Does MDwise Cover Phendimetrazine

Explore Phendimetrazine coverage options with MDwise, reasons for denial, costs without insurance, and FAQs in this comprehensive guide.
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MDwise Coverage for Phendimetrazine

 

  • MDwise typically covers Phendimetrazine under certain conditions. Coverage often depends on the specific plan and the medical necessity as determined by the healthcare provider.
  •  

  • Phendimetrazine is generally prescribed for cases of obesity, where other weight loss methods like diet and exercise have not been successful.
  •  

  • To have Phendimetrazine covered, a prescriber may need to provide evidence of medical necessity, including documenting the patient's history with weight loss attempts and health risks associated with obesity.
  •  

  • The patient might need to go through prior authorization, where MDwise reviews and approves the necessity of the prescription before coverage is granted.
  •  

  • Coverage rules may be subject to changes, so it's crucial to check with MDwise directly or consult their formulary for the most current information regarding medication coverage.

 

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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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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 MDwise

 

Start with MDwise Enrollment

 

  • Contact MDwise to enroll in a suitable health plan. Ensure that the plan provides pharmacy benefits, which might cover prescription medications like Phendimetrazine.
  •  

  • Visit the MDwise website to explore various plans and select one that matches your healthcare needs. Ensure that your pharmacy benefits are included in the plan.
  •  

  • Complete the application process by providing the necessary personal and health details as requested by MDwise during enrollment.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Phendimetrazine with your healthcare provider. Provide any medical records or history that support the necessity of this medication for your treatment.
  •  

  • Request your healthcare provider to prescribe Phendimetrazine if deemed appropriate for your medical condition.
  •  

  • Ensure that your healthcare provider is aware of MDwise's prescription formulary and can help guide you in complying with any requirements.

 

Check MDwise Formulary for Coverage

 

  • Visit the MDwise website and check their formulary directory to confirm that Phendimetrazine is covered under your plan.
  •  

  • If Phendimetrazine is not covered, review any alternative medications that might be covered or consider appealing for coverage with the aid of your healthcare provider's recommendation.
  •  

  • Contact MDwise customer service for detailed information on drug coverage and any associated costs you might incur.

 

Process Prior Authorization, if Necessary

 

  • Verify if Phendimetrazine requires prior authorization under your MDwise plan to avoid out-of-pocket expenses.
  •  

  • If prior authorization is required, have your healthcare provider submit the necessary documentation to MDwise, explaining the medical need for Phendimetrazine.
  •  

  • Follow up with MDwise to ensure the authorization was approved, and understand any further steps you need to take.

 

Fill Your Phendimetrazine Prescription

 

  • Use an in-network pharmacy to fill your Phendimetrazine prescription to maximize coverage benefits under your MDwise plan.
  •  

  • Provide your MDwise insurance card when filling the prescription to ensure any applicable coverage and discounts are applied.
  •  

  • Verify with the pharmacist that the medication is being covered appropriately, according to your plan's formulary.

 

Address Coverage Issues

 

  • If you encounter issues with coverage for Phendimetrazine, contact MDwise member services for assistance in resolving the matter.
  •  

  • Your healthcare provider may need to provide additional information or appeal the decision if coverage is denied.
  •  

  • Keep detailed records of communications with MDwise and your pharmacy to help resolve any issues efficiently.

 

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FAQs

Does MDwise Cover Phendimetrazine

Explore Phendimetrazine coverage options with MDwise, reasons for denial, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Phendimetrazine Covered by MDwise

 

MDwise Coverage for Phendimetrazine

 

  • MDwise typically covers Phendimetrazine under certain conditions. Coverage often depends on the specific plan and the medical necessity as determined by the healthcare provider.
  •  

  • Phendimetrazine is generally prescribed for cases of obesity, where other weight loss methods like diet and exercise have not been successful.
  •  

  • To have Phendimetrazine covered, a prescriber may need to provide evidence of medical necessity, including documenting the patient's history with weight loss attempts and health risks associated with obesity.
  •  

  • The patient might need to go through prior authorization, where MDwise reviews and approves the necessity of the prescription before coverage is granted.
  •  

  • Coverage rules may be subject to changes, so it's crucial to check with MDwise directly or consult their formulary for the most current information regarding medication coverage.

 

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MDwise's Approved Criteria for Phendimetrazine Coverage

 

MDwise's Approved Criteria for Phendimetrazine Coverage

 

  • The patient must be diagnosed with obesity, defined as a body mass index (BMI) of 30 kg/m² or higher.
  •  

  • The patient may qualify if they have a BMI of 27 kg/m² or higher with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must have attempted weight management methods such as dietary changes, exercise, and behavioral modification for a duration generally specified as at least 6 months without achieving adequate weight loss.
  •  

  • The prescribing healthcare provider must document that they have evaluated the patient’s health condition and convinced that phendimetrazine is necessary as an adjunct therapy to a comprehensive weight management plan.
  •  

  • The prescription must be written by an endocrinologist, bariatric specialist, or any healthcare provider specializing in obesity management.
  •  

  • Regular monitoring of the patient's progress on phendimetrazine, including weight, health status, and any potential side effects, must be indicated in the treatment plan.
  •  

  • The patient should not have any contraindications to phendimetrazine, which might include severe cardiovascular disease, hyperthyroidism, glaucoma, or extreme sensitivity to sympathomimetic amines.
  •  

  • The treatment must show documented efficacy and an improvement in the patient's overall health status to continue coverage.
  •  

 

Why MDwise Might Deny Phendimetrazine Coverage

 

Exclusions for Phendimetrazine Coverage

 

  • Use for weight management in patients who have not demonstrated prior unsuccessful weight loss attempts with diet and exercise alone.
  •  

  • Prescriptions requested for off-label use that is not specifically approved by the FDA.
  •  

  • Patients with a history of cardiovascular disease or uncontrolled hypertension that contraindicate the use of stimulant medications.
  •  

  • Cases where the medication is sought for a duration exceeding the recommended short-term use guidelines.
  •  

  • Patients under a certain age threshold, typically because of concerns about safety and efficacy in pediatric populations.
  •  

  • Missing required documentation or diagnostic criteria to validate the medical necessity of Phendimetrazine use.
  •  

  • Simultaneous use with other central nervous system stimulants posing a risk of additive adverse effects.

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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 MDwise

 

Start with MDwise Enrollment

 

  • Contact MDwise to enroll in a suitable health plan. Ensure that the plan provides pharmacy benefits, which might cover prescription medications like Phendimetrazine.
  •  

  • Visit the MDwise website to explore various plans and select one that matches your healthcare needs. Ensure that your pharmacy benefits are included in the plan.
  •  

  • Complete the application process by providing the necessary personal and health details as requested by MDwise during enrollment.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Phendimetrazine with your healthcare provider. Provide any medical records or history that support the necessity of this medication for your treatment.
  •  

  • Request your healthcare provider to prescribe Phendimetrazine if deemed appropriate for your medical condition.
  •  

  • Ensure that your healthcare provider is aware of MDwise's prescription formulary and can help guide you in complying with any requirements.

 

Check MDwise Formulary for Coverage

 

  • Visit the MDwise website and check their formulary directory to confirm that Phendimetrazine is covered under your plan.
  •  

  • If Phendimetrazine is not covered, review any alternative medications that might be covered or consider appealing for coverage with the aid of your healthcare provider's recommendation.
  •  

  • Contact MDwise customer service for detailed information on drug coverage and any associated costs you might incur.

 

Process Prior Authorization, if Necessary

 

  • Verify if Phendimetrazine requires prior authorization under your MDwise plan to avoid out-of-pocket expenses.
  •  

  • If prior authorization is required, have your healthcare provider submit the necessary documentation to MDwise, explaining the medical need for Phendimetrazine.
  •  

  • Follow up with MDwise to ensure the authorization was approved, and understand any further steps you need to take.

 

Fill Your Phendimetrazine Prescription

 

  • Use an in-network pharmacy to fill your Phendimetrazine prescription to maximize coverage benefits under your MDwise plan.
  •  

  • Provide your MDwise insurance card when filling the prescription to ensure any applicable coverage and discounts are applied.
  •  

  • Verify with the pharmacist that the medication is being covered appropriately, according to your plan's formulary.

 

Address Coverage Issues

 

  • If you encounter issues with coverage for Phendimetrazine, contact MDwise member services for assistance in resolving the matter.
  •  

  • Your healthcare provider may need to provide additional information or appeal the decision if coverage is denied.
  •  

  • Keep detailed records of communications with MDwise and your pharmacy to help resolve any issues efficiently.

 

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

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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.

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Do your plans include prescriptions and medications?

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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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