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Does Kaiser Permanente Cover Diethylpropion (Tenuate)

Learn why Kaiser Permanente might not cover Diethylpropion, how to get coverage, cost without insurance, and find answers to your burning questions.
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Coverage for Diethylpropion (Tenuate)

 

  • Kaiser Permanente's coverage for Diethylpropion, also known as Tenuate, varies based on individual health plans and regional policies.

    •  

  • Diethylpropion is typically used as a short-term aid for weight loss, so its coverage may depend on if it's deemed medically necessary.

    •  

  • Members should verify their specific plan details to confirm coverage, as not all plans may include this medication.

 

Criteria for Coverage

 

  • Diethylpropion may be covered if prescribed for weight loss in patients who have not had success with diet and exercise alone.

    •  

  • Patients might need to meet certain body mass index (BMI) criteria, typically a BMI over 30, or over 27 with obesity-related conditions.

    •  

  • Pre-authorization or a letter of medical necessity from a healthcare provider may be required to ensure coverage.

 

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Clinical Support

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 Diethylpropion (Tenuate) Coverage with Kaiser Permanente

 

Initial Consultation with Kaiser Permanente

 

  • Contact your primary care provider (PCP) within the Kaiser Permanente network to discuss your needs and health goals. Ensure that your PCP understands that you are seeking a prescription for Diethylpropion (Tenuate).

    •  

  • Provide your PCP with a detailed medical history, including any weight loss efforts and previous medications tried. This information can assist your PCP in understanding why Diethylpropion may be necessary.

 

Prescription Requirements and Documentation

 

  • After the consultation, your doctor will determine if Diethylpropion (Tenuate) is a suitable option. They will assess your Body Mass Index (BMI), weight-related health issues, and previous weight loss attempts.

    •  

  • If prescribed, ensure the physician notes the medical necessity of Diethylpropion in your medical records. This documentation is crucial for insurance coverage.

 

Review Kaiser Permanente’s Drug Formulary

 

  • Check if Diethylpropion is included in Kaiser Permanente’s drug formulary. You can access this list online through Kaiser’s official website or request a copy from your provider.

    •  

  • If Diethylpropion is not listed, discuss possible substitutes or next steps with your doctor. They might recommend alternatives that are covered.

 

Request a Prior Authorization

 

  • If Diethylpropion is not automatically covered, you or your physician can request a prior authorization (PA). This process involves submitting a detailed justification for why the medication is necessary for your treatment.

    •  

  • The PA request should include all supporting documentation and be submitted through the appropriate Kaiser Permanente channels.

 

Follow Up on the Authorization Status

 

  • Regularly check the status of your prior authorization request. Contact Kaiser Permanente’s pharmacy services or customer service for updates.

    •  

  • If denied, inquire about the specific reasons for denial and discuss potential appeals with your physician. They may need to provide additional information or alternative documentation.

 

Appeal if Necessary

 

  • In case of denial after PA, work with your healthcare provider to formulate an appeal. This should include new evidence to support your case, additional medical documentation, or a letter of necessity from your doctor.

    •  

  • Submit the appeal through the appropriate Kaiser Permanente process, and ensure you meet any deadlines outlined in the denial paperwork.

 

Alternative Solutions

 

  • If coverage is ultimately denied, discuss other therapeutic options with your physician that might be covered under your plan.

    •  

  • Consider generic alternatives or potential discounts through pharmaceutical assistance programs if coverage is not approved.

 

Maintain Open Communication

 

  • Stay in regular communication with your healthcare provider and Kaiser Permanente to ensure that all necessary steps are followed for potential coverage.

    •  

  • Update your provider with any changes in your health status that might support the necessity of Diethylpropion for your treatment plan.

 

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FAQs

Does Kaiser Permanente Cover Diethylpropion (Tenuate)

Learn why Kaiser Permanente might not cover Diethylpropion, how to get coverage, cost without insurance, and find answers to your burning questions.
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Is Diethylpropion (Tenuate) Covered by Kaiser Permanente

 

Coverage for Diethylpropion (Tenuate)

 

  • Kaiser Permanente's coverage for Diethylpropion, also known as Tenuate, varies based on individual health plans and regional policies.

    •  

  • Diethylpropion is typically used as a short-term aid for weight loss, so its coverage may depend on if it's deemed medically necessary.

    •  

  • Members should verify their specific plan details to confirm coverage, as not all plans may include this medication.

 

Criteria for Coverage

 

  • Diethylpropion may be covered if prescribed for weight loss in patients who have not had success with diet and exercise alone.

    •  

  • Patients might need to meet certain body mass index (BMI) criteria, typically a BMI over 30, or over 27 with obesity-related conditions.

    •  

  • Pre-authorization or a letter of medical necessity from a healthcare provider may be required to ensure coverage.

 

A weight management program tailored to you

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Kaiser Permanente's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility Criteria for Diethylpropion (Tenuate) Coverage

 

  • The patient must have a documented diagnosis of obesity, defined as a Body Mass Index (BMI) ≥ 30 kg/m², or a BMI ≥ 27 kg/m² in the presence of weight-related comorbidities such as hypertension, type 2 diabetes mellitus, or dyslipidemia.

    •  

  • An evaluation from an appropriate healthcare provider confirming the patient has tried and failed a comprehensive program of diet, exercise, and behavioral modification for weight loss.

    •  

  • Diethylpropion is indicated as a short-term adjunct in the management of exogenous obesity in conjunction with a reduced-calorie diet and exercise regimen. There should be evidence of continued adherence to these lifestyle changes.

    •  

  • The initial prescription must be written by, or in consultation with, a specialist knowledgeable in obesity management, such as an endocrinologist or bariatric specialist.

    •  

  • Diethylpropion may be considered in patients who have not adequately responded to, or are intolerant of, other FDA-approved pharmacologic therapies for weight loss.

    •  

  • Patients should not have a history of cardiovascular disease, uncontrolled high blood pressure, or hyperthyroidism.

    •  

  • The patient’s healthcare provider must provide documentation of informed consent discussing the potential risks and benefits of diethylpropion therapy.

 

Continuation of Therapy Criteria

 

  • Within the initial 12-week period of therapy, the patient must demonstrate a clinically significant weight loss, defined as a reduction of at least 5% of baseline body weight.

    •  

  • Ongoing treatment should be evaluated every 30 days to ensure continued effectiveness and safety, with medical records documenting weight loss progression and absence of adverse effects.

    •  

  • Continuation beyond the initial coverage period requires reassessment of the patient's overall health status, lifestyle adherence, and the renewal of informed consent expressing the patient's continued motivation and understanding of therapy goals.

 

Why Kaiser Permanente Might Deny Diethylpropion (Tenuate) Coverage

 

General Exclusions from Coverage

 

  • Diethylpropion is categorized as a weight loss medication, and many health insurance policies, including Kaiser Permanente, might have specific exclusions for drugs used primarily for cosmetic weight loss purposes.

    •  

  • The medication may also be excluded if used for non-medically necessary purposes as determined by the provider's policy guidelines.

 

Failure to Meet Medical Criteria

 

  • Patients who do not meet the body mass index (BMI) criteria or other specific medical conditions outlined by Kaiser Permanente for the use of weight management medications might be denied coverage.

    •  

  • Absence of physician documentation demonstrating prior efforts at weight loss, such as diet, exercise, or non-pharmacologic interventions, might result in denial.

 

Restricted Drug List

 

  • If Diethylpropion is not included in Kaiser Permanente's formulary or is placed on a restricted drug list, it might be denied unless there is compelling evidence justifying its necessity over covered alternatives.

 

Policy and Plan Specific Exclusions

 

  • Some Kaiser Permanente plans may have specific benefit exclusions for certain categories of medications, including appetite suppressants, regardless of individual circumstances.

    •  

  • The coverage might also be affected by the specific plan type, such as HMO, PPO, or a high-deductible plan, which could have its own restrictions or limitations on coverage for particular medications.

 

Lack of Preauthorization

 

  • Failure to obtain required preauthorization or lack of referral from a primary care provider might result in denial of coverage for Diethylpropion.

 

State-Specific Restrictions

 

  • Certain state regulations might have specific restrictions on coverage for weight-loss medications, which would apply to Kaiser Permanente policyholders in those regions.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.

    •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.

    •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.

    •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.

    •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

Clinical Support

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 Diethylpropion (Tenuate) Coverage with Kaiser Permanente

 

Initial Consultation with Kaiser Permanente

 

  • Contact your primary care provider (PCP) within the Kaiser Permanente network to discuss your needs and health goals. Ensure that your PCP understands that you are seeking a prescription for Diethylpropion (Tenuate).

    •  

  • Provide your PCP with a detailed medical history, including any weight loss efforts and previous medications tried. This information can assist your PCP in understanding why Diethylpropion may be necessary.

 

Prescription Requirements and Documentation

 

  • After the consultation, your doctor will determine if Diethylpropion (Tenuate) is a suitable option. They will assess your Body Mass Index (BMI), weight-related health issues, and previous weight loss attempts.

    •  

  • If prescribed, ensure the physician notes the medical necessity of Diethylpropion in your medical records. This documentation is crucial for insurance coverage.

 

Review Kaiser Permanente’s Drug Formulary

 

  • Check if Diethylpropion is included in Kaiser Permanente’s drug formulary. You can access this list online through Kaiser’s official website or request a copy from your provider.

    •  

  • If Diethylpropion is not listed, discuss possible substitutes or next steps with your doctor. They might recommend alternatives that are covered.

 

Request a Prior Authorization

 

  • If Diethylpropion is not automatically covered, you or your physician can request a prior authorization (PA). This process involves submitting a detailed justification for why the medication is necessary for your treatment.

    •  

  • The PA request should include all supporting documentation and be submitted through the appropriate Kaiser Permanente channels.

 

Follow Up on the Authorization Status

 

  • Regularly check the status of your prior authorization request. Contact Kaiser Permanente’s pharmacy services or customer service for updates.

    •  

  • If denied, inquire about the specific reasons for denial and discuss potential appeals with your physician. They may need to provide additional information or alternative documentation.

 

Appeal if Necessary

 

  • In case of denial after PA, work with your healthcare provider to formulate an appeal. This should include new evidence to support your case, additional medical documentation, or a letter of necessity from your doctor.

    •  

  • Submit the appeal through the appropriate Kaiser Permanente process, and ensure you meet any deadlines outlined in the denial paperwork.

 

Alternative Solutions

 

  • If coverage is ultimately denied, discuss other therapeutic options with your physician that might be covered under your plan.

    •  

  • Consider generic alternatives or potential discounts through pharmaceutical assistance programs if coverage is not approved.

 

Maintain Open Communication

 

  • Stay in regular communication with your healthcare provider and Kaiser Permanente to ensure that all necessary steps are followed for potential coverage.

    •  

  • Update your provider with any changes in your health status that might support the necessity of Diethylpropion for your treatment plan.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.

    •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.

    •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.

    •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.

    •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.

    •  

  • Primarily effective when combined with a structured diet and exercise plan.

    •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.

    •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.

    •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.

    •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.

    •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.

    •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.

    •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.

    •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.

    •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

Have questions left?

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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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
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Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

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