Does Molina Healthcare Cover Naltrexone/Bupropion (Contrave)

Explore how Molina Healthcare covers Contrave, why coverage might be denied, ways to secure coverage, costs without insurance, plus FAQs.
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Does Molina Healthcare Cover Naltrexone/Bupropion (Contrave)

 

  • Naltrexone/Bupropion (Contrave) is often covered by Molina Healthcare, but coverage can vary by plan and state. It’s typically covered for weight management in adults with a BMI of 30 or higher, or 27 with obesity-related conditions.
  •  

  • Prior authorization is generally required. This means a healthcare provider must demonstrate medical necessity, often by documenting previous weight management efforts and failure to achieve weight loss with other treatments.
  •  

  • Members may need to meet specific criteria outlined in their policy. It’s advisable to check individual state and policy details or contact Molina Healthcare directly for precise coverage information.
  •  

  • Some plans may require step therapy, where other weight loss medications must be tried first before authorizing Contrave.

 

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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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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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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 Naltrexone/Bupropion (Contrave) Coverage with Molina Healthcare

 

Verify Your Coverage

 

  • Log in to your Molina Healthcare member portal or contact Molina customer service to check if your current plan includes coverage for medications like Naltrexone/Bupropion (Contrave).
  •  

  • Review the plan documents, focusing on sections related to prescription drug coverage to see if Contrave is listed.
  •  

  • Inquire specifically about any restrictions or prior authorization requirements for coverage.

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the potential benefits of Naltrexone/Bupropion for your condition.
  •  

  • Ask your provider if they have experience securing coverage for this medication with Molina Healthcare and whether they believe it's a suitable treatment option for you.
  •  

  • Have your provider complete any necessary documentation or forms that Molina might require, such as a prior authorization form.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request to Molina Healthcare if required for Naltrexone/Bupropion (Contrave).
  •  

  • Ensure that all necessary details are included, such as the diagnosis, treatment history, and rationale for using Contrave over other treatments.
  •  

  • Follow up with both your provider and Molina Healthcare to confirm receipt and review status of the prior authorization request.

 

Fill the Prescription

 

  • Once the prior authorization is approved, take the prescription from your provider to a pharmacy that accepts Molina Healthcare coverage.
  •  

  • Verify with the pharmacy that they have received and processed the prior authorization for Naltrexone/Bupropion (Contrave).
  •  

  • If there are any issues at the pharmacy, contact Molina Healthcare for assistance with resolving the coverage discrepancy.

 

Appeal If Necessary

 

  • If your request for coverage is denied, review the denial letter provided by Molina Healthcare for the specific reasons.
  •  

  • Consult with your healthcare provider to prepare an appeal, including any additional medical evidence or provider recommendations that support your need for the medication.
  •  

  • Submit the appeal through the appropriate channels outlined in the denial letter and follow up regularly until a resolution is reached.

 

Maintain Communication

 

  • Keep open lines of communication with both Molina Healthcare and your healthcare provider to ensure ongoing coverage and to address any future issues that might arise.
  •  

  • Stay informed about any changes to your healthcare plan that might affect your prescription drug coverage.

 

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FAQs

Does Molina Healthcare Cover Naltrexone/Bupropion (Contrave)

Explore how Molina Healthcare covers Contrave, why coverage might be denied, ways to secure coverage, costs without insurance, plus FAQs.
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Is Naltrexone/Bupropion (Contrave) Covered by Molina Healthcare

 

Does Molina Healthcare Cover Naltrexone/Bupropion (Contrave)

 

  • Naltrexone/Bupropion (Contrave) is often covered by Molina Healthcare, but coverage can vary by plan and state. It’s typically covered for weight management in adults with a BMI of 30 or higher, or 27 with obesity-related conditions.
  •  

  • Prior authorization is generally required. This means a healthcare provider must demonstrate medical necessity, often by documenting previous weight management efforts and failure to achieve weight loss with other treatments.
  •  

  • Members may need to meet specific criteria outlined in their policy. It’s advisable to check individual state and policy details or contact Molina Healthcare directly for precise coverage information.
  •  

  • Some plans may require step therapy, where other weight loss medications must be tried first before authorizing Contrave.

 

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Molina Healthcare's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Molina Healthcare's Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

  • The patient must be at least 18 years old.
  •  

  • Naltrexone/Bupropion (Contrave) is designated for adults with an initial BMI (Body Mass Index) of 30 kg/m² or greater.
  •  

  • Coverage extends to patients with a BMI of 27 kg/m² or greater who have at least one weight-related comorbidity such as:
    • Type 2 Diabetes Mellitus
    • Hypertension
    • Dyslipidemia
  •  

  • The patient must demonstrate previous weight management efforts, typically through diet and exercise interventions, and must provide relevant documentation.
  •  

  • A licensed healthcare provider should prescribe the medication as part of a comprehensive weight management program that includes a reduced-calorie diet and increased physical activity.
  •  

  • The provider must conduct a thorough clinical assessment to ensure no contraindications with Naltrexone/Bupropion (Contrave).
  •  

  • There must be evidence showing that the patient was counseled regarding behavior modification, dietary changes, and physical activity as an integral component of weight management therapy.
  •  

  • Ongoing treatment will require documentation that demonstrates efficacy such as evidence of weight reduction or improvement in weight-related health conditions.
  •  

 

Why Molina Healthcare Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Situations When Molina Healthcare Does Not Cover Naltrexone/Bupropion (Contrave)

 

  • **Non-FDA Approved Usage**: The medication is prescribed for reasons other than its FDA-approved indications for weight management in adults who are overweight or obese.
  •  

  • **Lack of Required Documentation**: There is insufficient documentation to prove that the patient meets the specific criteria for obesity treatment, such as BMI thresholds or comorbid conditions.
  •  

  • **Prior Authorization Failure**: The required prior authorization process has not been completed or approved by Molina Healthcare.
  •  

  • **Non-Covered Population**: The patient does not fall within the specified population for which the medication is covered, which may be limited based on the plan specifics.
  •  

  • **Age Restrictions**: The patient does not meet the age criteria established by Molina Healthcare for coverage of this medication.
  •  

  • **Generic Alternatives**: If there are generic alternatives available, Molina Healthcare might deny coverage for the branded version unless it is medically necessary.
  •  

  • **Non-Compliance with Weight Management Program**: If the patient is not participating in or adhering to a comprehensive weight management program, which is often a requirement for coverage.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Molina Healthcare

 

Verify Your Coverage

 

  • Log in to your Molina Healthcare member portal or contact Molina customer service to check if your current plan includes coverage for medications like Naltrexone/Bupropion (Contrave).
  •  

  • Review the plan documents, focusing on sections related to prescription drug coverage to see if Contrave is listed.
  •  

  • Inquire specifically about any restrictions or prior authorization requirements for coverage.

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the potential benefits of Naltrexone/Bupropion for your condition.
  •  

  • Ask your provider if they have experience securing coverage for this medication with Molina Healthcare and whether they believe it's a suitable treatment option for you.
  •  

  • Have your provider complete any necessary documentation or forms that Molina might require, such as a prior authorization form.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request to Molina Healthcare if required for Naltrexone/Bupropion (Contrave).
  •  

  • Ensure that all necessary details are included, such as the diagnosis, treatment history, and rationale for using Contrave over other treatments.
  •  

  • Follow up with both your provider and Molina Healthcare to confirm receipt and review status of the prior authorization request.

 

Fill the Prescription

 

  • Once the prior authorization is approved, take the prescription from your provider to a pharmacy that accepts Molina Healthcare coverage.
  •  

  • Verify with the pharmacy that they have received and processed the prior authorization for Naltrexone/Bupropion (Contrave).
  •  

  • If there are any issues at the pharmacy, contact Molina Healthcare for assistance with resolving the coverage discrepancy.

 

Appeal If Necessary

 

  • If your request for coverage is denied, review the denial letter provided by Molina Healthcare for the specific reasons.
  •  

  • Consult with your healthcare provider to prepare an appeal, including any additional medical evidence or provider recommendations that support your need for the medication.
  •  

  • Submit the appeal through the appropriate channels outlined in the denial letter and follow up regularly until a resolution is reached.

 

Maintain Communication

 

  • Keep open lines of communication with both Molina Healthcare and your healthcare provider to ensure ongoing coverage and to address any future issues that might arise.
  •  

  • Stay informed about any changes to your healthcare plan that might affect your prescription drug coverage.

 

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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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Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

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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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