  • Access the Highmark formulary online which lists all medications covered under their insurance plans. This will help confirm if Naltrexone/Bupropion (Contrave) is included and if there are tier-specific requirements.
  •  

  • Determine any prior authorization, step therapy, or quantity limits associated with the medication.

 

Speak with Your Healthcare Provider

 

  • Discuss with your healthcare provider the desire to start Naltrexone/Bupropion (Contrave) and your need for insurance coverage assistance.
  •  

  • Ask your provider to submit any necessary documentation, such as a letter of medical necessity, to Highmark to support your case for coverage.

 

Request Prior Authorization

 

  • If your insurance plan requires prior authorization, ask your healthcare provider to submit a request on your behalf to Highmark.
  •  

  • Ensure that all necessary clinical information and justifications for the use of Naltrexone/Bupropion (Contrave) are included to facilitate approval.

 

Appeal Denied Claims

 

  • If Highmark denies the coverage request, review the denial letter to understand the reason and gather supporting documentation for an appeal.
  •  

  • Submit an appeal through Highmark's appeals process by providing additional evidence or clarifying information about your medical necessity for the medication.
  • Consider involving your healthcare provider in the appeal process to bolster your case for coverage approval.

 

Explore Alternative Assistance Programs

 

  • If coverage through Highmark is still not possible, inquire about any manufacturer programs or financial assistance programs that could help reduce the cost of Naltrexone/Bupropion (Contrave).
  •  

  • Discuss alternative treatment options with your healthcare provider if necessary, which may be covered under your insurance plan.

 

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FAQs

Does Highmark Cover Naltrexone/Bupropion (Contrave)

Discover if Highmark covers Naltrexone/Bupropion (Contrave). Learn why coverage might be denied, how to get approval, and costs without insurance.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Highmark

 

Highmark Coverage for Naltrexone/Bupropion (Contrave)

 

  • Highmark may cover Naltrexone/Bupropion (Contrave) under certain conditions, primarily related to weight management.
  •  

  • Candidates typically need a diagnosis of obesity (BMI ≥30) or overweight status (BMI ≥27) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Coverage often requires demonstrated lifestyle changes (e.g., diet and exercise) that have not resulted in significant weight loss.
  •  

  • Pre-authorization from Highmark is usually needed to determine medical necessity and coverage eligibility.

 

Steps to Obtain Coverage

 

  • Consult your healthcare provider to assess eligibility based on medical history and current health status.
  •  

  • Submit a pre-authorization request to Highmark, including medical documentation and a prescription from your doctor.
  •  

  • Check with Highmark directly to verify specific plan coverage, as coverage can vary by plan and location.

 

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Highmark's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Highmark's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

  • Member must have a documented diagnosis of obesity defined as a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related comorbid condition (e.g., hypertension, type 2 diabetes mellitus, or dyslipidemia).
  •  

  • Member must be 18 years of age or older.
  •  

  • Member should have attempted to lose weight through diet and exercise for a minimum of six months prior to requesting coverage.
  •  

  • Documentation of unsuccessful weight loss efforts with diet and exercise, pharmaceutical therapy, or behavioral therapy should be provided.
  •  

  • Prescription of Naltrexone/Bupropion (Contrave) should be part of a comprehensive weight management program. This includes ongoing nutritional education, behavioral support, and physical activity components.
  •  

  • The prescribing physician is required to monitor the member's progress and any potential side effects regularly to ensure the treatment's safety and efficacy.
  •  

  • Members should not have any contraindications to Naltrexone/Bupropion therapy, such as uncontrolled hypertension, seizure disorders, chronic opioid use, or a history of major depressive disorder or other mood disorders.
  •  

  • No concurrent usage of other pharmaceutical weight management treatments unless otherwise specified by the prescriber and approved by Highmark provisions.
  •  

  • Additional documentation may be required to support the necessity of Naltrexone/Bupropion therapy consistent with weight management.

 

Why Highmark Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Highmark's Exclusions for Naltrexone/Bupropion (Contrave) Coverage

 

  • The patient does not meet the BMI requirements: Highmark may deny coverage if the patient's Body Mass Index (BMI) is not above the threshold specified in their policies.
  •  

  • Lack of documentation: Highmark may not cover the medication if there's insufficient or incomplete medical documentation to justify its prescription.
  •  

  • Non-compliance with lifestyle modifications: If a patient has not adhered to prescribed lifestyle changes such as diet and exercise regimens, coverage might be denied.
  •  

  • Concomitant use with other weight loss drugs: Highmark typically does not cover Naltrexone/Bupropion if the patient is simultaneously taking other weight loss medications.
  •  

  • Medical history contraindications: Coverage can be denied if the patient has certain pre-existing medical conditions that contraindicate the use of Naltrexone/Bupropion.
  •  

  • Off-label usage: If the medication is prescribed for uses not approved by the FDA, Highmark may deny coverage.
  •  

  • Non-adherence to the step therapy protocol: If the patient has not followed Highmark's step therapy guidelines, which might include trying other, lower-cost medications first, the coverage could be denied.
  •  

 

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How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Highmark

 

Contact Highmark Customer Service

 

  • Begin by calling the Highmark customer service number located on the back of your insurance card to clarify coverage details for Naltrexone/Bupropion (Contrave).
  •  

  • Ask specific questions about whether this medication is covered under your current plan and identify any requirements or restrictions that may apply.

 

Review Your Insurance Policy

 

  • Carefully review your Summary of Benefits and Coverage (SBC) document to see if Naltrexone/Bupropion (Contrave) is listed as a covered medication.
  •  

  • Pay special attention to the details regarding prescription drug coverage and any formulary restrictions or requirements for obtaining coverage.

 

Check the Highmark Formulary

 

  • Access the Highmark formulary online which lists all medications covered under their insurance plans. This will help confirm if Naltrexone/Bupropion (Contrave) is included and if there are tier-specific requirements.
  •  

  • Determine any prior authorization, step therapy, or quantity limits associated with the medication.

 

Speak with Your Healthcare Provider

 

  • Discuss with your healthcare provider the desire to start Naltrexone/Bupropion (Contrave) and your need for insurance coverage assistance.
  •  

  • Ask your provider to submit any necessary documentation, such as a letter of medical necessity, to Highmark to support your case for coverage.

 

Request Prior Authorization

 

  • If your insurance plan requires prior authorization, ask your healthcare provider to submit a request on your behalf to Highmark.
  •  

  • Ensure that all necessary clinical information and justifications for the use of Naltrexone/Bupropion (Contrave) are included to facilitate approval.

 

Appeal Denied Claims

 

  • If Highmark denies the coverage request, review the denial letter to understand the reason and gather supporting documentation for an appeal.
  •  

  • Submit an appeal through Highmark's appeals process by providing additional evidence or clarifying information about your medical necessity for the medication.
  • Consider involving your healthcare provider in the appeal process to bolster your case for coverage approval.

 

Explore Alternative Assistance Programs

 

  • If coverage through Highmark is still not possible, inquire about any manufacturer programs or financial assistance programs that could help reduce the cost of Naltrexone/Bupropion (Contrave).
  •  

  • Discuss alternative treatment options with your healthcare provider if necessary, which may be covered under your insurance plan.

 

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Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

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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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