Does Humana Cover Orlistat (Xenical, Alli)

Discover if Humana covers Orlistat (Xenical, Alli), reasons for denial, ways to secure coverage, cost without insurance, and FAQs answered.
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Coverage by Humana

 

  • Humana may cover Orlistat (Xenical, Alli) for weight loss in certain medical situations. Coverage typically requires a diagnosis of obesity or conditions related to excess weight.
  •  

  • Documentation from your healthcare provider indicating the medical necessity of Orlistat may be required to get coverage.

 

Basic Rules and Criteria

 

  • Orlistat coverage might require prior authorization. Check with Humana for specific prior authorization forms and processes.
  •  

  • You may need to demonstrate that you've tried other weight loss methods without success before Orlistat is covered.
  •  

  • Humana may impose quantity limits on Orlistat prescriptions, so consult your plan for specific limitations.

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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 Orlistat (Xenical, Alli) Coverage with Humana

 

Start by Understanding Humana's Coverage

 

  • Visit the Humana website or contact Humana customer service for details on their pharmacy coverage policies regarding weight loss medications, including Orlistat (Xenical, Alli).
  •  

  • Check if Orlistat is included in your specific Humana plan's formulary. Note the drug tier and any associated restrictions such as prior authorization or quantity limits.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat. Ensure your doctor understands your medical needs and supports your request for the medication.
  •  

  • Request a prescription for Orlistat, if your provider agrees it is necessary for your treatment plan. Discuss alternative treatments if Orlistat is not deemed appropriate.

 

Submit a Prior Authorization Request

 

  • If your Humana plan requires a prior authorization for Orlistat, ask your healthcare provider’s office to submit the necessary documentation on your behalf.
  •  

  • Provide any additional information Humana might require, such as a history of previous treatments tried, your BMI, and other health metrics relevant to the necessity of Orlistat.

 

Follow Up with Humana

 

  • Contact Humana to confirm receipt of the prior authorization request and inquire about the status. Stay informed about any further information they might need from you or your healthcare provider.
  •  

  • Understand the expected timeline for the prior authorization review process, as delays may occur if additional documentation is needed.

 

Understand Your Benefits and Costs

 

  • Once approved, review your Humana plan details regarding prescription copayments, coinsurance, and deductibles related to Orlistat.
  •  

  • Contact Humana or visit their website to verify which pharmacies are in-network, ensuring you receive the best pricing available. Consider mail-order options for additional savings.

 

Appeal If Necessary

 

  • If your request for Orlistat coverage is denied, inquire about the appeals process with Humana. Understand the reason for denial and prepare any additional information required to support your appeal.
  •  

  • Work with your healthcare provider during the appeals process to reinforce the necessity for Orlistat in your treatment plan.

 

Check for Prescription Assistance Programs

 

  • Explore potential prescription assistance programs offered by Humana or external organizations that may provide financial help or discounts on Orlistat.
  •  

  • Confirm any additional documentation you may need to submit to apply for or renew assistance.

 

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FAQs

Does Humana Cover Orlistat (Xenical, Alli)

Discover if Humana covers Orlistat (Xenical, Alli), reasons for denial, ways to secure coverage, cost without insurance, and FAQs answered.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Humana

 

Coverage by Humana

 

  • Humana may cover Orlistat (Xenical, Alli) for weight loss in certain medical situations. Coverage typically requires a diagnosis of obesity or conditions related to excess weight.
  •  

  • Documentation from your healthcare provider indicating the medical necessity of Orlistat may be required to get coverage.

 

Basic Rules and Criteria

 

  • Orlistat coverage might require prior authorization. Check with Humana for specific prior authorization forms and processes.
  •  

  • You may need to demonstrate that you've tried other weight loss methods without success before Orlistat is covered.
  •  

  • Humana may impose quantity limits on Orlistat prescriptions, so consult your plan for specific limitations.

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Humana's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Criteria for Humana Coverage of Orlistat (Xenical, Alli)

 

  • **Body Mass Index (BMI) Requirement**: The patient should have a BMI greater than or equal to 30 kg/m² (obese category), or a BMI greater than or equal to 27 kg/m² with accompanying risk factors such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Age Limitation**: Coverage is provided for patients who are 18 years of age or older.
  •  

  • **Prior Weight Management Efforts**: The patient must have engaged in a documented, physician-supervised weight management program that includes dietary, physical activity, and behavioral interventions for at least six months.
  •  

  • **Prescription Requirement**: Orlistat must be prescribed by a healthcare professional, and the prescriber should provide documentation of the patient's adherence to the weight management program and their need for pharmacological intervention.
  •  

  • **Concurrent Lifestyle Modifications**: The patient must be engaged in a comprehensive weight management plan that includes a reduced-calorie diet and increased physical activity, as Orlistat is intended to be adjunctive therapy.
  •  

  • **Plan Limitations**: Coverage is subject to the limits and conditions set within the specific Humana health plan, including possible dosage limitations or step therapy requirements.
  •  

  • **Monitoring of Treatment**: Continuous assessment for at least 12 weeks after treatment initiation is necessary, demonstrating that the patient has achieved a minimum of 5% weight loss from baseline. Continued use may be subject to reassessment based on weight loss and health improvements.
  •  

 

Why Humana Might Deny Orlistat (Xenical, Alli) Coverage

 

Criteria for Denial of Orlistat (Xenical, Alli) Coverage by Humana

 

  • Non-Compliance with Weight Management Program: If the patient is not enrolled in or compliant with a structured weight management program, coverage may be denied as the medication is typically intended to be part of a comprehensive plan.
  •  

  • Lack of Medical Necessity: If the patient's medical records do not adequately demonstrate the necessity of Orlistat for weight management, such as not having related comorbid conditions like hypertension or diabetes, coverage may be refused.
  •  

  • Absence of Obesity Diagnosis: Coverage could be denied if there is no documented diagnosis of obesity, generally defined as a body mass index (BMI) of 30 or higher.
  •  

  • Previous Authorization Requirement: Failure to obtain prior authorization before starting the medication can lead to denial. This step is often mandatory for confirming eligibility and necessity.
  •  

  • Exceeding Dosage Limits: If the prescribed dosage exceeds the plan's coverage limits, the medication might not be covered.
  •  

  • Inadequate Documentation of Previous Weight Loss Attempts: Lack of convincing documentation regarding previous attempts at weight loss might result in denial, as this may be needed to justify the need for Orlistat.
  •  

  • Non-Adherence to Age Requirements: If the patient does not meet specific age criteria stipulated by Humana's policy, coverage could be denied. Some plans have specific age restrictions for coverage.

 

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How Much Does Orlistat (Xenical, Alli) Cost without Insurance?

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

  • Xenical: The brand-name Orlistat, Xenical, can be quite expensive without insurance. Typically, the cost is around $800 to $1,000 for a supply of 90 capsules, with each capsule being 120 mg.
  •  

  • Alli: The over-the-counter version, Alli, is generally less expensive than its prescription counterpart. The price for Alli ranges from $50 to $100 for a supply of 120 capsules, with each capsule being 60 mg.
  •  

  • Generic Orlistat: While generic options may be available, they usually do not offer significant savings over the brand-name versions. The prices for generic Orlistat are often comparable to those of Alli, varying from $50 to $100 for a similar quantity.
  •  

  • Shopping Tips: Prices can vary depending on the pharmacy, location, and availability. Consider using pharmacy discount cards, online coupons, or comparing prices at different pharmacies to obtain the best deal.
  •  

  • Considerations: Always consult a healthcare provider before starting Orlistat, and discuss any potential insurance coverage or assistance programs they might recommend.

 

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 Orlistat (Xenical, Alli) Coverage with Humana

 

Start by Understanding Humana's Coverage

 

  • Visit the Humana website or contact Humana customer service for details on their pharmacy coverage policies regarding weight loss medications, including Orlistat (Xenical, Alli).
  •  

  • Check if Orlistat is included in your specific Humana plan's formulary. Note the drug tier and any associated restrictions such as prior authorization or quantity limits.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat. Ensure your doctor understands your medical needs and supports your request for the medication.
  •  

  • Request a prescription for Orlistat, if your provider agrees it is necessary for your treatment plan. Discuss alternative treatments if Orlistat is not deemed appropriate.

 

Submit a Prior Authorization Request

 

  • If your Humana plan requires a prior authorization for Orlistat, ask your healthcare provider’s office to submit the necessary documentation on your behalf.
  •  

  • Provide any additional information Humana might require, such as a history of previous treatments tried, your BMI, and other health metrics relevant to the necessity of Orlistat.

 

Follow Up with Humana

 

  • Contact Humana to confirm receipt of the prior authorization request and inquire about the status. Stay informed about any further information they might need from you or your healthcare provider.
  •  

  • Understand the expected timeline for the prior authorization review process, as delays may occur if additional documentation is needed.

 

Understand Your Benefits and Costs

 

  • Once approved, review your Humana plan details regarding prescription copayments, coinsurance, and deductibles related to Orlistat.
  •  

  • Contact Humana or visit their website to verify which pharmacies are in-network, ensuring you receive the best pricing available. Consider mail-order options for additional savings.

 

Appeal If Necessary

 

  • If your request for Orlistat coverage is denied, inquire about the appeals process with Humana. Understand the reason for denial and prepare any additional information required to support your appeal.
  •  

  • Work with your healthcare provider during the appeals process to reinforce the necessity for Orlistat in your treatment plan.

 

Check for Prescription Assistance Programs

 

  • Explore potential prescription assistance programs offered by Humana or external organizations that may provide financial help or discounts on Orlistat.
  •  

  • Confirm any additional documentation you may need to submit to apply for or renew assistance.

 

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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

  • Gastrointestinal issues: Common effects include oily or fatty stools, increased defecation, and the urgent or difficult need to control bowel movements.
  •  

  • Abdominal discomfort: Some users experience pain or discomfort in the abdomen region.
  •  

  • Reduced absorption of fat-soluble vitamins: Orlistat can interfere with the absorption of vitamins A, D, E, and K. A multivitamin supplement is often recommended.
  •  

  • Allergic reactions: Though rare, symptoms may include itching, rash, or swelling, especially of the face, tongue, or throat.
  •  

  • Others: Some users report headaches, back pain, or flu-like symptoms.

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

  • Orlistat aids weight loss by blocking the absorption of fats from the diet, reducing caloric intake. It can block approximately 25-30% of dietary fat.
  •  

  • Clinical studies suggest that Orlistat use for one year can result in an average weight loss of about 5-10% of initial body weight, when combined with a calorie-reduced diet.
  •  

  • It promotes modest weight loss over time and helps maintain weight loss. The effectiveness can improve with lifestyle changes such as increased physical activity and diet modifications.
  •  

  • Orlistat also has beneficial effects on cholesterol levels and may help reduce blood pressure.

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

  • Orlistat is available in two forms: prescription strength (Xenical) and over-the-counter (Alli).
  •  

  • **Xenical**: This is the 120 mg version and requires a doctor's prescription. It's typically used for patients with a higher body mass index (BMI) or more specific medical conditions.
  •  

  • **Alli**: The 60 mg variant can be purchased over the counter in many countries, including the United States and the UK.
  •  

  • Even though Alli is accessible without a prescription, it is advised to consult with a healthcare professional before starting, to discuss its suitability and ensure proper usage.
  •  

 

Considerations Before Using Orlistat

 

  • Proper dietary changes are necessary when taking Orlistat to maximize effectiveness and reduce side effects.
  •  

  • Discuss your complete medical history and any other medications you are taking with your healthcare provider.

 

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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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