Does Kaiser Permanente Cover Phendimetrazine

Explore coverage details, costs, and FAQs about Phendimetrazine with Kaiser Permanente. Learn why it might be denied and how to secure insurance coverage.
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Phendimetrazine Coverage by Kaiser Permanente

 

  • Kaiser Permanente's coverage for Phendimetrazine varies based on individual health plans and medical necessity criteria.
  •  

  • Primarily, Phendimetrazine may be covered for patients with obesity-related health conditions, where weight loss is deemed medically necessary.
  •  

  • Physicians may need to provide documentation stating that non-pharmacological interventions have been ineffective.
  •  

  • Coverage may require prior authorization, confirming that Phendimetrazine is part of a comprehensive weight-loss program.
  •  

  • Patients may be required to meet specific BMI thresholds or have certain co-morbid conditions to qualify for coverage.
  •  

  • It's advisable to consult your plan details or contact a Kaiser Permanente representative to get specific information on coverage and necessary steps.

 

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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 Phendimetrazine Coverage with Kaiser Permanente

 

Verify Your Plan Benefits

 

  • Log in to your Kaiser Permanente member account or review your plan documents to confirm your prescription drug coverage details.
  •  

  • Check if Phendimetrazine is included in the covered medications list (formulary). You may need to use the search feature or browse by drug category.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your primary care physician to discuss your need for Phendimetrazine. Ensure they understand your health history and weight loss goals.
  •  

  • Your doctor will evaluate whether Phendimetrazine is a suitable medication for your condition and if it is the right choice for your treatment plan.

 

Obtain a Prescription

 

  • If the healthcare provider agrees that Phendimetrazine is appropriate for you, they will issue a prescription.
  •  

  • Make sure the prescription includes all necessary details and complies with Kaiser Permanente’s prescribing guidelines.

 

Confirm In-Network Pharmacy Availability

 

  • Locate an in-network pharmacy where you can fill your prescription. Use Kaiser Permanente’s online tools or contact customer service for assistance.
  •  

  • Check if the pharmacy has Phendimetrazine in stock and verify any special requirements for controlled substances.

 

Submit a Coverage Request

 

  • If Phendimetrazine is not automatically covered, you may need to submit a prior authorization request. Your physician’s office can assist with this process.
  •  

  • Kaiser Permanente will review the request to determine if the medication is medically necessary and covered under your plan.

 

Monitor Request Status and Appeals

 

  • Follow up on the status of your coverage request. You can do this through your Kaiser Permanente online account or by contacting their customer service.
  •  

  • If your initial request is denied, you have the right to appeal the decision. Gather any additional documentation your doctor can provide to support your appeal.

 

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FAQs

Does Kaiser Permanente Cover Phendimetrazine

Explore coverage details, costs, and FAQs about Phendimetrazine with Kaiser Permanente. Learn why it might be denied and how to secure insurance coverage.
Curex allergy drops unboxing

Is Phendimetrazine Covered by Kaiser Permanente

 

Phendimetrazine Coverage by Kaiser Permanente

 

  • Kaiser Permanente's coverage for Phendimetrazine varies based on individual health plans and medical necessity criteria.
  •  

  • Primarily, Phendimetrazine may be covered for patients with obesity-related health conditions, where weight loss is deemed medically necessary.
  •  

  • Physicians may need to provide documentation stating that non-pharmacological interventions have been ineffective.
  •  

  • Coverage may require prior authorization, confirming that Phendimetrazine is part of a comprehensive weight-loss program.
  •  

  • Patients may be required to meet specific BMI thresholds or have certain co-morbid conditions to qualify for coverage.
  •  

  • It's advisable to consult your plan details or contact a Kaiser Permanente representative to get specific information on coverage and necessary steps.

 

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Kaiser Permanente's Approved Criteria for Phendimetrazine Coverage

 

Kaiser Permanente's Approved Criteria for Phendimetrazine Coverage

 

  • Phendimetrazine is approved for patients who have tried and failed other weight loss management strategies. This includes verified attempts with lifestyle changes such as diet and exercise.
  •  

  • Patient must have a Body Mass Index (BMI) of 30 kg/m2 or greater. Alternatively, coverage is also approved for patients with a BMI of 27 kg/m2 or greater if they have comorbid conditions like hypertension, diabetes, or dyslipidemia.
  •  

  • The prescribing physician must determine that Phendimetrazine is medically necessary and appropriate for the patient’s treatment plan.
  •  

  • Continued coverage depends on the patient achieving a weight reduction of at least 4% within the initial 12 weeks of therapy.
  •  

  • Patient should not have a history of abuse of drugs or alcohol. The prescribing physician must confirm this through medical histories and evaluations.
  •  

  • Coverage may be subject to periodic review, ensuring ongoing need and patient adherence to prescribed regimen and lifestyle adjustments.

 

Why Kaiser Permanente Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage by Kaiser Permanente

 

  • The prescription does not meet the necessary diagnostic criteria for coverage. It may be denied if the patient does not have a documented medical need for weight management medication.
  •  

  • Lack of adherence to prior authorization requirements. If the necessary prior authorization was not obtained before prescribing Phendimetrazine, coverage might be denied.
  •  

  • Prescription is deemed as off-label use. If Phendimetrazine is prescribed for a condition that is not covered under the patient’s specific health plan, it may result in denial.
  •  

  • Usage exceeds the plan limitations. If the prescribed dosage or duration of treatment is beyond what Kaiser Permanente covers, the coverage may not be approved.
  •  

  • Non-compliance with formulary guidelines. If Phendimetrazine is not included in the formulary or if a formulary alternative exists, coverage could be declined.
  •  

  • Incomplete or incorrect information provided. If the required information is missing or contains errors in the coverage request, the approval might be withheld.

 

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

How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Kaiser Permanente

 

Verify Your Plan Benefits

 

  • Log in to your Kaiser Permanente member account or review your plan documents to confirm your prescription drug coverage details.
  •  

  • Check if Phendimetrazine is included in the covered medications list (formulary). You may need to use the search feature or browse by drug category.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your primary care physician to discuss your need for Phendimetrazine. Ensure they understand your health history and weight loss goals.
  •  

  • Your doctor will evaluate whether Phendimetrazine is a suitable medication for your condition and if it is the right choice for your treatment plan.

 

Obtain a Prescription

 

  • If the healthcare provider agrees that Phendimetrazine is appropriate for you, they will issue a prescription.
  •  

  • Make sure the prescription includes all necessary details and complies with Kaiser Permanente’s prescribing guidelines.

 

Confirm In-Network Pharmacy Availability

 

  • Locate an in-network pharmacy where you can fill your prescription. Use Kaiser Permanente’s online tools or contact customer service for assistance.
  •  

  • Check if the pharmacy has Phendimetrazine in stock and verify any special requirements for controlled substances.

 

Submit a Coverage Request

 

  • If Phendimetrazine is not automatically covered, you may need to submit a prior authorization request. Your physician’s office can assist with this process.
  •  

  • Kaiser Permanente will review the request to determine if the medication is medically necessary and covered under your plan.

 

Monitor Request Status and Appeals

 

  • Follow up on the status of your coverage request. You can do this through your Kaiser Permanente online account or by contacting their customer service.
  •  

  • If your initial request is denied, you have the right to appeal the decision. Gather any additional documentation your doctor can provide to support your appeal.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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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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