Does Humana Cover Liraglutide (Saxenda)

Find out if Humana covers Liraglutide (Saxenda), reasons for denial, how to secure coverage, costs without insurance, and answers to FAQs.
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Does Humana Cover Liraglutide (Saxenda)

 

  • Humana may cover Saxenda for weight management, typically if prescribed for patients with a BMI of 30 or higher (obesity) or a BMI of 27 or higher with at least one weight-related medical condition such as hypertension or type 2 diabetes.
  •  

  • Coverage often requires prior authorization. This means your doctor must confirm that Saxenda is medically necessary for your condition and document any previous weight loss attempts.
  •  

  • Policy specifics can vary based on your plan. It’s recommended to review your specific Humana insurance plan or contact Humana directly to understand the exact coverage details and any out-of-pocket costs that may apply.
  •  

  • Additional criteria may include documentation of continued weight loss success with Saxenda to maintain ongoing coverage.

 

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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 Liraglutide (Saxenda) Coverage with Humana

 

Verify Your Insurance Coverage

 

  • Contact Humana directly to discuss your current plan specifics and verify if Liraglutide (Saxenda) is covered under your prescription benefits.
  •  

  • Review your plan’s formulary, a document that lists covered drugs; check if Saxenda or its generic counterparts are listed.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Saxenda and confirm if it’s a suitable treatment for your condition.
  •  

  • Ask your healthcare provider to provide medical documentation and a letter of medical necessity if required by Humana for coverage justification.

 

Pre-authorization Process

 

  • Check if pre-authorization is needed for Saxenda under your Humana plan, which is often necessary for specialty medications.
  •  

  • Coordinate with your healthcare provider to submit the necessary pre-authorization request forms and documentation to Humana.

 

Explore Savings Programs

 

  • Investigate if there are manufacturer savings programs or coupons for Saxenda that can be applied alongside insurance coverage to lower out-of-pocket costs.
  •  

  • Visit the official Saxenda website or contact the manufacturer for information on available patient assistance programs.

 

Follow Up on Claim Status

 

  • After submission, regularly follow up with Humana and your pharmacy to monitor the status of your pre-authorization request and any claims filed.
  •  

  • In case of a denial, work with your healthcare provider to address any issues or additional information needed to appeal the decision.

 

Additional Support and Assistance

 

  • Contact Humana member services for assistance with navigating coverage details, understanding your benefits, or resolving issues with claims and authorizations.
  •  

  • Consider reaching out to a healthcare advocate or a pharmacist who can provide additional guidance on medication management and insurance processes.

 

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FAQs

Does Humana Cover Liraglutide (Saxenda)

Find out if Humana covers Liraglutide (Saxenda), reasons for denial, how to secure coverage, costs without insurance, and answers to FAQs.
Curex allergy drops unboxing

Is Liraglutide (Saxenda) Covered by Humana

 

Does Humana Cover Liraglutide (Saxenda)

 

  • Humana may cover Saxenda for weight management, typically if prescribed for patients with a BMI of 30 or higher (obesity) or a BMI of 27 or higher with at least one weight-related medical condition such as hypertension or type 2 diabetes.
  •  

  • Coverage often requires prior authorization. This means your doctor must confirm that Saxenda is medically necessary for your condition and document any previous weight loss attempts.
  •  

  • Policy specifics can vary based on your plan. It’s recommended to review your specific Humana insurance plan or contact Humana directly to understand the exact coverage details and any out-of-pocket costs that may apply.
  •  

  • Additional criteria may include documentation of continued weight loss success with Saxenda to maintain ongoing coverage.

 

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Humana's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Eligibility for Coverage

 

  • Patient must be 18 years or older.
  •  

  • Must have a Body Mass Index (BMI) of 30 kg/m² or greater (classified as obese).
  •  

  • Alternatively, if the patient has a BMI of 27 kg/m² or greater, they must have at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.

 

Prior Treatment Requirements

 

  • The patient must have previously attempted weight management using a plan that includes dietary and behavioral modifications without achieving significant weight loss.
  •  

  • Evidence of engagement in a supervised weight reduction program should be provided.

 

Medication Compliance

 

  • Patient must demonstrate the ability to adhere to the medication regimen consistently as prescribed.
  •  

  • A follow-up assessment must confirm adherence and tolerability of the medication.

 

Clinical Monitoring Criteria

 

  • Regular follow-up consultations with healthcare professionals to monitor progress and any side effects.
  •  

  • Demonstrated reduction in body weight that indicates a positive response to the treatment within the first 16 weeks.

 

Additional Considerations

 

  • Patient must be free from contraindications associated with Liraglutide use, such as personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.
  •  

  • Approval may require submission of relevant medical history and a treatment plan from the healthcare provider.

 

Why Humana Might Deny Liraglutide (Saxenda) Coverage

 

Situations When Humana Does Not Cover Liraglutide (Saxenda)

 

  • The patient does not meet the BMI criteria: Humana may deny coverage if the patient does not have a body mass index (BMI) of 30 or greater, or a BMI of 27 or higher with at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Lack of documentation supporting weight-related comorbidities: If there is insufficient medical documentation to confirm the presence of a weight-related comorbidity, Humana might deny coverage.
  •  

  • Use for cosmetic purposes: Liraglutide (Saxenda) will not be covered by Humana if it is prescribed for cosmetic weight loss purposes rather than for treating obesity or weight-related conditions.
  •  

  • Age restrictions: Humana may not cover this medication if prescribed to patients under the age of 18, as it is not approved for pediatric weight management.
  •  

  • Failure to adhere to lifestyle modifications: If there is no evidence that the patient is following a comprehensive lifestyle intervention program including dietary, exercise, and behavioral changes, coverage may be denied.
  •  

  • Prior authorization requirements not met: Humana may require prior authorization and could deny coverage if the necessary documentation and criteria for prior approval are not met.
  •  

  • Exclusion from plan benefits: Some Humana insurance plans may specifically exclude weight loss drugs like Saxenda from their benefits coverage.

 

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

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 Liraglutide (Saxenda) Coverage with Humana

 

Verify Your Insurance Coverage

 

  • Contact Humana directly to discuss your current plan specifics and verify if Liraglutide (Saxenda) is covered under your prescription benefits.
  •  

  • Review your plan’s formulary, a document that lists covered drugs; check if Saxenda or its generic counterparts are listed.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Saxenda and confirm if it’s a suitable treatment for your condition.
  •  

  • Ask your healthcare provider to provide medical documentation and a letter of medical necessity if required by Humana for coverage justification.

 

Pre-authorization Process

 

  • Check if pre-authorization is needed for Saxenda under your Humana plan, which is often necessary for specialty medications.
  •  

  • Coordinate with your healthcare provider to submit the necessary pre-authorization request forms and documentation to Humana.

 

Explore Savings Programs

 

  • Investigate if there are manufacturer savings programs or coupons for Saxenda that can be applied alongside insurance coverage to lower out-of-pocket costs.
  •  

  • Visit the official Saxenda website or contact the manufacturer for information on available patient assistance programs.

 

Follow Up on Claim Status

 

  • After submission, regularly follow up with Humana and your pharmacy to monitor the status of your pre-authorization request and any claims filed.
  •  

  • In case of a denial, work with your healthcare provider to address any issues or additional information needed to appeal the decision.

 

Additional Support and Assistance

 

  • Contact Humana member services for assistance with navigating coverage details, understanding your benefits, or resolving issues with claims and authorizations.
  •  

  • Consider reaching out to a healthcare advocate or a pharmacist who can provide additional guidance on medication management and insurance processes.

 

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Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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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