Does Kaiser Permanente Cover Orlistat (Xenical, Alli)

Explore coverage details for Orlistat by Kaiser, denial reasons, cost without insurance, and FAQs to navigate your prescription effectively.
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Orlistat Coverage by Kaiser Permanente

 

  • **Eligibility**: Kaiser Permanente generally covers Orlistat (Xenical, Alli) as part of its pharmacy benefit scheme. Coverage may depend on the specific health plan and region, as well as medical necessity.
  •  

  • **Medical Criteria**: Before covering Orlistat, Kaiser Permanente typically requires a diagnosis of obesity-related conditions, such as a BMI of 30 or higher, or a BMI of 27 with associated risk factors like hypertension or diabetes.
  •  

  • **Prescription Requirement**: A prescription from a Kaiser Permanente healthcare provider is necessary. The provider's assessment and documentation justify the need for Orlistat.
  •  

  • **Plan Verification**: As formularies differ, it's important to verify coverage details directly through the member's specific health plan. Contact Kaiser Permanente customer service for precise information.
  •  

  • **Approval Process**: Pre-authorization might be required, ensuring that the medication aligns with Kaiser Permanente's criteria for medical necessity and plan guidelines.
  •  

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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.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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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 Kaiser Permanente

 

Understand Kaiser Permanente's Coverage Policies

 

  • Contact Kaiser Permanente member services to determine whether Orlistat (Xenical, Alli) is covered under your specific health plan. You can usually find the contact information on your insurance card or through the Kaiser Permanente website.
  •  

  • Visit the Kaiser Permanente website and log into your member account to access detailed information about drug coverage and health benefits related to weight management.

 

Consult with Your Primary Care Provider

 

  • Schedule an appointment with your primary care physician to discuss your weight loss goals and medical history. Ensure this provider is within the Kaiser Permanente network to facilitate coverage discussions and prescriptions.
  •  

  • Discuss the appropriateness of Orlistat for your weight loss plan and health conditions. Your physician will need to agree that this medication is a suitable option for you.

 

Obtain a Prescription

 

  • If your doctor agrees that Orlistat is suitable, they will prescribe the medication. Ensure they send the prescription to a Kaiser Permanente pharmacy to streamline the coverage process.
  •  

  • Check with the pharmacy about any forms or documentation you need to complete to conform with Kaiser Permanente's billing procedures.

 

Check Your Plan's Prior Authorization Requirements

 

  • Some insurance plans require prior authorization for medications like Orlistat. Confirm with your provider or pharmacy if Kaiser's policy mandates prior authorization for Orlistat and ask your physician to submit any necessary documentation.
  •  

  • Ensure all pre-authorization forms are filled accurately and completely to avoid delays in approval. Regularly follow up with your provider and Kaiser Permanente on the status of your authorization request.

 

Follow Up on Approval Status

 

  • Contact your pharmacy to verify if the prescription is approved and ready for pick-up. If there are any issues, work with your provider or member services to resolve them promptly.
  •  

  • Always keep copies of approval documents or correspondence in case any issues arise regarding coverage later.

 

Understand Your Costs

 

  • Review the copayment or coinsurance terms under your Kaiser Permanente plan. Knowing your out-of-pocket costs will help you budget for the medication.
  •  

  • Inquire about payment plans or financial assistance if you're concerned about being able to afford your medication, as Kaiser Permanente often provides options based on financial need.

 

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FAQs

Does Kaiser Permanente Cover Orlistat (Xenical, Alli)

Explore coverage details for Orlistat by Kaiser, denial reasons, cost without insurance, and FAQs to navigate your prescription effectively.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Kaiser Permanente

 

Orlistat Coverage by Kaiser Permanente

 

  • **Eligibility**: Kaiser Permanente generally covers Orlistat (Xenical, Alli) as part of its pharmacy benefit scheme. Coverage may depend on the specific health plan and region, as well as medical necessity.
  •  

  • **Medical Criteria**: Before covering Orlistat, Kaiser Permanente typically requires a diagnosis of obesity-related conditions, such as a BMI of 30 or higher, or a BMI of 27 with associated risk factors like hypertension or diabetes.
  •  

  • **Prescription Requirement**: A prescription from a Kaiser Permanente healthcare provider is necessary. The provider's assessment and documentation justify the need for Orlistat.
  •  

  • **Plan Verification**: As formularies differ, it's important to verify coverage details directly through the member's specific health plan. Contact Kaiser Permanente customer service for precise information.
  •  

  • **Approval Process**: Pre-authorization might be required, ensuring that the medication aligns with Kaiser Permanente's criteria for medical necessity and plan guidelines.
  •  

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

 

Eligibility Criteria for Orlistat (Xenical, Alli) Coverage

 

  • Member must have a Body Mass Index (BMI) of 30 kg/m² or higher.
  •  

  • Members with a BMI of 27 kg/m² or higher may be eligible if they have associated risk factors such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Member must have attempted weight loss through a structured program involving diet, exercise, and behavior modification, but without sufficient weight loss.
  •  

  • The prescribing physician must determine that the potential benefits of using Orlistat outweigh the risks for the individual member.

 

Documentation Requirements

 

  • A record of the member's weight loss attempts including types of programs and duration is required.
  •  

  • Clinical documentation supporting any associated risk factors, if applying under the 27 kg/m² BMI criteria, should be provided.
  •  

  • A comprehensive medical evaluation ruled by the prescribing physician to exclude other causes of obesity.

 

Prescription and Usage Guidelines

 

  • The prescription must be initiated and supervised by a healthcare provider experienced in the management of obesity.
  •  

  • The member should continue to be involved in a comprehensive weight management program while on Orlistat treatment.
  •  

  • Periodic evaluation by the provider to assess efficacy and safety is required for continued coverage.
  •  

  • The usage of Orlistat should be in conjunction with a nutritionally balanced, reduced-calorie diet containing approximately 30% of calories from fat.

 

Why Kaiser Permanente Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons for Denial of Orlistat Coverage

 

  • Kaiser Permanente may deny coverage if Orlistat is not deemed medically necessary for the patient's condition. This determination is made based on their medical policies and guidelines.
  •  

  • Orlistat may not be covered if it is prescribed for off-label uses that are not approved by the FDA or lack sufficient evidence of efficacy.
  •  

  • If the patient's body mass index (BMI) or weight-related health conditions do not meet the specific criteria established by Kaiser Permanente for obesity treatment, coverage for Orlistat may be denied.
  •  

  • Coverage might be denied if the patient has not complied with other prior treatments or lifestyle interventions recommended by healthcare providers, such as diet and exercise modifications.
  •  

  • Kaiser Permanente may deny coverage if there is a presence of specific contraindications or potential drug interactions outlined in their policy that make the use of Orlistat unsafe for the patient.
  •  

 

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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 Kaiser Permanente

 

Understand Kaiser Permanente's Coverage Policies

 

  • Contact Kaiser Permanente member services to determine whether Orlistat (Xenical, Alli) is covered under your specific health plan. You can usually find the contact information on your insurance card or through the Kaiser Permanente website.
  •  

  • Visit the Kaiser Permanente website and log into your member account to access detailed information about drug coverage and health benefits related to weight management.

 

Consult with Your Primary Care Provider

 

  • Schedule an appointment with your primary care physician to discuss your weight loss goals and medical history. Ensure this provider is within the Kaiser Permanente network to facilitate coverage discussions and prescriptions.
  •  

  • Discuss the appropriateness of Orlistat for your weight loss plan and health conditions. Your physician will need to agree that this medication is a suitable option for you.

 

Obtain a Prescription

 

  • If your doctor agrees that Orlistat is suitable, they will prescribe the medication. Ensure they send the prescription to a Kaiser Permanente pharmacy to streamline the coverage process.
  •  

  • Check with the pharmacy about any forms or documentation you need to complete to conform with Kaiser Permanente's billing procedures.

 

Check Your Plan's Prior Authorization Requirements

 

  • Some insurance plans require prior authorization for medications like Orlistat. Confirm with your provider or pharmacy if Kaiser's policy mandates prior authorization for Orlistat and ask your physician to submit any necessary documentation.
  •  

  • Ensure all pre-authorization forms are filled accurately and completely to avoid delays in approval. Regularly follow up with your provider and Kaiser Permanente on the status of your authorization request.

 

Follow Up on Approval Status

 

  • Contact your pharmacy to verify if the prescription is approved and ready for pick-up. If there are any issues, work with your provider or member services to resolve them promptly.
  •  

  • Always keep copies of approval documents or correspondence in case any issues arise regarding coverage later.

 

Understand Your Costs

 

  • Review the copayment or coinsurance terms under your Kaiser Permanente plan. Knowing your out-of-pocket costs will help you budget for the medication.
  •  

  • Inquire about payment plans or financial assistance if you're concerned about being able to afford your medication, as Kaiser Permanente often provides options based on financial need.

 

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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.

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.

 

Have questions left?

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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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