Does Independence Blue Cross Cover Contrave

Explore coverage for Contrave with Independence Blue Cross, reasons for denial, costs without insurance, and tips to secure coverage. FAQs included.
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Coverage for Contrave

 

  • Independence Blue Cross may cover Contrave, a medication used to assist with weight management, depending on your specific plan and the medical necessity determined by your healthcare provider.
  •  

  • Coverage may require prior authorization where a healthcare provider must justify the necessity of Contrave for the patient.
  •  

  • It is often required that the patient has attempted other weight loss solutions without success before approval for Contrave.

 

Basic Rules and Criteria

 

  • The insured must typically meet specific BMI criteria or have weight-related health issues such as hypertension or diabetes.
  •  

  • The plan might necessitate enrolling in a weight management program as part of the treatment plan.
  •  

  • Regular follow-ups and documentation from your healthcare provider may be necessary to continue receiving coverage for Contrave.

 

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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 Contrave Coverage with Independence Blue Cross

 

Verify Your Coverage Options

 

  • Contact Independence Blue Cross directly by calling the customer service number on your insurance card to confirm if Contrave is included in your prescription drug coverage.
  •  

  • Visit your Independence Blue Cross member portal online, if available, to check your plan details for prescription medication benefits.
  •  

  • Review your specific policy documents for information related to weight loss medications and any restrictions that might apply.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave as part of your weight management plan.
  •  

  • Ask your provider to provide any necessary medical justification for prescribing Contrave, including documenting previous weight loss efforts and medical history.
  •  

  • Ensure that your provider is aware of any required prior authorization or specific documentation needed by Independence Blue Cross for coverage approval.

 

Obtain Prior Authorization

 

  • Work with your doctor to complete any prior authorization forms required by Independence Blue Cross. This step often involves providing a medical necessity statement.
  •  

  • Submit the completed prior authorization paperwork through the appropriate channels specified by Independence Blue Cross, either via fax, online submission, or mail.
  •  

  • Follow up with your insurance provider to confirm receipt and processing of the authorization request, if necessary.

 

Explore Financial Assistance Options

 

  • If Contrave is not covered or the out-of-pocket cost is too high, consider enrolling in a patient assistance program provided by the manufacturer.
  •  

  • Check if there are co-pay cards or discounts available through the Contrave official website that could reduce your expenses.
  •  

  • Consult with your pharmacy about generic or alternative medications covered under your plan that may have similar effects.

 

Appeal if Necessary

 

  • If your request for coverage is denied, request an explanation and details on filing an appeal from Independence Blue Cross.
  •  

  • Gather supporting documentation and a letter from your healthcare provider explaining why Contrave is medically necessary for your condition.
  •  

  • Submit your appeal in accordance with the guidelines provided by Independence Blue Cross and monitor the appeal process timeline to ensure timely resolution.

 

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Potential for results in as few as 6 months

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

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FAQs

Does Independence Blue Cross Cover Contrave

Explore coverage for Contrave with Independence Blue Cross, reasons for denial, costs without insurance, and tips to secure coverage. FAQs included.
Curex allergy drops unboxing

Is Contrave Covered by Independence Blue Cross

 

Coverage for Contrave

 

  • Independence Blue Cross may cover Contrave, a medication used to assist with weight management, depending on your specific plan and the medical necessity determined by your healthcare provider.
  •  

  • Coverage may require prior authorization where a healthcare provider must justify the necessity of Contrave for the patient.
  •  

  • It is often required that the patient has attempted other weight loss solutions without success before approval for Contrave.

 

Basic Rules and Criteria

 

  • The insured must typically meet specific BMI criteria or have weight-related health issues such as hypertension or diabetes.
  •  

  • The plan might necessitate enrolling in a weight management program as part of the treatment plan.
  •  

  • Regular follow-ups and documentation from your healthcare provider may be necessary to continue receiving coverage for Contrave.

 

A weight management program tailored to you

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Independence Blue Cross's Approved Criteria for Contrave Coverage

 

Criteria for Contrave Coverage under Independence Blue Cross

 

  • **BMI Requirements**: Individuals must have a body mass index (BMI) of 30 kg/m² or greater, OR a BMI of 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Age Restrictions**: Must be an adult aged 18 years or older.
  •  

  • **Prior Weight Management Attempts**: Documentation required of previous engagement in unsuccessful weight management attempts, including lifestyle changes or pharmacotherapy.
  •  

  • **Clinician Supervision**: Must be prescribed by a healthcare provider with experience and expertise in weight management.
  •  

  • **Combination Therapy Considerations**: If the individual is on existing weight-loss medication, medical justification for addition of Contrave must be provided.
  •  

  • **Compliance and Monitoring**: Commitment to continuous clinical monitoring and attendance of follow-up sessions to evaluate the effectiveness and safety of treatment.
  •  

  • **Renewal Criteria**: Subsequent reauthorization may require evidence of weight reduction, generally of at least 5% within a specified treatment period.

 

Why Independence Blue Cross Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage by Independence Blue Cross

 

  • Contrave is prescribed for off-label use that is not approved by the FDA.
  •  

  • The patient has not met the required BMI threshold as defined by the plan's medical policy guidelines.
  •  

  • The prescribed therapy does not comply with the step therapy protocols established in the policy.
  •  

  • There is insufficient medical documentation provided to justify the medical necessity of Contrave for the patient.
  •  

  • The patient has not tried or been unsuccessful with alternative, lower-cost weight management therapies before being prescribed Contrave.
  •  

  • Provisions of the patient’s health plan do not include weight management drugs or treatments.
  •  

  • The prescribed dosage does not align with the FDA-approved dosing guidelines and there is no supporting evidence for an exception.
  •  

  • Lack of coverage for lifestyle or preventive medications under the specific health plan of the insured.

 

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

How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with Independence Blue Cross

 

Verify Your Coverage Options

 

  • Contact Independence Blue Cross directly by calling the customer service number on your insurance card to confirm if Contrave is included in your prescription drug coverage.
  •  

  • Visit your Independence Blue Cross member portal online, if available, to check your plan details for prescription medication benefits.
  •  

  • Review your specific policy documents for information related to weight loss medications and any restrictions that might apply.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave as part of your weight management plan.
  •  

  • Ask your provider to provide any necessary medical justification for prescribing Contrave, including documenting previous weight loss efforts and medical history.
  •  

  • Ensure that your provider is aware of any required prior authorization or specific documentation needed by Independence Blue Cross for coverage approval.

 

Obtain Prior Authorization

 

  • Work with your doctor to complete any prior authorization forms required by Independence Blue Cross. This step often involves providing a medical necessity statement.
  •  

  • Submit the completed prior authorization paperwork through the appropriate channels specified by Independence Blue Cross, either via fax, online submission, or mail.
  •  

  • Follow up with your insurance provider to confirm receipt and processing of the authorization request, if necessary.

 

Explore Financial Assistance Options

 

  • If Contrave is not covered or the out-of-pocket cost is too high, consider enrolling in a patient assistance program provided by the manufacturer.
  •  

  • Check if there are co-pay cards or discounts available through the Contrave official website that could reduce your expenses.
  •  

  • Consult with your pharmacy about generic or alternative medications covered under your plan that may have similar effects.

 

Appeal if Necessary

 

  • If your request for coverage is denied, request an explanation and details on filing an appeal from Independence Blue Cross.
  •  

  • Gather supporting documentation and a letter from your healthcare provider explaining why Contrave is medically necessary for your condition.
  •  

  • Submit your appeal in accordance with the guidelines provided by Independence Blue Cross and monitor the appeal process timeline to ensure timely resolution.

 

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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A weight management program tailored to you

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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