Does MDwise Cover Saxenda

Explore MDwise coverage for Saxenda, with tips on securing coverage, understanding costs without insurance, and answers to frequently asked questions.
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Does MDwise Cover Saxenda?

 

  • MDwise may cover Saxenda, a medication for chronic weight management, under certain conditions. Coverage generally applies to individuals with specific medical criteria, such as a BMI indicating obesity or overweight with related health issues.
  •  

  • It is essential for patients to meet clinical guidelines and criteria set by MDwise, which typically include a documented failure of other weight loss methods and a prescription by a healthcare provider.
  •  

  • Prior authorization is often required, involving a healthcare provider submitting a request demonstrating medical necessity.
  •  

  • Coverage details and criteria may vary, so verifying with MDwise customer service or checking the policy directly is recommended.

 

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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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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 Saxenda Coverage with MDwise

 

Check Eligibility

 

  • Contact MDwise to verify if Saxenda is covered under your specific health plan. Coverage can vary based on individual plans, so confirm if it's available to you.
  • Review the MDwise drug formulary online or request a physical copy, noting the tier level of Saxenda and any associated restrictions.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the necessity of Saxenda for your condition.
  • Obtain a prescription for Saxenda from your healthcare provider once they confirm it's an appropriate treatment option for you.

 

Preauthorization Process

 

  • Coordinate with your healthcare provider to initiate a preauthorization request through MDwise. This step is crucial as it often determines coverage approval.
  • Ensure that your provider submits any required documentation or medical records to support the prescription of Saxenda.

 

Submit Necessary Documentation

 

  • Prepare and submit any required documentation, such as a prior authorization form, to MDwise. Your healthcare provider's office usually assists in submitting the form directly.
  • Keep copies of all submitted documents for your records in case follow-up communication is required.

 

Follow-up with MDwise

 

  • Regularly follow up with MDwise to check on the status of your preauthorization request. This helps keep the process on track and addresses any issues promptly.
  • If the initial request is denied, inquire about the appeals process and gather further justification from your healthcare provider to support your appeal.

 

Pharmacy Coordination

 

  • Once coverage is approved, work with a preferred pharmacy that is in-network with MDwise to fill your Saxenda prescription.
  • Ensure the pharmacy is aware of any co-payment or benefit limitations associated with Saxenda under your coverage plan.

 

Maintain Coverage

 

  • Keep track of any changes to your MDwise plan during renewal periods that might affect Saxenda coverage, and address these proactively.
  • Regularly consult with your healthcare provider to assess the efficacy and necessity of continuing treatment with Saxenda, and update MDwise accordingly.

 

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FAQs

Does MDwise Cover Saxenda

Explore MDwise coverage for Saxenda, with tips on securing coverage, understanding costs without insurance, and answers to frequently asked questions.
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Is Saxenda Covered by MDwise

 

Does MDwise Cover Saxenda?

 

  • MDwise may cover Saxenda, a medication for chronic weight management, under certain conditions. Coverage generally applies to individuals with specific medical criteria, such as a BMI indicating obesity or overweight with related health issues.
  •  

  • It is essential for patients to meet clinical guidelines and criteria set by MDwise, which typically include a documented failure of other weight loss methods and a prescription by a healthcare provider.
  •  

  • Prior authorization is often required, involving a healthcare provider submitting a request demonstrating medical necessity.
  •  

  • Coverage details and criteria may vary, so verifying with MDwise customer service or checking the policy directly is recommended.

 

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MDwise's Approved Criteria for Saxenda Coverage

 

Eligibility Criteria for Saxenda Coverage

 

  • MDwise provides coverage for patients who are 18 years or older with a documented diagnosis of obesity, defined as having a Body Mass Index (BMI) of 30 kg/m2 or greater.
  •  

  • Patients with a BMI of 27 kg/m2 or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia are also eligible for Saxenda coverage.

 

Documentation Requirements

 

  • Physician-provided documentation of the patient's current BMI.
  •  

  • Medical records that detail the patient's documented weight-related health conditions, if applicable.
  •  

  • Evidence of the patient's attempt at previous weight management strategies which may include lifestyle changes such as diet and exercise, and previous pharmacotherapy.

 

Initial Authorization and Duration

 

  • Initial authorization for Saxenda is typically granted for a period of 16 weeks.
  •  

  • During this period, the patient must demonstrate at least a 4% reduction in baseline weight to qualify for continued coverage.

 

Continuation of Therapy

 

  • Continued Saxenda coverage is contingent upon achieving the required weight loss target during the initial authorization period.
  •  

  • Regular monitoring of patient weight and health status is required, with updates submitted to substantiate the ongoing need for Saxenda.

 

Comprehensive Weight Management Plan

 

  • MDwise requires that Saxenda is part of a comprehensive weight management plan including a reduced-calorie diet, physical activity, and behavioral therapy as recommended by a healthcare provider.

 

Why MDwise Might Deny Saxenda Coverage

 

Reasons MDwise Might Deny Saxenda Coverage

 

  • Saxenda is not prescribed for FDA-approved indications.
  •  

  • Failure to meet specified BMI criteria as per MDwise's policy.
  •  

  • Lack of documented previous weight management attempts, such as diet or exercise, before Saxenda prescription.
  •  

  • Use of Saxenda for off-label purposes, such as non-weight related conditions.
  •  

  • Absence of medical documentation supporting the necessity of Saxenda for weight management.
  •  

  • Patient's age does not fall within the approved range as specified by MDwise policy guidelines.
  •  

  • Prescription of Saxenda in conjunction with other weight management medications not approved by MDwise.
  •  

  • Re-initiation of Saxenda in patients who did not exhibit a satisfactory response previously, as defined by MDwise standards.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with MDwise

 

Check Eligibility

 

  • Contact MDwise to verify if Saxenda is covered under your specific health plan. Coverage can vary based on individual plans, so confirm if it's available to you.
  • Review the MDwise drug formulary online or request a physical copy, noting the tier level of Saxenda and any associated restrictions.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the necessity of Saxenda for your condition.
  • Obtain a prescription for Saxenda from your healthcare provider once they confirm it's an appropriate treatment option for you.

 

Preauthorization Process

 

  • Coordinate with your healthcare provider to initiate a preauthorization request through MDwise. This step is crucial as it often determines coverage approval.
  • Ensure that your provider submits any required documentation or medical records to support the prescription of Saxenda.

 

Submit Necessary Documentation

 

  • Prepare and submit any required documentation, such as a prior authorization form, to MDwise. Your healthcare provider's office usually assists in submitting the form directly.
  • Keep copies of all submitted documents for your records in case follow-up communication is required.

 

Follow-up with MDwise

 

  • Regularly follow up with MDwise to check on the status of your preauthorization request. This helps keep the process on track and addresses any issues promptly.
  • If the initial request is denied, inquire about the appeals process and gather further justification from your healthcare provider to support your appeal.

 

Pharmacy Coordination

 

  • Once coverage is approved, work with a preferred pharmacy that is in-network with MDwise to fill your Saxenda prescription.
  • Ensure the pharmacy is aware of any co-payment or benefit limitations associated with Saxenda under your coverage plan.

 

Maintain Coverage

 

  • Keep track of any changes to your MDwise plan during renewal periods that might affect Saxenda coverage, and address these proactively.
  • Regularly consult with your healthcare provider to assess the efficacy and necessity of continuing treatment with Saxenda, and update MDwise accordingly.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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.

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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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