Does Horizon Blue Cross Blue Shield of New Jersey Cover Saxenda

Explore Saxenda coverage with Horizon BCBS of NJ, learn reasons for denial, coverage tips, costs without insurance, and FAQs in this comprehensive guide.
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Does Horizon Blue Cross Blue Shield of New Jersey Cover Saxenda?

 

  • Horizon BCBSNJ may cover Saxenda under certain conditions and depending on the specific health plan. Coverage is often for those diagnosed with obesity-related complications, such as type 2 diabetes.
  •  

  • For coverage eligibility, a BMI of ≥30 kg/m², or ≥27 kg/m² with one weight-related condition, is generally required, aligning with FDA labeling.
  •  

  • A prior authorization might be needed, where prescribing physicians must provide medical justification for Saxenda use, showing that other weight management attempts have been unsuccessful.
  •  

  • Each plan may have different formulary restrictions or preferences, so consult your specific benefit plan or contact Horizon BCBSNJ for details.
  •  

  • Employing wellness visits and engaging in a Horizon-approved weight management program may enhance chances of coverage approval.

 

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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.

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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 Saxenda Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Verify Current Health Plan Coverage

 

  • Contact Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) customer service to verify if Saxenda is included in your current plan. Use the phone number on your insurance card.
  •  

  • Ask about Saxenda coverage specifics, including co-pays, prior authorization, and any existing limitations such as preferred pharmacy networks or dosage restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss the need for Saxenda with your healthcare provider. They must be familiar with your health plan’s requirements and can help prepare the necessary documentation for coverage requests.
  •  

  • Make sure your healthcare provider writes a detailed justification for prescribing Saxenda, highlighting medical necessity according to your specific health conditions and history.

 

Initiate Prior Authorization

 

  • Request that your healthcare provider submit a prior authorization request form to Horizon BCBSNJ. This form is necessary to begin the coverage approval process for Saxenda.
  •  

  • Ensure all required forms and documentation are complete, including your provider's justification and any supporting medical records that may strengthen your case.

 

Follow Up with Horizon BCBSNJ

 

  • Contact Horizon BCBSNJ regularly to check the status of your prior authorization request. Having your policy number and claim reference handy will aid in quicker service.
  •  

  • If the request is denied, ask for specific reasons for the denial and what additional information is needed to reconsider the request.

 

Appeal if Necessary

 

  • If your request is denied, work with your healthcare provider to gather more detailed information and insights to support an appeal.
  •  

  • Submit an appeal to Horizon BCBSNJ, clearly outlining why Saxenda is necessary for your health based on additional information or overlooked evidence in the initial request.

 

Use Approved Pharmacies

 

  • Once you have received authorization, ensure that you fill your Saxenda prescriptions at a pharmacy within Horizon BCBSNJ's approved network to avoid any additional out-of-pocket expenses.
  •  

  • Keep track of your co-pays and any receipts for possible further claims or reimbursement inquiries.

 

Regularly Review Benefits

 

  • Periodically review your pharmacy benefits and discuss any changes in coverage with Horizon BCBSNJ during open enrollment periods to ensure continued coverage of Saxenda.
  •  

  • Stay informed of any updates to your plan that may affect your medication coverage or co-payment responsibilities.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Saxenda

Explore Saxenda coverage with Horizon BCBS of NJ, learn reasons for denial, coverage tips, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

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

 

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

 

  • Horizon BCBSNJ may cover Saxenda under certain conditions and depending on the specific health plan. Coverage is often for those diagnosed with obesity-related complications, such as type 2 diabetes.
  •  

  • For coverage eligibility, a BMI of ≥30 kg/m², or ≥27 kg/m² with one weight-related condition, is generally required, aligning with FDA labeling.
  •  

  • A prior authorization might be needed, where prescribing physicians must provide medical justification for Saxenda use, showing that other weight management attempts have been unsuccessful.
  •  

  • Each plan may have different formulary restrictions or preferences, so consult your specific benefit plan or contact Horizon BCBSNJ for details.
  •  

  • Employing wellness visits and engaging in a Horizon-approved weight management program may enhance chances of coverage approval.

 

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

 

Eligibility Criteria for Saxenda Coverage

 

  • The patient must be at least 18 years of age or older.
  •  

  • Saxenda is approved for adults with a Body Mass Index (BMI) of 30 kg/m² or greater.
  •  

  • Coverage is also available for adults with a BMI of 27 kg/m² or greater if accompanied by at least one weight-related comorbid condition, such as:
    • Hypertension
    • Type 2 Diabetes Mellitus
    • Dyslipidemia
  •  

  • Patients must have attempted prior weight management strategies with a structured lifestyle modification program which includes dietary changes, physical activity, and behavior therapy, and have had inadequate response despite this effort.
  •  

  • The use of Saxenda must be prescribed by a healthcare professional who is licensed to prescribe medications and who will oversee ongoing monitoring and progress of the treatment.
  •  

  • Continued use beyond an initial period of 16 weeks may require evidence of clinically meaningful weight loss, typically defined as at least 4% reduction in baseline body weight.

 

Documentation Requirements

 

  • Submission of a complete medical history, detailing the above criteria, including BMI measurements and any weight-related comorbid conditions.
  •  

  • Documentation of attempts at lifestyle interventions for weight loss, including duration and nature of the programs followed.
  •  

  • A statement of medical necessity from the prescribing healthcare professional asserting the clinical justification for Saxenda treatment.

 

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

 

Situations When Saxenda Coverage is Denied

 

  • Patients not meeting the Body Mass Index (BMI) requirement set by the policy, such as BMIs below the specified threshold for coverage.
  •  

  • Lack of documentation showing previous unsuccessful weight management programs or therapies.
  •  

  • Use of Saxenda for conditions not approved in the policy, such as weight management for non-obese individuals.
  •  

  • Concurrent use with other similar weight loss medications without clear medical justification.
  •  

  • Prescription of Saxenda without proper evaluation by a healthcare professional or specialist as required by the policy guidelines.
  •  

  • Instances of non-compliance with follow-up assessments or therapy monitoring, which are part of the coverage conditions.
  •  

  • Requests deemed experimental or investigational based on Horizon BCBSNJ’s medical policy.
  •  

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket 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 Saxenda Coverage with Horizon Blue Cross Blue Shield of New Jersey

 

Verify Current Health Plan Coverage

 

  • Contact Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) customer service to verify if Saxenda is included in your current plan. Use the phone number on your insurance card.
  •  

  • Ask about Saxenda coverage specifics, including co-pays, prior authorization, and any existing limitations such as preferred pharmacy networks or dosage restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss the need for Saxenda with your healthcare provider. They must be familiar with your health plan’s requirements and can help prepare the necessary documentation for coverage requests.
  •  

  • Make sure your healthcare provider writes a detailed justification for prescribing Saxenda, highlighting medical necessity according to your specific health conditions and history.

 

Initiate Prior Authorization

 

  • Request that your healthcare provider submit a prior authorization request form to Horizon BCBSNJ. This form is necessary to begin the coverage approval process for Saxenda.
  •  

  • Ensure all required forms and documentation are complete, including your provider's justification and any supporting medical records that may strengthen your case.

 

Follow Up with Horizon BCBSNJ

 

  • Contact Horizon BCBSNJ regularly to check the status of your prior authorization request. Having your policy number and claim reference handy will aid in quicker service.
  •  

  • If the request is denied, ask for specific reasons for the denial and what additional information is needed to reconsider the request.

 

Appeal if Necessary

 

  • If your request is denied, work with your healthcare provider to gather more detailed information and insights to support an appeal.
  •  

  • Submit an appeal to Horizon BCBSNJ, clearly outlining why Saxenda is necessary for your health based on additional information or overlooked evidence in the initial request.

 

Use Approved Pharmacies

 

  • Once you have received authorization, ensure that you fill your Saxenda prescriptions at a pharmacy within Horizon BCBSNJ's approved network to avoid any additional out-of-pocket expenses.
  •  

  • Keep track of your co-pays and any receipts for possible further claims or reimbursement inquiries.

 

Regularly Review Benefits

 

  • Periodically review your pharmacy benefits and discuss any changes in coverage with Horizon BCBSNJ during open enrollment periods to ensure continued coverage of Saxenda.
  •  

  • Stay informed of any updates to your plan that may affect your medication coverage or co-payment responsibilities.

 

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.

Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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.

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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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