Does Horizon Blue Cross Blue Shield of New Jersey Cover Naltrexone/Bupropion (Contrave)

Explore if Horizon BCBSNJ covers Naltrexone/Bupropion (Contrave) and learn about costs, coverage denial reasons, and FAQs in this comprehensive guide.
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Horizon BCBSNJ Coverage for Contrave

 

  • Horizon BCBSNJ may cover Naltrexone/Bupropion (Contrave) subject to plan-specific criteria and guidelines.
  •  

  • Coverage often requires the medication to be medically necessary for weight management in adults who are obese or overweight with at least one weight-related condition, such as type 2 diabetes or hypertension.
  •  

  • Prior authorization may be necessary, requiring your healthcare provider to submit a request demonstrating the need for Contrave based on your health status and history.
  •  

  • The plan might insist on previous unsuccessful attempts with other weight-loss interventions before approving Contrave.
  •  

  • Check with Horizon for your plan’s specific formulary, as coverage levels and criteria can vary depending on your employer or individual policy.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Contact Horizon Blue Cross Blue Shield

 

  • Call the customer service number on your insurance card or visit the official Horizon website to find the contact information. Speak with a representative to confirm coverage for Naltrexone/Bupropion (Contrave).
  •  

  • Gather information about your specific policy to understand any prerequisites or restrictions for medication coverage.

 

Consult Your Healthcare Provider

 

  • Discuss your interest in Naltrexone/Bupropion (Contrave) with your doctor. Ensure they are aware of any insurance requirements for authorization or preferred drug lists.
  •  

  • Ask your healthcare provider to prescribe Naltrexone/Bupropion if they deem it appropriate for your treatment plan.

 

Pre-Authorization Request

 

  • Your doctor may need to submit a pre-authorization request to Horizon Blue Cross Blue Shield. This request typically includes medical necessity and how the medication fits into your treatment plan.
  •  

  • Ensure your doctor’s office follows up on this request to expedite the process. You can also contact Horizon to check the status of pre-authorization.

 

Review Preferred Drug List

 

  • Check if Naltrexone/Bupropion (Contrave) is on Horizon's preferred drug list through their website or by asking a customer service representative.
  •  

  • If it is not on the preferred list, discuss alternatives with your doctor or inquire about an exception process.

 

Prepare for Out-of-Pocket Costs

 

  • Clarify copayment or coinsurance responsibilities with Horizon for covering Naltrexone/Bupropion.
  •  

  • Inquire about possible financial assistance programs offered by the drug manufacturer or third-party organizations if your plan has a high out-of-pocket cost.

 

File an Appeal if Necessary

 

  • If coverage is denied, review the denial letter for reasons and appeal instructions. Gather supporting documentation from your provider to strengthen your appeal.
  •  

  • Submit the appeal within the timeframe specified by Horizon, and follow up regularly to ensure it is processed.

 

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Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Naltrexone/Bupropion (Contrave)

Explore if Horizon BCBSNJ covers Naltrexone/Bupropion (Contrave) and learn about costs, coverage denial reasons, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Horizon BCBSNJ Coverage for Contrave

 

  • Horizon BCBSNJ may cover Naltrexone/Bupropion (Contrave) subject to plan-specific criteria and guidelines.
  •  

  • Coverage often requires the medication to be medically necessary for weight management in adults who are obese or overweight with at least one weight-related condition, such as type 2 diabetes or hypertension.
  •  

  • Prior authorization may be necessary, requiring your healthcare provider to submit a request demonstrating the need for Contrave based on your health status and history.
  •  

  • The plan might insist on previous unsuccessful attempts with other weight-loss interventions before approving Contrave.
  •  

  • Check with Horizon for your plan’s specific formulary, as coverage levels and criteria can vary depending on your employer or individual policy.

 

A weight management program tailored to you

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Horizon Blue Cross Blue Shield of New Jersey's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Naltrexone/Bupropion (Contrave) Coverage Criteria

 

  • **BMI Requirement**: Patient must have a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27-29.9 kg/m² with at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes mellitus, dyslipidemia).
  •  

  • **Age Requirement**: Patient must be 18 years of age or older.
  •  

  • **Diet and Exercise**: Patient must demonstrate a commitment to a reduced-calorie diet and increased physical activity.
  •  

  • **Previous Weight Loss Attempts**: Patient must have documented unsuccessful weight loss attempts with lifestyle changes alone.
  •  

  • **Clinical Indication of Use**: The medication must be used as an adjunct to a comprehensive weight management program.
  •  

  • **Duration of Treatment**: Coverage is applicable for an initial trial period, generally 12 weeks, to assess the effectiveness and response of the patient to therapy.
  •  

  • **Monitoring and Follow-Up**: Healthcare providers must regularly monitor patient progress and adherence to the treatment and lifestyle modifications planned.
  •  

  • **Prescription Requirement**: Prescription must be provided by a licensed healthcare provider who specializes in weight management or related health issues.

 

Why Horizon Blue Cross Blue Shield of New Jersey Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Naltrexone/Bupropion (Contrave) Exclusion Criteria

 

  • **Non-FDA Approved Indications**: Horizon Blue Cross Blue Shield of New Jersey does not cover Naltrexone/Bupropion (Contrave) for any conditions or indications that are not approved by the FDA. Use of the medication must align with the FDA-approved indications.
  •  

  • **Experimental or Investigational Use**: The insurance plan excludes coverage for any use of Naltrexone/Bupropion (Contrave) that is deemed experimental or investigational. This includes any off-label uses that do not have established efficacy and safety through rigorous clinical research.
  •  

  • **Failure to Meet Medical Necessity Criteria**: If the use of Naltrexone/Bupropion (Contrave) does not meet the specific medical necessity criteria established by the insurance provider, coverage may be denied. This can include lack of documented attempts at other weight loss strategies or medications.
  •  

  • **Exclusion of Weight Management Programs**: The policy may not cover costs related to weight management programs, which could include medications like Naltrexone/Bupropion (Contrave) as part of such programs if they are not considered medically necessary.
  •  

  • **Failure to Adhere to Policy Guidelines**: Coverage may be denied if the request does not adhere to established policy guidelines, such as the requirement for prior authorization.
  •  

  • **Lack of Required Documentation**: Insurance may require specific documentation to support the medical necessity of Naltrexone/Bupropion (Contrave). If this documentation is incomplete or not provided, coverage may be denied.
  •  

  • **Benefit Limitations or Exclusions**: Naltrexone/Bupropion (Contrave) may be excluded based on specific benefit limitations within an individual's plan. This includes exclusions for medications related to weight loss if not otherwise stated in the plan benefits.

 

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

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 Horizon Blue Cross Blue Shield of New Jersey

 

Contact Horizon Blue Cross Blue Shield

 

  • Call the customer service number on your insurance card or visit the official Horizon website to find the contact information. Speak with a representative to confirm coverage for Naltrexone/Bupropion (Contrave).
  •  

  • Gather information about your specific policy to understand any prerequisites or restrictions for medication coverage.

 

Consult Your Healthcare Provider

 

  • Discuss your interest in Naltrexone/Bupropion (Contrave) with your doctor. Ensure they are aware of any insurance requirements for authorization or preferred drug lists.
  •  

  • Ask your healthcare provider to prescribe Naltrexone/Bupropion if they deem it appropriate for your treatment plan.

 

Pre-Authorization Request

 

  • Your doctor may need to submit a pre-authorization request to Horizon Blue Cross Blue Shield. This request typically includes medical necessity and how the medication fits into your treatment plan.
  •  

  • Ensure your doctor’s office follows up on this request to expedite the process. You can also contact Horizon to check the status of pre-authorization.

 

Review Preferred Drug List

 

  • Check if Naltrexone/Bupropion (Contrave) is on Horizon's preferred drug list through their website or by asking a customer service representative.
  •  

  • If it is not on the preferred list, discuss alternatives with your doctor or inquire about an exception process.

 

Prepare for Out-of-Pocket Costs

 

  • Clarify copayment or coinsurance responsibilities with Horizon for covering Naltrexone/Bupropion.
  •  

  • Inquire about possible financial assistance programs offered by the drug manufacturer or third-party organizations if your plan has a high out-of-pocket cost.

 

File an Appeal if Necessary

 

  • If coverage is denied, review the denial letter for reasons and appeal instructions. Gather supporting documentation from your provider to strengthen your appeal.
  •  

  • Submit the appeal within the timeframe specified by Horizon, and follow up regularly to ensure it is processed.

 

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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.

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.

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.

 

Have questions left?

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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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