Does Highmark Cover Phendimetrazine

Explore Phendimetrazine coverage by Highmark, reasons for denial, steps to secure coverage, costs without insurance, and FAQs. Get informed now.
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Does Highmark Cover Phendimetrazine?

 

  • Highmark may cover Phendimetrazine under certain conditions, focusing primarily on individuals with weight-related health issues where weight loss is essential for health improvement.
  •  

  • Coverage typically requires prior authorization to confirm the necessity of the medication.
  •  

  • Patients usually need to demonstrate that they have attempted other weight loss programs or treatments without success before Phendimetrazine is approved.
  •  

  • Healthcare providers must supply documentation supporting the need for Phendimetrazine, including health records showing weight-related health risks or conditions.
  •  

  • Patients may also need to meet specific BMI criteria or have obesity-related comorbidities for eligibility.
  •  

  • It's recommended for patients to verify their specific policy details, as coverage can vary based on plan type and jurisdiction.

 

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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 Phendimetrazine Coverage with Highmark

 

Understand Highmark's Coverage Policies

 

  • Visit the Highmark official website or contact their customer service to get specific details about their prescription drug coverage policies.
  •  

  • Gather information on Phendimetrazine's coverage status under your particular plan, as coverage can vary based on your specific policy.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider why you are being prescribed Phendimetrazine and obtain any necessary documentation that supports the medical necessity of this medication.
  •  

  • Ensure your healthcare provider is willing to work with you and provide any required information to Highmark for obtaining coverage.

 

Verify if Pre-authorization is Required

 

  • Contact Highmark customer service to verify if Phendimetrazine requires pre-authorization under your plan.
  •  

  • If pre-authorization is necessary, request information on how to submit a pre-authorization request.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete the Highmark Prior Authorization form for Phendimetrazine.
  •  

  • Submit the completed form along with any required documentation that justifies the medical necessity of Phendimetrazine to Highmark for review.
  •  

  • Ensure that all forms and documents are complete and correct to avoid delays in the approval process.

 

Follow Up on the Authorization Request

 

  • Contact Highmark approximately one to two weeks after submission to ensure that your request is being processed.
  •  

  • Inquire about the expected timeline for a decision on the prior authorization request.

 

Appeal if Necessary

 

  • If your initial request is denied, review the denial letter carefully to understand the reasons for denial.
  •  

  • Work with your healthcare provider to collect additional documentation or information that addresses the reasons for denial.
  •  

  • Submit an appeal with Highmark if you have new supporting evidence or documentation that addresses the denial reasons.

 

Attend to Pharmacy Coordination

 

  • Once approval is obtained, coordinate with your pharmacy to ensure they have the pre-authorization on file.
  •  

  • Keep a record of the approval documentation for your personal records and for any future pharmacy transactions involving Phendimetrazine.

 

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FAQs

Does Highmark Cover Phendimetrazine

Explore Phendimetrazine coverage by Highmark, reasons for denial, steps to secure coverage, costs without insurance, and FAQs. Get informed now.
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Is Phendimetrazine Covered by Highmark

 

Does Highmark Cover Phendimetrazine?

 

  • Highmark may cover Phendimetrazine under certain conditions, focusing primarily on individuals with weight-related health issues where weight loss is essential for health improvement.
  •  

  • Coverage typically requires prior authorization to confirm the necessity of the medication.
  •  

  • Patients usually need to demonstrate that they have attempted other weight loss programs or treatments without success before Phendimetrazine is approved.
  •  

  • Healthcare providers must supply documentation supporting the need for Phendimetrazine, including health records showing weight-related health risks or conditions.
  •  

  • Patients may also need to meet specific BMI criteria or have obesity-related comorbidities for eligibility.
  •  

  • It's recommended for patients to verify their specific policy details, as coverage can vary based on plan type and jurisdiction.

 

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Highmark's Approved Criteria for Phendimetrazine Coverage

 

Eligibility Criteria for Phendimetrazine Coverage

 

  • The member must be an adult aged 18 years or older.
  •  

  • Phendimetrazine is covered for the management of significant obesity, defined as a body mass index (BMI) of 30 kg/m2 or higher.
  •  

  • Coverage is also considered for individuals with a BMI of 27 kg/m2 or higher if accompanied by a clinically significant condition related to obesity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia.

 

Trial and Documentation Requirements

 

  • Documentation must reflect the member's weight management history, including previous trials with other weight management medications unless contraindicated.
  •  

  • Evidence of participation in a comprehensive weight management program, including dietary, physical activity, and behavioral interventions, is necessary.
  •  

  • Medical records should note ongoing physician supervision and monitoring while using Phendimetrazine.

 

Duration and Monitoring for Continued Coverage

 

  • Initial coverage of Phendimetrazine usually does not exceed 12 weeks but may be considered beyond this period upon furnishing sufficient documentation of effective weight loss and adherence to the comprehensive weight management plan.
  •  

  • Continued coverage requires periodic reassessment by the prescribing physician, with updates demonstrating weight loss and management progress.
  •  

  • Follow-up documentation must confirm compliance with lifestyle modifications and ongoing medical evaluations.

 

Why Highmark Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage by Highmark

 

  • Phendimetrazine is prescribed for indications not approved by the FDA. Coverage is typically limited to FDA-approved uses, and Highmark may deny claims that fall outside of these parameters.
  •  

  • Lack of documentation of the patient's medical necessity for Phendimetrazine. Highmark requires detailed medical records supporting the prescription of this medication, and failure to provide adequate evidence can result in denial.
  •  

  • Patient does not meet the specific BMI criteria for Phendimetrazine use. Highmark may have strict weight or BMI thresholds, and individuals below these standards may not qualify for coverage.
  •  

  • Absence of prior authorization if required by the plan. Some Highmark insurance plans may mandate obtaining prior authorization before covering Phendimetrazine. Claims submitted without this authorization are likely to be rejected.
  •  

  • Patient has a history of substance abuse or conditions that contraindicate the use of Phendimetrazine. Highmark can deny coverage if there are concerns regarding the patient's ability to safely use the medication.
  •  

  • Exceeding prescribed dosage limits or duration of treatment. If the use of Phendimetrazine extends beyond the accepted or defined limits without proper justification, Highmark may deny further coverage.
  •  

 

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

How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Highmark

 

Understand Highmark's Coverage Policies

 

  • Visit the Highmark official website or contact their customer service to get specific details about their prescription drug coverage policies.
  •  

  • Gather information on Phendimetrazine's coverage status under your particular plan, as coverage can vary based on your specific policy.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider why you are being prescribed Phendimetrazine and obtain any necessary documentation that supports the medical necessity of this medication.
  •  

  • Ensure your healthcare provider is willing to work with you and provide any required information to Highmark for obtaining coverage.

 

Verify if Pre-authorization is Required

 

  • Contact Highmark customer service to verify if Phendimetrazine requires pre-authorization under your plan.
  •  

  • If pre-authorization is necessary, request information on how to submit a pre-authorization request.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete the Highmark Prior Authorization form for Phendimetrazine.
  •  

  • Submit the completed form along with any required documentation that justifies the medical necessity of Phendimetrazine to Highmark for review.
  •  

  • Ensure that all forms and documents are complete and correct to avoid delays in the approval process.

 

Follow Up on the Authorization Request

 

  • Contact Highmark approximately one to two weeks after submission to ensure that your request is being processed.
  •  

  • Inquire about the expected timeline for a decision on the prior authorization request.

 

Appeal if Necessary

 

  • If your initial request is denied, review the denial letter carefully to understand the reasons for denial.
  •  

  • Work with your healthcare provider to collect additional documentation or information that addresses the reasons for denial.
  •  

  • Submit an appeal with Highmark if you have new supporting evidence or documentation that addresses the denial reasons.

 

Attend to Pharmacy Coordination

 

  • Once approval is obtained, coordinate with your pharmacy to ensure they have the pre-authorization on file.
  •  

  • Keep a record of the approval documentation for your personal records and for any future pharmacy transactions involving Phendimetrazine.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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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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