Does MDwise Cover Naltrexone/Bupropion (Contrave)

Explore MDwise coverage for Naltrexone/Bupropion. Understand denial reasons, steps to get coverage, costs without insurance, and FAQs in our detailed guide.
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Coverage Criteria

 

  • MDwise often covers Naltrexone/Bupropion (Contrave) for treating obesity and weight management as part of their prescription drug plan, contingent upon meeting specific criteria.

 

Basic Requirements

 

  • Prescription required: The medication must be prescribed by a healthcare provider.
  • Medical necessity: Prior authorization may be necessary to verify the medical necessity based on body mass index (BMI) and other health conditions.

 

Prior Authorization

 

  • Medical documentation: Health records supporting the use of Contrave for weight management might be requested.
  • Treatment history: Details of prior weight-loss treatments and outcomes may be required to justify the use of Contrave.

 

Steps to Verify Coverage

 

  • Contact Customer Service: Call MDwise customer service to confirm Contrave's coverage and discuss specific plan details.
  • Consult Prescriber: Ensure your healthcare provider submits necessary authorizations and any required supporting documentation.

 

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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 Naltrexone/Bupropion (Contrave) Coverage with MDwise

 

Contact MDwise Member Services

 

  • Call MDwise Member Services using the number found on your insurance card. Verify the specific benefits and coverage limits for prescriptions.
  •  

  • Ask the representative about the requirements for covering Naltrexone/Bupropion (Contrave). They may provide details about prior authorization or step therapy requirements.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor the need for Naltrexone/Bupropion (Contrave) and ensure that it's appropriate for your condition.
  •  

  • Your healthcare provider should be prepared to provide documentation about the necessity of the medication for the insurance company.

 

Request Prior Authorization

 

  • Work with your healthcare provider to initiate a prior authorization request with MDwise.
  •  

  • Your provider may need to complete specific forms or provide medical records demonstrating the need for the medication.

 

Understand Step Therapy Requirements

 

  • Confirm with MDwise if step therapy is required for Naltrexone/Bupropion (Contrave).
  •  

  • If required, review the alternative drugs that must be tried before Naltrexone/Bupropion (Contrave) will be covered.

 

Submit Required Documentation

 

  • Ensure all required documentation and forms are correctly submitted by your healthcare provider to MDwise.
  •  

  • Include any additional information that MDwise may require, such as previous treatment failures or special medical circumstances.

 

Follow Up

 

  • Regularly contact MDwise to check on the status of your prior authorization request. Timely follow-up can ensure faster processing.
  •  

  • Address any requests for additional information promptly to avoid delays in the approval process.

 

Appeal if Necessary

 

  • If MDwise denies coverage for Naltrexone/Bupropion (Contrave), consult your doctor to initiate an appeal process.
  •  

  • Gather supporting documents and evidence to strengthen your appeal, such as additional medical records or expert opinions.

 

Review Your Prescription Benefits

 

  • Check your specific MDwise plan’s formulary to confirm if Naltrexone/Bupropion (Contrave) is covered under your prescription benefits.
  •  

  • Review any copay or costs associated with obtaining the medication as per your plan’s guidelines.

 

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FAQs

Does MDwise Cover Naltrexone/Bupropion (Contrave)

Explore MDwise coverage for Naltrexone/Bupropion. Understand denial reasons, steps to get coverage, costs without insurance, and FAQs in our detailed guide.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by MDwise

 

Coverage Criteria

 

  • MDwise often covers Naltrexone/Bupropion (Contrave) for treating obesity and weight management as part of their prescription drug plan, contingent upon meeting specific criteria.

 

Basic Requirements

 

  • Prescription required: The medication must be prescribed by a healthcare provider.
  • Medical necessity: Prior authorization may be necessary to verify the medical necessity based on body mass index (BMI) and other health conditions.

 

Prior Authorization

 

  • Medical documentation: Health records supporting the use of Contrave for weight management might be requested.
  • Treatment history: Details of prior weight-loss treatments and outcomes may be required to justify the use of Contrave.

 

Steps to Verify Coverage

 

  • Contact Customer Service: Call MDwise customer service to confirm Contrave's coverage and discuss specific plan details.
  • Consult Prescriber: Ensure your healthcare provider submits necessary authorizations and any required supporting documentation.

 

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MDwise's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Eligibility Criteria for Coverage

 

  • The patient must be 18 years of age or older.
  •  

  • The patient should have a documented 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 type 2 diabetes, dyslipidemia, or hypertension.
  •  

  • There should be a documented attempt of a comprehensive weight management program which includes dietary changes, physical activity, and behavioral therapy prior to pharmacotherapy.

 

Documented Clinical Justification

 

  • Evidence of previous unsuccessful attempts to lose and maintain weight loss through lifestyle changes alone.
  •  

  • A detailed explanation by the healthcare provider on how the combination of Naltrexone/Bupropion will aid in achieving weight loss goals.

 

Prescribing and Usage Guidelines

 

  • Naltrexone/Bupropion should be prescribed by a licensed healthcare provider with expertise in managing obesity or related comorbidities.
  •  

  • The patient must agree to use the medication in conjunction with a reduced-calorie diet and increased physical activity.
  •  

  • The dosage should follow FDA-approved guidelines for Naltrexone/Bupropion. Initial prescriptions often require titration phases and monitoring for effectiveness and tolerance.

 

Continuation of Therapy

 

  • Follow-up must occur within the first 16 weeks to evaluate the patient's progress. A minimum of 5% weight loss from the baseline is often required to continue therapy.
  •  

  • Continued documentation of adherence to dietary and exercise programs is necessary.
  •  

  • Periodic follow-up and reassessment by the prescribing physician to ensure continued therapeutic benefit is essential for ongoing coverage.

 

Healthcare Provider Documentation

 

  • Detailed medical history and records supporting the necessity for pharmacotherapy.
  •  

  • A plan for monitoring progress and managing any side effects should be clearly outlined in the patient’s medical record.

 

Why MDwise Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Reasons for Denial of Coverage for Naltrexone/Bupropion (Contrave)

 

  • The patient does not meet the medical necessity criteria as defined by MDwise policy guidelines.
  •  

  • The prescribed dosage does not align with the approved dosage indications according to MDwise standards.
  •  

  • The medication is not included in the patient's specific prescription drug plan formulary, and exceptions have not been granted.
  •  

  • The patient has a contraindication that is specifically listed in MDwise's exclusion criteria, such as certain medical conditions or interactions with other medications.
  •  

  • Necessary prior authorization paperwork has not been submitted or approved before the prescription request.
  •  

  • The medication is being used for off-label purposes not recognized by MDwise for this specific treatment.
  •  

  • A more cost-effective alternative or generic equivalent is available according to MDwise's tiered drug formulary.

 

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How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with MDwise

 

Contact MDwise Member Services

 

  • Call MDwise Member Services using the number found on your insurance card. Verify the specific benefits and coverage limits for prescriptions.
  •  

  • Ask the representative about the requirements for covering Naltrexone/Bupropion (Contrave). They may provide details about prior authorization or step therapy requirements.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor the need for Naltrexone/Bupropion (Contrave) and ensure that it's appropriate for your condition.
  •  

  • Your healthcare provider should be prepared to provide documentation about the necessity of the medication for the insurance company.

 

Request Prior Authorization

 

  • Work with your healthcare provider to initiate a prior authorization request with MDwise.
  •  

  • Your provider may need to complete specific forms or provide medical records demonstrating the need for the medication.

 

Understand Step Therapy Requirements

 

  • Confirm with MDwise if step therapy is required for Naltrexone/Bupropion (Contrave).
  •  

  • If required, review the alternative drugs that must be tried before Naltrexone/Bupropion (Contrave) will be covered.

 

Submit Required Documentation

 

  • Ensure all required documentation and forms are correctly submitted by your healthcare provider to MDwise.
  •  

  • Include any additional information that MDwise may require, such as previous treatment failures or special medical circumstances.

 

Follow Up

 

  • Regularly contact MDwise to check on the status of your prior authorization request. Timely follow-up can ensure faster processing.
  •  

  • Address any requests for additional information promptly to avoid delays in the approval process.

 

Appeal if Necessary

 

  • If MDwise denies coverage for Naltrexone/Bupropion (Contrave), consult your doctor to initiate an appeal process.
  •  

  • Gather supporting documents and evidence to strengthen your appeal, such as additional medical records or expert opinions.

 

Review Your Prescription Benefits

 

  • Check your specific MDwise plan’s formulary to confirm if Naltrexone/Bupropion (Contrave) is covered under your prescription benefits.
  •  

  • Review any copay or costs associated with obtaining the medication as per your plan’s guidelines.

 

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Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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