Does MDwise Cover Phentermine (Adipex-P, Lomaira)

Explore if MDwise covers Phentermine and discover tips on obtaining coverage, costs without insurance, and essential FAQs in this informative guide.
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Does MDwise Cover Phentermine (Adipex-P, Lomaira)

 

  • MDwise may cover Phentermine (Adipex-P, Lomaira) as part of their health insurance plans, but this depends on the specific plan and medical necessity.
  •  

  • Coverage often applies when it's prescribed for weight loss in patients with a BMI over a certain threshold, typically when other weight loss methods have failed.
  •  

  • A prior authorization from a healthcare provider is usually required, demonstrating the need for the medication due to medical conditions like obesity or related health risks.
  •  

  • Patients may need to meet specific criteria, such as implementing a comprehensive weight-loss plan including diet and exercise, that is monitored by a healthcare provider.
  •  

  • It's crucial for patients to contact MDwise directly or check their plan details to confirm specific coverage, limitations, and necessary 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 Phentermine (Adipex-P, Lomaira) Coverage with MDwise

 

Check Your MDwise Plan

 

  • Review your MDwise plan documents or log into your MDwise member account to understand your specific coverage benefits and limitations.
  •  

  • Look for details about prescription drug coverage to confirm if Phentermine (Adipex-P, Lomaira) is included.

 

Consult with Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss your health needs and whether Phentermine is appropriate for you.
  •  

  • Ensure that your doctor is aware you are covered by MDwise, as prescriptions might need pre-approval from them before coverage is granted.

 

Check for Prior Authorization

 

  • Contact MDwise customer service to inquire if Phentermine requires prior authorization. This step is crucial because it involves additional forms and justifications from your doctor.
  •  

  • If needed, your doctor should submit a prior authorization request to MDwise providing reasons why this medication is necessary.

 

Visit an In-Network Pharmacy

 

  • Locate a pharmacy that is within the MDwise network to ensure you receive coverage benefits.
  •  

  • Present your MDwise member ID when filling the prescription to help verify coverage.

 

Understand Co-Payment or Cost-Sharing Requirements

 

  • Check if there are any co-payment or cost-sharing requirements associated with your medication under your specific MDwise plan.
  •  

  • Prepare for any out-of-pocket expenses that may arise even after coverage.

 

Follow Up with MDwise

 

  • After submitting a prior authorization request, follow up with MDwise to check the status and ensure approval has been granted.
  •  

  • In case of any delays or denials, work with your healthcare provider and MDwise to address any issues or misunderstandings.

 

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FAQs

Does MDwise Cover Phentermine (Adipex-P, Lomaira)

Explore if MDwise covers Phentermine and discover tips on obtaining coverage, costs without insurance, and essential FAQs in this informative guide.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by MDwise

 

Does MDwise Cover Phentermine (Adipex-P, Lomaira)

 

  • MDwise may cover Phentermine (Adipex-P, Lomaira) as part of their health insurance plans, but this depends on the specific plan and medical necessity.
  •  

  • Coverage often applies when it's prescribed for weight loss in patients with a BMI over a certain threshold, typically when other weight loss methods have failed.
  •  

  • A prior authorization from a healthcare provider is usually required, demonstrating the need for the medication due to medical conditions like obesity or related health risks.
  •  

  • Patients may need to meet specific criteria, such as implementing a comprehensive weight-loss plan including diet and exercise, that is monitored by a healthcare provider.
  •  

  • It's crucial for patients to contact MDwise directly or check their plan details to confirm specific coverage, limitations, and necessary documentation.

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MDwise's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Criteria for Phentermine Coverage

 

  • Body Mass Index (BMI) Requirement: The patient must have a BMI of 30 kg/m² or higher, or a BMI of 27 kg/m² or higher if accompanied by weight-related comorbid conditions such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • Age Restriction: Phentermine is approved for use in adult patients who are 18 years old or older.
  •  

  • Initial Use Limit: Patients are eligible for coverage for an initial duration up to 12 weeks.

 

Documented Weight Loss Attempts

 

  • Patients must provide documentation of previous unsuccessful weight loss attempts using lifestyle modifications such as diet and exercise.
  •  

  • Proof of participation in a structured weight management program may be required.

 

Continued Use Criteria

 

  • After the initial 12-week period, further coverage requires evidence of at least a 5% reduction in baseline body weight.
  •  

  • Continuation of therapy beyond 12 weeks should involve regular monitoring and documentation of the patient's weight and overall health status.

 

Physician Evaluation and Prescription

 

  • A healthcare provider must evaluate the patient and provide a prescription, noting the clinical justification for the use of phentermine.
  •  

  • The prescriber must demonstrate that the benefits of phentermine outweigh the potential risks.

 

Figuring Potential Drug Interactions

 

  • Assessment of the patient’s current medication list to avoid potential drug interactions with phentermine.
  •  

  • Close monitoring is necessary if the patient is on medications for conditions such as hypertension or diabetes.

 

General Coverage Limitations

 

  • Phentermine coverage is subjected to standard formulary restrictions and tiering levels unless specified otherwise.
  •  

  • Prior authorization may be required to ensure compliance with the aforementioned criteria.

 

Why MDwise Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons for Denial of Phentermine Coverage

 

  • MDwise may deny coverage for Phentermine if it is not prescribed as part of a comprehensive weight loss plan that includes diet, exercise, and behavior therapy.
  •  

  • Coverage might be denied if there is insufficient documentation to support the medical necessity of Phentermine for the patient's weight management.
  •  

  • MDwise may not cover Phentermine if the patient has a history of substance abuse or other contraindications for stimulants.
  •  

  • Denial may occur if the patient is under 16 years old, as Phentermine is typically not recommended for this age group.
  •  

  • Situations involving the long-term use of Phentermine beyond the recommended duration of treatment might lead to a denial of coverage from MDwise.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with MDwise

 

Check Your MDwise Plan

 

  • Review your MDwise plan documents or log into your MDwise member account to understand your specific coverage benefits and limitations.
  •  

  • Look for details about prescription drug coverage to confirm if Phentermine (Adipex-P, Lomaira) is included.

 

Consult with Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss your health needs and whether Phentermine is appropriate for you.
  •  

  • Ensure that your doctor is aware you are covered by MDwise, as prescriptions might need pre-approval from them before coverage is granted.

 

Check for Prior Authorization

 

  • Contact MDwise customer service to inquire if Phentermine requires prior authorization. This step is crucial because it involves additional forms and justifications from your doctor.
  •  

  • If needed, your doctor should submit a prior authorization request to MDwise providing reasons why this medication is necessary.

 

Visit an In-Network Pharmacy

 

  • Locate a pharmacy that is within the MDwise network to ensure you receive coverage benefits.
  •  

  • Present your MDwise member ID when filling the prescription to help verify coverage.

 

Understand Co-Payment or Cost-Sharing Requirements

 

  • Check if there are any co-payment or cost-sharing requirements associated with your medication under your specific MDwise plan.
  •  

  • Prepare for any out-of-pocket expenses that may arise even after coverage.

 

Follow Up with MDwise

 

  • After submitting a prior authorization request, follow up with MDwise to check the status and ensure approval has been granted.
  •  

  • In case of any delays or denials, work with your healthcare provider and MDwise to address any issues or misunderstandings.

 

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Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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