Does Horizon Blue Cross Blue Shield of New Jersey Cover Phendimetrazine

Explore Horizon BCBSNJ's coverage of Phendimetrazine, reasons for denial, tips to gain approval, costs without insurance, and FAQs in our comprehensive guide.
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Does Horizon Blue Cross Blue Shield of New Jersey Cover Phendimetrazine?

 

  • Horizon BCBSNJ may cover Phendimetrazine as it is classified under prescription weight-loss medications.
  • Coverage is typically dependent on the specific health plan and prescription benefits associated with it.
  • Prior authorization might be required, meaning healthcare providers must obtain approval from Horizon before prescribing the medication to ensure it's medically necessary.
  • Coverage often requires a demonstration of obesity (BMI requirement) or risk factors indicating health issues due to weight.
  • Patients might need to try and fail other weight loss methods before Phendimetrazine is covered.
  • Participating in a comprehensive weight management program could be a criterion for coverage.
  • Exact coverage details can vary; contacting Horizon BCBSNJ directly or consulting the member's individual policy for specific terms is recommended.

 

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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.

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Contact Horizon Blue Cross Blue Shield of New Jersey

 

  • Call the customer service number on the back of your insurance card to inquire about coverage for Phendimetrazine. This direct contact will provide specifics tailored to your individual policy.
  •  

  • Ask the representative about the prescription drug benefits included in your plan, specifically focusing on coverage for weight loss medications.
  •  

  • Inquire if there's a formulary or preferred drug list that Phendimetrazine might be a part of, which could affect your coverage.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Phendimetrazine. Make sure to have your medical records handy that document the necessity for a weight loss medication.
  •  

  • Request a prescription from your healthcare provider along with a letter detailing why Phendimetrazine is medically necessary for your condition.
  •  

  • Ensure your healthcare provider includes specific diagnosis codes that may increase the likelihood of coverage approval when submitting to Horizon BCBSNJ.

 

Review Your Prescription Benefits

 

  • Log into your Horizon BCBSNJ member account online to review your specific prescription drug benefits and check if Phendimetrazine is covered.
  •  

  • Look for information regarding any prior authorization requirements, quantity limits, or step therapy protocols that might apply to Phendimetrazine.
  •  

  • If available, download or request a copy of your policy's drug formulary to better understand where Phendimetrazine fits within your coverage plan.

 

Submit a Prior Authorization Request

 

  • If prior authorization is required for Phendimetrazine, work with your healthcare provider to prepare and submit the necessary forms to Horizon BCBSNJ.
  •  

  • Include all supporting documents, such as your healthcare provider's written justification and relevant health records, to strengthen the request.
  •  

  • Follow up with Horizon BCBSNJ to ensure the request is being processed and provide any additional information if requested.

 

Appeal a Denial if Necessary

 

  • If your request for coverage is denied, review the explanation of benefits or denial letter carefully to understand the reasons why.
  •  

  • Work with your doctor to gather any additional documentation that might support an appeal, such as more recent health evaluations or secondary recommendations from specialists.
  •  

  • Submit an appeal in writing to Horizon BCBSNJ, addressing the issues stated in the denial and including any new evidence provided by your healthcare provider.
  •  

  • Consider reaching out to Horizon BCBSNJ customer service if you need clarification or help navigating the appeals process.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Phendimetrazine

Explore Horizon BCBSNJ's coverage of Phendimetrazine, reasons for denial, tips to gain approval, costs without insurance, and FAQs in our comprehensive guide.
Curex allergy drops unboxing

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

 

Does Horizon Blue Cross Blue Shield of New Jersey Cover Phendimetrazine?

 

  • Horizon BCBSNJ may cover Phendimetrazine as it is classified under prescription weight-loss medications.
  • Coverage is typically dependent on the specific health plan and prescription benefits associated with it.
  • Prior authorization might be required, meaning healthcare providers must obtain approval from Horizon before prescribing the medication to ensure it's medically necessary.
  • Coverage often requires a demonstration of obesity (BMI requirement) or risk factors indicating health issues due to weight.
  • Patients might need to try and fail other weight loss methods before Phendimetrazine is covered.
  • Participating in a comprehensive weight management program could be a criterion for coverage.
  • Exact coverage details can vary; contacting Horizon BCBSNJ directly or consulting the member's individual policy for specific terms is recommended.

 

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

 

Eligibility Criteria for Phendimetrazine Coverage

 

  • Phendimetrazine is covered for individuals aged 18 and older.
  •  

  • Applicants must have a body mass index (BMI) of 30 kg/m² or greater.
  •  

  • Coverage is also available for those with a BMI of 27 kg/m² or greater if they have at least one weight-related comorbid condition, such as hypertension, type 2 diabetes, or dyslipidemia.

 

Documentation Requirements

 

  • A detailed medical history and physical examination must be provided by the prescribing physician.
  •  

  • Documentation should include an assessment of weight-related comorbidities.
  •  

  • Records of previous weight loss attempts and interventions should be submitted.

 

Duration of Coverage

 

  • Initial coverage is granted for a 12-week period.
  •  

  • Continued coverage beyond 12 weeks requires evidence of significant weight loss, typically defined as at least a 5% reduction in total body weight.

 

Prescribing Guidelines

 

  • Phendimetrazine should be prescribed as part of a comprehensive weight management program that includes dietary adjustments, increased physical activity, and behavioral modifications.
  •  

  • The prescribing physician should provide regular follow-ups to assess progress and make necessary adjustments to the treatment plan.

 

Preferred Pharmacy Network

 

  • Use of in-network pharmacies is encouraged to minimize out-of-pocket costs.
  •  

  • Members may access a list of Horizon Blue Cross Blue Shield of New Jersey's preferred pharmacies through their online member portal or customer service.

 

Reevaluation Requirement

 

  • A comprehensive reevaluation by the prescribing physician is required before any extension of coverage is granted beyond the initial period.

 

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

 

Reasons for Denial of Phendimetrazine Coverage

 

  • Phendimetrazine is not covered if it is prescribed for non-FDA approved uses. Horizon Blue Cross Blue Shield of New Jersey follows FDA guidelines strictly and any off-label use might lead to denial.
  •  

  • The medication may not be covered if it is prescribed for a patient whose Body Mass Index (BMI) does not meet the specific criteria set by the insurer for the treatment of obesity-related conditions.
  •  

  • Coverage might be denied if the patient has not met the established prior authorization requirements. This often entails proving that other weight loss measures have been attempted and failed.
  •  

  • If there is insufficient documentation to justify the medical necessity of Phendimetrazine, the request for coverage can be rejected.
  •  

  • Patients with a history of drug abuse may be denied coverage, as Phendimetrazine is a controlled substance with potential for misuse.
  •  

  • Coverage is also likely to be denied if the prescribing physician does not adhere to the specific formulary restrictions or guidelines outlined by Horizon Blue Cross Blue Shield of New Jersey.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Contact Horizon Blue Cross Blue Shield of New Jersey

 

  • Call the customer service number on the back of your insurance card to inquire about coverage for Phendimetrazine. This direct contact will provide specifics tailored to your individual policy.
  •  

  • Ask the representative about the prescription drug benefits included in your plan, specifically focusing on coverage for weight loss medications.
  •  

  • Inquire if there's a formulary or preferred drug list that Phendimetrazine might be a part of, which could affect your coverage.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Phendimetrazine. Make sure to have your medical records handy that document the necessity for a weight loss medication.
  •  

  • Request a prescription from your healthcare provider along with a letter detailing why Phendimetrazine is medically necessary for your condition.
  •  

  • Ensure your healthcare provider includes specific diagnosis codes that may increase the likelihood of coverage approval when submitting to Horizon BCBSNJ.

 

Review Your Prescription Benefits

 

  • Log into your Horizon BCBSNJ member account online to review your specific prescription drug benefits and check if Phendimetrazine is covered.
  •  

  • Look for information regarding any prior authorization requirements, quantity limits, or step therapy protocols that might apply to Phendimetrazine.
  •  

  • If available, download or request a copy of your policy's drug formulary to better understand where Phendimetrazine fits within your coverage plan.

 

Submit a Prior Authorization Request

 

  • If prior authorization is required for Phendimetrazine, work with your healthcare provider to prepare and submit the necessary forms to Horizon BCBSNJ.
  •  

  • Include all supporting documents, such as your healthcare provider's written justification and relevant health records, to strengthen the request.
  •  

  • Follow up with Horizon BCBSNJ to ensure the request is being processed and provide any additional information if requested.

 

Appeal a Denial if Necessary

 

  • If your request for coverage is denied, review the explanation of benefits or denial letter carefully to understand the reasons why.
  •  

  • Work with your doctor to gather any additional documentation that might support an appeal, such as more recent health evaluations or secondary recommendations from specialists.
  •  

  • Submit an appeal in writing to Horizon BCBSNJ, addressing the issues stated in the denial and including any new evidence provided by your healthcare provider.
  •  

  • Consider reaching out to Horizon BCBSNJ customer service if you need clarification or help navigating the appeals process.

 

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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.

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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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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