Does Horizon Blue Cross Blue Shield of New Jersey Cover Contrave

Discover if Horizon BCBS of NJ covers Contrave, learn denial reasons, coverage tips, out-of-pocket costs, and FAQs for a smooth insurance experience.
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Coverage for Contrave

 

  • Horizon Blue Cross Blue Shield of New Jersey might cover Contrave, a weight management medication, under specific circumstances depending on your policy.
  •  

  • Coverage often applies if prescribed for obesity management, typically indicated by a high BMI, usually 30 or above, or 27 with comorbid conditions.
  •  

  • A prior authorization may be required to assess medical necessity, ensuring that other weight loss methods have been attempted without significant results.

 

Criteria and Rules

 

  • Coverage eligibility could depend on meeting clinical guidelines, which might include a documented history of weight management attempts.
  •  

  • Regular follow-ups with healthcare providers may be necessary while using Contrave to evaluate its efficacy and continue coverage.
  •  

  • Check your specific plan details or contact Horizon directly to get precise information about your coverage specifics for Contrave.

 

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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 Contrave Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Check Your Insurance Plan Details

 

  • Begin by reviewing your current Horizon Blue Cross Blue Shield of New Jersey plan documentation to confirm if prescription weight management medications like Contrave are covered.
  •  

  • Identify your plan type (e.g., HMO, PPO, EPO) because coverage can vary significantly between these types.

 

Contact Horizon Customer Service

 

  • Call Horizon Blue Cross Blue Shield customer service using the phone number on the back of your insurance card for detailed information regarding Contrave coverage.
  •  

  • Inquire specifically if Contrave is included in your formulary list and ask about any required pre-authorizations or step therapy protocols.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Contrave with your healthcare provider. Your doctor will need to provide documentation supporting the medical necessity for Contrave.
  •  

  • Ask your healthcare provider if they have experience with obtaining prior authorization for Contrave and any recommendations they might have.

 

Obtain Prior Authorization (if required)

 

  • If prior authorization is required, ask your healthcare provider to initiate the process by submitting necessary forms and medical documentation to Horizon Blue Cross Blue Shield.
  •  

  • Ensure the documentation comprehensively outlines your diagnosis, previous weight management attempts, and reasons why Contrave is medically necessary for you.

 

Follow Up with Horizon

 

  • Monitor the status of your prior authorization request by contacting Horizon periodically to check the progress and address any additional information requests promptly.
  •  

  • Be prepared to provide additional documentation or advocate on your behalf if the request is denied initially. Have your healthcare provider assist with appeal processes, if necessary.

 

Review Coverage Decision

 

  • Once a decision has been made, review any coverage terms, such as co-pays, deductibles, or limits on the duration for which Contrave will be covered.
  •  

  • If approved, fill your Contrave prescription at a network pharmacy to ensure maximum coverage from Horizon Blue Cross Blue Shield of New Jersey.

 

Appeal if Necessary

 

  • If your coverage request for Contrave is denied, promptly appeal the decision. Gather any additional supporting documentation or personal testimonials to help strengthen your case.
  •  

  • Consider working with your healthcare provider or a healthcare advocate to navigate the appeals process more effectively.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Contrave

Discover if Horizon BCBS of NJ covers Contrave, learn denial reasons, coverage tips, out-of-pocket costs, and FAQs for a smooth insurance experience.
Curex allergy drops unboxing

Is Contrave Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Coverage for Contrave

 

  • Horizon Blue Cross Blue Shield of New Jersey might cover Contrave, a weight management medication, under specific circumstances depending on your policy.
  •  

  • Coverage often applies if prescribed for obesity management, typically indicated by a high BMI, usually 30 or above, or 27 with comorbid conditions.
  •  

  • A prior authorization may be required to assess medical necessity, ensuring that other weight loss methods have been attempted without significant results.

 

Criteria and Rules

 

  • Coverage eligibility could depend on meeting clinical guidelines, which might include a documented history of weight management attempts.
  •  

  • Regular follow-ups with healthcare providers may be necessary while using Contrave to evaluate its efficacy and continue coverage.
  •  

  • Check your specific plan details or contact Horizon directly to get precise information about your coverage specifics for Contrave.

 

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Horizon Blue Cross Blue Shield of New Jersey's Approved Criteria for Contrave Coverage

 

Criteria for Coverage of Contrave by Horizon Blue Cross Blue Shield of New Jersey

 

  • **Medical Necessity Requirement**: The prescription for Contrave must be deemed medically necessary by a qualified healthcare provider.
  •  

  • **BMI Guidelines**: The patient should have a Body Mass Index (BMI) of 30 kg/m² or greater. Alternatively, a BMI of 27 kg/m² or greater is acceptable if the patient has obesity-related comorbidities.
  •  

  • **Documented Weight Loss Attempts**: There must be documentation showing previous unsuccessful weight loss attempts through diet and exercise programs.
  •  

  • **Age Requirement**: Coverage is generally provided for adult patients aged 18 years or older.
  •  

  • **Prescription and Supervision**: The medication must be prescribed and monitored by a licensed physician specializing in weight management or related fields.
  •  

  • **Adherence to Recommended Guidelines**: The patient must adhere to prescribed lifestyle interventions, including diet and exercise, alongside taking Contrave.
  •  

  • **Continued Response Evaluation**: Insurance coverage may require ongoing evaluations showing weight loss or control progress as a continuous qualification for coverage.
  •  

  • **Absence of Contraindications**: The prescribing physician must attest that the patient has no contraindications to taking Contrave, as specified in the prescribing information.

 

Why Horizon Blue Cross Blue Shield of New Jersey Might Deny Contrave Coverage

 

Non-Compliance with Medical Criteria

 

  • Horizon Blue Cross Blue Shield of New Jersey may deny coverage for Contrave if the patient does not meet the specific medical criteria established for weight management medications.

 

Lack of Prior Authorization

 

  • If Contrave requires prior authorization and this step has not been completed or approved, coverage may be denied.

 

Use Outside Approved Guidelines

 

  • Contrave prescribed for uses other than those approved by the FDA or for individuals outside the specified age or health conditions may not be covered.

 

Failure to Demonstrate Medical Necessity

 

  • Coverage might be denied if there is inadequate documentation or rationale demonstrating the medical necessity of Contrave over other treatment options.

 

Non-Formulary Drug Status

 

  • If Contrave is not on the formulary list of medications, Horizon Blue Cross Blue Shield of New Jersey may deny coverage.

 

Pre-existing Condition Clause

 

  • Coverage may be denied if the use of Contrave is related to a pre-existing condition that is excluded from the policy coverage terms.

 

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

How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing costs.

 

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 Contrave Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Check Your Insurance Plan Details

 

  • Begin by reviewing your current Horizon Blue Cross Blue Shield of New Jersey plan documentation to confirm if prescription weight management medications like Contrave are covered.
  •  

  • Identify your plan type (e.g., HMO, PPO, EPO) because coverage can vary significantly between these types.

 

Contact Horizon Customer Service

 

  • Call Horizon Blue Cross Blue Shield customer service using the phone number on the back of your insurance card for detailed information regarding Contrave coverage.
  •  

  • Inquire specifically if Contrave is included in your formulary list and ask about any required pre-authorizations or step therapy protocols.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Contrave with your healthcare provider. Your doctor will need to provide documentation supporting the medical necessity for Contrave.
  •  

  • Ask your healthcare provider if they have experience with obtaining prior authorization for Contrave and any recommendations they might have.

 

Obtain Prior Authorization (if required)

 

  • If prior authorization is required, ask your healthcare provider to initiate the process by submitting necessary forms and medical documentation to Horizon Blue Cross Blue Shield.
  •  

  • Ensure the documentation comprehensively outlines your diagnosis, previous weight management attempts, and reasons why Contrave is medically necessary for you.

 

Follow Up with Horizon

 

  • Monitor the status of your prior authorization request by contacting Horizon periodically to check the progress and address any additional information requests promptly.
  •  

  • Be prepared to provide additional documentation or advocate on your behalf if the request is denied initially. Have your healthcare provider assist with appeal processes, if necessary.

 

Review Coverage Decision

 

  • Once a decision has been made, review any coverage terms, such as co-pays, deductibles, or limits on the duration for which Contrave will be covered.
  •  

  • If approved, fill your Contrave prescription at a network pharmacy to ensure maximum coverage from Horizon Blue Cross Blue Shield of New Jersey.

 

Appeal if Necessary

 

  • If your coverage request for Contrave is denied, promptly appeal the decision. Gather any additional supporting documentation or personal testimonials to help strengthen your case.
  •  

  • Consider working with your healthcare provider or a healthcare advocate to navigate the appeals process more effectively.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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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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