Does Molina Healthcare Cover Diethylpropion (Tenuate)

Explore Molina Healthcare coverage for Diethylpropion, why it might be denied, ways to secure coverage, costs without insurance, and FAQs in this detailed guide.
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Coverage for Diethylpropion (Tenuate) by Molina Healthcare

 

  • Molina Healthcare coverage for Diethylpropion (Tenuate) depends on the patient's specific plan and medical necessity.
  •  

  • If covered, it is typically under specific circumstances such as when prescribed for weight management and when other weight loss interventions have not been successful.
  •  

  • To qualify for coverage, a patient may need to meet criteria such as having a body mass index (BMI) above a certain threshold and having tried other weight loss methods under medical supervision.
  •  

  • Prior authorization may be required, meaning the prescribing physician must demonstrate medical necessity and submit appropriate documentation.
  •  

  • Patients should consult their specific Molina plan details and coordinate with their healthcare provider to ensure all criteria are met.

 

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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 Diethylpropion (Tenuate) Coverage with Molina Healthcare

 

Research Molina Healthcare Formulary

 

  • Visit the Molina Healthcare website or contact your local Molina representative to access their drug formulary.
  •  

  • Check if diethylpropion (Tenuate) is listed on the formulary, and note any specific coverage requirements or restrictions mentioned.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of diethylpropion for your condition.
  •  

  • Your provider may need to provide documentation or submit prior authorization to justify the need for this medication under your plan.

 

Check Your Plan Benefits

 

  • Review the details of your particular Molina Healthcare plan to understand your prescription drug coverage benefits.
  •  

  • Identify any copays, deductibles, or limitations that might affect the coverage of diethylpropion.

 

Contact Molina's Pharmacy Services

 

  • Reach out to Molina's Pharmacy Services for guidance on drug coverage, particularly if diethylpropion is not readily covered in the formulary.
  •  

  • Inquire about the steps required to pursue a formulary exception or alternative options that might be available.

 

Submit Prior Authorization or Exception Requests

 

  • If necessary, work with your healthcare provider to submit any required prior authorization or exception requests to Molina Healthcare.
  •  

  • Ensure all supporting documentation is complete and clearly demonstrates the necessity of diethylpropion.

 

Follow Up on Your Request

 

  • Maintain regular contact with Molina Healthcare to monitor the status of your submission.
  •  

  • Be prepared to provide additional information if requested and to appeal any denials as needed with the assistance of your healthcare provider.

 

Plan for Refills and Continued Coverage

 

  • Once approved, understand the requirements for prescription refills and any recurring authorizations to ensure ongoing coverage of diethylpropion.
  •  

  • Keep track of any changes to your Molina plan that could affect drug coverage in the future.

 

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FAQs

Does Molina Healthcare Cover Diethylpropion (Tenuate)

Explore Molina Healthcare coverage for Diethylpropion, why it might be denied, ways to secure coverage, costs without insurance, and FAQs in this detailed guide.
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Is Diethylpropion (Tenuate) Covered by Molina Healthcare

 

Coverage for Diethylpropion (Tenuate) by Molina Healthcare

 

  • Molina Healthcare coverage for Diethylpropion (Tenuate) depends on the patient's specific plan and medical necessity.
  •  

  • If covered, it is typically under specific circumstances such as when prescribed for weight management and when other weight loss interventions have not been successful.
  •  

  • To qualify for coverage, a patient may need to meet criteria such as having a body mass index (BMI) above a certain threshold and having tried other weight loss methods under medical supervision.
  •  

  • Prior authorization may be required, meaning the prescribing physician must demonstrate medical necessity and submit appropriate documentation.
  •  

  • Patients should consult their specific Molina plan details and coordinate with their healthcare provider to ensure all criteria are met.

 

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Molina Healthcare's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Criteria for Diethylpropion (Tenuate) Coverage

 

  • The medication is prescribed for the treatment of exogenous obesity as a short-term adjunct in a regimen of weight reduction based on calorie restriction for patients with an initial body mass index (BMI) of 30 kg/m² or higher, or 27 kg/m² or higher in the presence of other risk factors (e.g., controlled hypertension, diabetes, hyperlipidemia).
  •  

  • There is documented evidence of a comprehensive weight management program, which includes at least six months of tried and failed lifestyle changes focusing on dietary modification and a structured exercise program.
  •  

  • The prescriber is a healthcare professional specializing in obesity or endocrinology, or a primary care provider with documented experience in managing obesity.
  •  

  • The patient does not have a history of cardiovascular diseases, such as coronary artery disease, stroke, arrhythmias, or heart failure, as diethylpropion is contraindicated in these conditions.
  •  

  • No evidence of uncontrolled hypertension; patient blood pressure is within the safe range as per current medical guidelines.
  •  

  • Renal function is adequate - verify that the patient has not been diagnosed with severe renal impairment.
  •  

  • The patient does not have a history of drug abuse or dependence.
  •  

  • Continuous coverage will require periodic evaluation showing adherence to the weight management plan, and the patient should demonstrate at least a 5% weight loss from baseline within a specified period, usually 12 weeks, to continue therapy.
  •  

  • Approval is typically given for a limited period, reflecting the short-term use indication of the medication, generally up to a maximum of 12 weeks, unless there is compelling clinical justification for an extended duration.

 

Why Molina Healthcare Might Deny Diethylpropion (Tenuate) Coverage

 

Situations When Diethylpropion (Tenuate) is Not Covered

 

  • Molina Healthcare does not cover Diethylpropion for patients who do not meet the specific BMI criteria. Typically, coverage is denied if the patient's Body Mass Index (BMI) does not meet the threshold requirement established by the healthcare policy.
  •  

  • Coverage is often denied when there is insufficient documentation indicating that the patient attempted and failed to lose weight through a supervised diet and exercise program.
  •  

  • Patients with a medical history of cardiovascular disease, including uncontrolled hypertension, may be denied coverage for Diethylpropion, as its use may pose risks to heart health.
  •  

  • Diethylpropion coverage may be denied if the patient is concurrently using other weight loss medications or supplements without prior authorization from Molina Healthcare.
  •  

  • If Diethylpropion is prescribed for off-label uses that are not approved by Molina Healthcare, coverage will likely be denied.
  •  

  • Eligibility may be affected and coverage denied if the prescription is not written by an in-network healthcare provider who follows the guidelines set forth by Molina Healthcare.
  •  

  • Diethylpropion is typically not covered for cosmetic weight loss purposes when there is no medical necessity documented in the patient's medical records.
  •  

  • Previous adverse reactions to similar medications may lead to coverage denial of Diethylpropion to ensure patient safety.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Molina Healthcare

 

Research Molina Healthcare Formulary

 

  • Visit the Molina Healthcare website or contact your local Molina representative to access their drug formulary.
  •  

  • Check if diethylpropion (Tenuate) is listed on the formulary, and note any specific coverage requirements or restrictions mentioned.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of diethylpropion for your condition.
  •  

  • Your provider may need to provide documentation or submit prior authorization to justify the need for this medication under your plan.

 

Check Your Plan Benefits

 

  • Review the details of your particular Molina Healthcare plan to understand your prescription drug coverage benefits.
  •  

  • Identify any copays, deductibles, or limitations that might affect the coverage of diethylpropion.

 

Contact Molina's Pharmacy Services

 

  • Reach out to Molina's Pharmacy Services for guidance on drug coverage, particularly if diethylpropion is not readily covered in the formulary.
  •  

  • Inquire about the steps required to pursue a formulary exception or alternative options that might be available.

 

Submit Prior Authorization or Exception Requests

 

  • If necessary, work with your healthcare provider to submit any required prior authorization or exception requests to Molina Healthcare.
  •  

  • Ensure all supporting documentation is complete and clearly demonstrates the necessity of diethylpropion.

 

Follow Up on Your Request

 

  • Maintain regular contact with Molina Healthcare to monitor the status of your submission.
  •  

  • Be prepared to provide additional information if requested and to appeal any denials as needed with the assistance of your healthcare provider.

 

Plan for Refills and Continued Coverage

 

  • Once approved, understand the requirements for prescription refills and any recurring authorizations to ensure ongoing coverage of diethylpropion.
  •  

  • Keep track of any changes to your Molina plan that could affect drug coverage in the future.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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.

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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?

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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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