Does Horizon Blue Cross Blue Shield of New Jersey Cover Diethylpropion (Tenuate)

Explore if Horizon BCBSNJ covers Diethylpropion, reasons for denial, ways to secure coverage, cost without insurance, and FAQs in this insightful article.
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Coverage Criteria for Diethylpropion (Tenuate)

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Diethylpropion (Tenuate) when deemed medically necessary for weight loss in patients with obesity-related conditions.
  • Coverage usually requires prior authorization to ensure the drug is used as part of a broader weight management program.
  • Patients typically must have a BMI that meets certain thresholds indicating obesity and have previously attempted weight loss through diet and exercise.
  • Continued coverage may depend on demonstrating effective weight loss and compliance with the healthcare provider's management plan.
  • Specific coverage policies are subject to change, so consulting the member's plan details or contacting the insurer for the most current information is crucial.

 

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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.

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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.

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 Horizon Blue Cross Blue Shield of New Jersey

 

Verify Your Prescription Coverage

 

  • Review your current health insurance policy documents from Horizon Blue Cross Blue Shield of New Jersey. Check if Diethylpropion (Tenuate) is listed under the formulary or covered drugs section.
  •  

  • Access the Horizon Blue Cross Blue Shield of New Jersey website or your member portal to search for drug coverage. Look for a comprehensive list of covered medications to ensure Diethylpropion is included.
  •  

  • Contact Horizon Blue Cross Blue Shield of New Jersey member services for specific information about Diethylpropion coverage. Customer support can confirm coverage details and any specific requirements.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your prescription needs. Explain the necessity for Diethylpropion (Tenuate) and obtain a valid prescription if you haven't already.
  •  

  • Request that your healthcare provider provide any necessary documentation or justification that may be required by the insurer for coverage approval.

 

Submit a Prior Authorization (if required)

 

  • Check with Horizon Blue Cross Blue Shield of New Jersey to see if Diethylpropion requires prior authorization. This step is often necessary for certain medications.
  •  

  • If prior authorization is required, complete and submit the necessary forms. Your healthcare provider may need to assist in providing detailed medical justification for why Diethylpropion is necessary for you.
  •  

  • Submit the prior authorization form to Horizon Blue Cross Blue Shield of New Jersey through the designated process, whether online, by fax, or via mail.

 

Understand Copayments and Deductibles

 

  • Review your insurance policy for information about copayments and deductibles related to prescription drugs. Note any potential costs you may incur even with coverage for Diethylpropion.
  •  

  • Contact Horizon Blue Cross Blue Shield of New Jersey to clarify any questions about the cost-sharing responsibilities related to your Diethylpropion prescription.

 

Fill Your Prescription at a Network Pharmacy

 

  • Choose a pharmacy within Horizon Blue Cross Blue Shield of New Jersey's network to fill your prescription, which can help minimize out-of-pocket expenses.
  •  

  • Present your insurance card when filling your prescription to ensure your coverage is applied. Confirm that the pharmacist has the necessary authorization documentation if prior authorization was required.

 

Appeal a Denied Claim

 

  • If coverage for Diethylpropion (Tenuate) is denied, review the denial letter to understand the reason for denial, which may include lack of medical necessity or incomplete documentation.
  •  

  • Work with your healthcare provider to gather additional supporting information and documentation to support your case for needing Diethylpropion.
  •  

  • Submit an appeal to Horizon Blue Cross Blue Shield of New Jersey with the additional information, following the insurer's specific appeal process and deadlines.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Diethylpropion (Tenuate)

Explore if Horizon BCBSNJ covers Diethylpropion, reasons for denial, ways to secure coverage, cost without insurance, and FAQs in this insightful article.
Curex allergy drops unboxing

Is Diethylpropion (Tenuate) Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Coverage Criteria for Diethylpropion (Tenuate)

 

  • Horizon Blue Cross Blue Shield of New Jersey may cover Diethylpropion (Tenuate) when deemed medically necessary for weight loss in patients with obesity-related conditions.
  • Coverage usually requires prior authorization to ensure the drug is used as part of a broader weight management program.
  • Patients typically must have a BMI that meets certain thresholds indicating obesity and have previously attempted weight loss through diet and exercise.
  • Continued coverage may depend on demonstrating effective weight loss and compliance with the healthcare provider's management plan.
  • Specific coverage policies are subject to change, so consulting the member's plan details or contacting the insurer for the most current information is crucial.

 

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Horizon Blue Cross Blue Shield of New Jersey's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Criteria for Coverage of Diethylpropion (Tenuate) by Horizon Blue Cross Blue Shield of New Jersey

 

  • Diethylpropion must be prescribed by a licensed healthcare provider specialized in weight management or a related medical field.
  •  

  • The patient must be an adult with a Body Mass Index (BMI) of 30 kg/m² or greater, or with a BMI of 27 kg/m² or greater and at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Confirmation of diagnosis and documentation of previous weight loss attempts, including dietary, physical activity, and behavioral interventions, must be provided. Documentation should demonstrate that these attempts were unsuccessful over a reasonable period.
  •  

  • The prescriber's evaluation should indicate that the benefits of using Diethylpropion for weight management outweigh potential risks for the patient, which must be documented in the patient's medical records.
  •  

  • The prescription must be for short-term management of obesity, generally limited to 12 weeks as part of a comprehensive weight loss program.
  •  

  • Continuous assessment and documentation of the patient’s progress and response to Diethylpropion will be required to ensure the drug's effectiveness and the patient’s adherence to the comprehensive weight management plan.
  •  

  • Patients must not have contraindications to Diethylpropion, such as hypersensitivity to sympathomimetic amines, advanced arteriosclerosis, severe hypertension, hyperthyroidism, glaucoma, or agitated states.
  •  

  • The patient's use of Diethylpropion must comply with federal and state regulations concerning controlled substances.

 

Why Horizon Blue Cross Blue Shield of New Jersey Might Deny Diethylpropion (Tenuate) Coverage

 

Situations Where Diethylpropion (Tenuate) is Not Covered by Horizon Blue Cross Blue Shield of New Jersey

 

  • **Non-Medical Necessity**: Coverage may be denied if Diethylpropion is deemed not medically necessary according to specific plan criteria or if it does not meet Horizon's medical policy guidelines for weight loss treatments.
  •  

  • **Lack of Prior Authorization**: Horizon Blue Cross Blue Shield of New Jersey might deny coverage if prior authorization is not obtained for the prescription as required by certain plans to ensure the medication is appropriate for the patient's condition.
  •  

  • **Off-Label Use**: Horizon may refuse coverage if Diethylpropion is being prescribed for conditions not approved by the FDA or not included in the plan’s coverage policy.
  •  

  • **Incomplete Documentation**: If there is insufficient clinical documentation to justify the use of Diethylpropion, such as failure to provide a comprehensive treatment history or assessments verifying the necessity of this medication, coverage may be denied.
  •  

  • **Exceeding Treatment Duration Limits**: Some plans have restrictions on the duration Diethylpropion can be used. Coverage may be denied if these predefined limits are exceeded without evidence of continued medical necessity.
  •  

  • **Age Restrictions**: Coverage may be denied if the patient falls outside of any age parameters specified by the plan for using Diethylpropion.
  •  

  • **Duplicate Therapy**: If the patient is already receiving similar medications, Horizon may deny coverage for Diethylpropion to avoid duplicative therapy unless clearly justified by the healthcare provider.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Verify Your Prescription Coverage

 

  • Review your current health insurance policy documents from Horizon Blue Cross Blue Shield of New Jersey. Check if Diethylpropion (Tenuate) is listed under the formulary or covered drugs section.
  •  

  • Access the Horizon Blue Cross Blue Shield of New Jersey website or your member portal to search for drug coverage. Look for a comprehensive list of covered medications to ensure Diethylpropion is included.
  •  

  • Contact Horizon Blue Cross Blue Shield of New Jersey member services for specific information about Diethylpropion coverage. Customer support can confirm coverage details and any specific requirements.

 

Consult Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss your prescription needs. Explain the necessity for Diethylpropion (Tenuate) and obtain a valid prescription if you haven't already.
  •  

  • Request that your healthcare provider provide any necessary documentation or justification that may be required by the insurer for coverage approval.

 

Submit a Prior Authorization (if required)

 

  • Check with Horizon Blue Cross Blue Shield of New Jersey to see if Diethylpropion requires prior authorization. This step is often necessary for certain medications.
  •  

  • If prior authorization is required, complete and submit the necessary forms. Your healthcare provider may need to assist in providing detailed medical justification for why Diethylpropion is necessary for you.
  •  

  • Submit the prior authorization form to Horizon Blue Cross Blue Shield of New Jersey through the designated process, whether online, by fax, or via mail.

 

Understand Copayments and Deductibles

 

  • Review your insurance policy for information about copayments and deductibles related to prescription drugs. Note any potential costs you may incur even with coverage for Diethylpropion.
  •  

  • Contact Horizon Blue Cross Blue Shield of New Jersey to clarify any questions about the cost-sharing responsibilities related to your Diethylpropion prescription.

 

Fill Your Prescription at a Network Pharmacy

 

  • Choose a pharmacy within Horizon Blue Cross Blue Shield of New Jersey's network to fill your prescription, which can help minimize out-of-pocket expenses.
  •  

  • Present your insurance card when filling your prescription to ensure your coverage is applied. Confirm that the pharmacist has the necessary authorization documentation if prior authorization was required.

 

Appeal a Denied Claim

 

  • If coverage for Diethylpropion (Tenuate) is denied, review the denial letter to understand the reason for denial, which may include lack of medical necessity or incomplete documentation.
  •  

  • Work with your healthcare provider to gather additional supporting information and documentation to support your case for needing Diethylpropion.
  •  

  • Submit an appeal to Horizon Blue Cross Blue Shield of New Jersey with the additional information, following the insurer's specific appeal process and deadlines.

 

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

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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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Titration

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?

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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