Does Medica Cover Contrave

Explore why Medica may deny Contrave, how to secure coverage, its costs without insurance, and get answers to common questions.
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Does Medica Cover Contrave?

 

  • Medica may cover Contrave, a prescription medication for weight management, but coverage varies by plan. It's important to check specific policy details.
  •  

  • Coverage often depends on whether the medication is deemed medically necessary. This is typically determined based on the patient's health condition, body mass index (BMI), and previous weight loss attempts.
  •  

  • Prior authorization may be required. This means that a healthcare provider must justify the need for the medication before Medica approves coverage.
  •  

  • Patients may need to have tried and not succeeded with other weight management strategies before Contrave is considered for coverage.
  •  

  • Plan members should contact Medica directly or consult their plan documents to understand specific criteria, coverage limitations, and any potential out-of-pocket costs.

 

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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 Contrave Coverage with Medica

 

Understanding Medica's Coverage Policy

 

  • Visit the Medica website to review their specific policy on prescription drug coverage, focusing on weight management medications like Contrave.
  • Look into the plan documents or member handbook provided by Medica to understand what weight management treatments are covered and any prerequisites like prior authorizations.
  • Check if your specific Medica plan covers the medication. Coverage can vary based on the plan type (e.g., HMO, PPO).

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave. Explain why you believe it's necessary for your situation.
  • Request your healthcare provider to prepare any necessary documentation or letters of medical necessity that may support the need for Contrave.
  • Ask your healthcare provider if they are familiar with Medica's prescription drug coverage requirements, as they might assist in easing the process.

 

Contact Medica Customer Service

 

  • Reach out to Medica's customer service for specific inquiries regarding Contrave coverage under your plan. Having your member ID number on hand can be helpful.
  • Ask about any prior authorization requirements, step therapy, or specific clinical criteria that need to be met for Contrave to be covered.
  • Inquire if any alternative medications are preferred by the plan and whether Contrave can be covered if those alternatives are ineffective.

 

Submit a Prior Authorization Request

 

  • Working with your healthcare provider, submit the required prior authorization form if Medica requires it for Contrave coverage.
  • Ensure all necessary medical documentation and the letter of medical necessity are included in the submission.
  • Follow up with Medica regarding the status of your prior authorization request to avoid any delays or miscommunications.

 

Appeal Denials if Necessary

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reason for the denial.
  • Prepare an appeal with the help of your healthcare provider, highlighting why Contrave is a medical necessity in your case.
  • Alternatively, consult with a patient advocate or the Office of the Insurance Ombudsman if you need assistance with the appeal process.

 

Monitor Your Coverage Annually

 

  • Review your Medica plan every year during open enrollment to verify continuing coverage of Contrave or any policy changes.
  • Ask Medica about any formulary changes that might affect your coverage and premiums.
  • Consider switching to a different Medica plan or external provider if coverage options for Contrave become unfavorable.

 

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FAQs

Does Medica Cover Contrave

Explore why Medica may deny Contrave, how to secure coverage, its costs without insurance, and get answers to common questions.
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Is Contrave Covered by Medica

 

Does Medica Cover Contrave?

 

  • Medica may cover Contrave, a prescription medication for weight management, but coverage varies by plan. It's important to check specific policy details.
  •  

  • Coverage often depends on whether the medication is deemed medically necessary. This is typically determined based on the patient's health condition, body mass index (BMI), and previous weight loss attempts.
  •  

  • Prior authorization may be required. This means that a healthcare provider must justify the need for the medication before Medica approves coverage.
  •  

  • Patients may need to have tried and not succeeded with other weight management strategies before Contrave is considered for coverage.
  •  

  • Plan members should contact Medica directly or consult their plan documents to understand specific criteria, coverage limitations, and any potential out-of-pocket costs.

 

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Medica's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Individuals must be 18 years of age or older at the time of the request.
  •  

  • The patient has a body mass index (BMI) equal to or greater than 30 kg/m², indicating obesity.
  •  

  • Alternatively, patients with a BMI equal to or greater than 27 kg/m² who also have at least one weight-related comorbidity such as type 2 diabetes, dyslipidemia, or hypertension are eligible.
  •  

  • The prescribing physician must provide documentation of previous attempts to manage weight through diet and exercise prior to considering pharmacologic intervention.
  •  

  • The patient should have experienced an insufficient response to prior weight loss efforts including lifestyle changes.

 

Ongoing Maintenance Criteria

 

  • Patients must demonstrate at least a 5% reduction in body weight within the first 16 weeks of therapy to continue receiving coverage.
  •  

  • Continued coverage is contingent on adherence to both the medication and an accompanying lifestyle change program involving diet and exercise.
  •  

  • Regular follow-up with the prescribing healthcare provider is required to evaluate the efficacy and adjust the treatment plan as needed.

 

Physician's Responsibilities

 

  • Provide appropriate documentation that the patient fulfills all medical criteria necessary for coverage.
  •  

  • Monitor the patient's progress and adherence to the prescribed weight management program.
  •  

  • Ensure that the patient understands the importance of ongoing lifestyle changes in conjunction with Contrave therapy.

 

Why Medica Might Deny Contrave Coverage

 

Situations Where Medica Denies Contrave Coverage

 

  • Prescriptions for patients not meeting the BMI (Body Mass Index) criteria as defined by Medica are denied coverage. Patients must have a specific BMI threshold, and those falling below it are not eligible.
  •  

  • If the patient does not have an established diagnosis of obesity-related comorbid conditions as required by Medica policy, they will not receive coverage.
  •  

  • Medica does not cover Contrave if there is a lack of documented comprehensive weight management program involvement. Patients must show engagement in a structured weight loss plan.
  •  

  • Coverage is denied if there is insufficient documentation of previous weight loss efforts. Medica requires evidence of attempts using behavioral interventions or other weight loss medications.
  •  

  • Failure to provide appropriate medical documentation or prescriptions from unauthorized or non-network healthcare providers results in denied coverage.
  •  

  • If the request for Contrave is for off-label use not approved by Medica's policy guidelines, it will not be covered.
  •  

  • Patients who fail to meet Medica's criteria for continued use of Contrave, such as adequate weight loss during the initial treatment period, will have coverage denied.
  •  

  • In situations where prior authorization is not obtained, or if authorization is denied, Medica will not cover Contrave prescriptions.
  •  

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with Medica

 

Understanding Medica's Coverage Policy

 

  • Visit the Medica website to review their specific policy on prescription drug coverage, focusing on weight management medications like Contrave.
  • Look into the plan documents or member handbook provided by Medica to understand what weight management treatments are covered and any prerequisites like prior authorizations.
  • Check if your specific Medica plan covers the medication. Coverage can vary based on the plan type (e.g., HMO, PPO).

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave. Explain why you believe it's necessary for your situation.
  • Request your healthcare provider to prepare any necessary documentation or letters of medical necessity that may support the need for Contrave.
  • Ask your healthcare provider if they are familiar with Medica's prescription drug coverage requirements, as they might assist in easing the process.

 

Contact Medica Customer Service

 

  • Reach out to Medica's customer service for specific inquiries regarding Contrave coverage under your plan. Having your member ID number on hand can be helpful.
  • Ask about any prior authorization requirements, step therapy, or specific clinical criteria that need to be met for Contrave to be covered.
  • Inquire if any alternative medications are preferred by the plan and whether Contrave can be covered if those alternatives are ineffective.

 

Submit a Prior Authorization Request

 

  • Working with your healthcare provider, submit the required prior authorization form if Medica requires it for Contrave coverage.
  • Ensure all necessary medical documentation and the letter of medical necessity are included in the submission.
  • Follow up with Medica regarding the status of your prior authorization request to avoid any delays or miscommunications.

 

Appeal Denials if Necessary

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reason for the denial.
  • Prepare an appeal with the help of your healthcare provider, highlighting why Contrave is a medical necessity in your case.
  • Alternatively, consult with a patient advocate or the Office of the Insurance Ombudsman if you need assistance with the appeal process.

 

Monitor Your Coverage Annually

 

  • Review your Medica plan every year during open enrollment to verify continuing coverage of Contrave or any policy changes.
  • Ask Medica about any formulary changes that might affect your coverage and premiums.
  • Consider switching to a different Medica plan or external provider if coverage options for Contrave become unfavorable.

 

Premium Medication you can trust

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.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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A weight management program tailored to you

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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