Does Molina Healthcare Cover Phentermine (Adipex-P, Lomaira)

Explore Molina Healthcare coverage for Phentermine, reasons for denial, ways to obtain coverage, and cost without insurance. FAQs answered.
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Coverage of Phentermine by Molina Healthcare

 

  • Molina Healthcare may cover Phentermine (Adipex-P, Lomaira) in certain situations, primarily for weight loss when other methods have not been effective.
  •  

  • Coverage depends on the specific plan and state regulations, as state Medicaid programs may vary in their drug coverage policies.
  •  

  • A doctor's prescription and demonstration of medical necessity are usually required, showing that Phentermine is part of a broader weight management program under medical supervision.
  •  

  • Typically, criteria for coverage include a BMI over a certain threshold and a documented history of failed weight loss attempts through diet and exercise alone.
  •  

  • Prior authorization might be necessary, where your healthcare provider needs to submit paperwork answering Molina's requirements and criteria for prescription approval.
  •  

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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 Phentermine (Adipex-P, Lomaira) Coverage with Molina Healthcare

 

Determine Eligibility with Molina Healthcare

 

  • Check your Molina Healthcare plan details to see if it includes weight management medications.
  •  

  • Verify any prerequisites for prescription coverage, such as clinical trials or lifestyle program participation.
  •  

  • Consult your Molina Healthcare policy or contact customer support for detailed coverage information.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the potential benefits and risks of taking Phentermine (Adipex-P, Lomaira).
  •  

  • Request your doctor to provide documentation or medical justification if Molina Healthcare requires it for coverage.
  •  

  • Ensure your healthcare provider is aware of Molina Healthcare's specific requirements and procedures for prescription coverage.

 

Obtain Prior Authorization

 

  • Contact Molina Healthcare to determine if prior authorization is necessary for Phentermine coverage.
  •  

  • If required, have your healthcare provider submit a prior authorization request on your behalf.
  •  

  • Include all necessary medical documentation and justification along with the prior authorization request.

 

Verify Pharmacy Network

 

  • Check if your preferred pharmacy is within Molina Healthcare's network to avoid additional costs.
  •  

  • Consult Molina Healthcare's website or customer support to find in-network pharmacies for your prescription.
  •  

  • Inform the pharmacy about your insurance plan to ensure the medication is processed with coverage.

 

Submit a Claim if Necessary

 

  • If required, follow Molina Healthcare’s procedures for submitting a claim for the Phentermine prescription.
  •  

  • Gather all essential documents, such as receipts and prescription details, to include with your claim.
  •  

  • Track your claim status through Molina Healthcare’s online portal or customer service to ensure proper processing.

 

Appeal Denials if Required

 

  • In case of a denial, review the denial letter to understand the specific reasons for the decision.
  •  

  • Consult your healthcare provider to gather additional evidence or documentation to support your appeal.
  •  

  • Submit an appeal to Molina Healthcare following their specific procedures, along with any supporting documentation.

 

Maintain Continuous Communication

 

  • Regularly communicate with your healthcare provider regarding treatment progress and any side effects from Phentermine.
  •  

  • Stay in touch with Molina Healthcare for updates on your coverage or if any issues arise.
  •  

  • Be prepared to renew authorization or address any changes to your coverage annually or as required.

 

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FAQs

Does Molina Healthcare Cover Phentermine (Adipex-P, Lomaira)

Explore Molina Healthcare coverage for Phentermine, reasons for denial, ways to obtain coverage, and cost without insurance. FAQs answered.
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Is Phentermine (Adipex-P, Lomaira) Covered by Molina Healthcare

 

Coverage of Phentermine by Molina Healthcare

 

  • Molina Healthcare may cover Phentermine (Adipex-P, Lomaira) in certain situations, primarily for weight loss when other methods have not been effective.
  •  

  • Coverage depends on the specific plan and state regulations, as state Medicaid programs may vary in their drug coverage policies.
  •  

  • A doctor's prescription and demonstration of medical necessity are usually required, showing that Phentermine is part of a broader weight management program under medical supervision.
  •  

  • Typically, criteria for coverage include a BMI over a certain threshold and a documented history of failed weight loss attempts through diet and exercise alone.
  •  

  • Prior authorization might be necessary, where your healthcare provider needs to submit paperwork answering Molina's requirements and criteria for prescription approval.
  •  

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

 

Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

  • The patient must have a diagnosis of obesity, markedly above a specified body mass index (BMI) threshold or equivalent measurement that has been validated for clinical use.
  •  

  • Prior documentation is required showing that traditional methods of weight loss such as a reduced-calorie diet and exercise have not been effective in achieving adequate weight loss results over an extended period.
  •  

  • Coverage is available for patients who are undergoing a comprehensive weight management program that includes lifestyle modification, nutritional counseling, and regular monitoring of progress under healthcare professional supervision.
  •  

  • The prescribing healthcare professional must confirm that the patient does not have contraindications to Phentermine such as hypertension, cardiovascular disease, or mental health disorders that are not well-controlled.
  •  

  • There is an expectation that Phentermine is used as a short-term adjunct in the management of exogenous obesity with a specific duration limit (e.g., a few weeks) as per FDA recommendations, and this is clearly communicated in the prescription plan.
  •  

  • Patients must demonstrate continuous engagement with the healthcare provider’s weight management initiatives, showing compliance with treatment plans and scheduled follow-up evaluations.
  •  

  • Specific age limits may be adhered to, such as approving patients over a particular age threshold, like adulthood, ensuring the adult patient is adequately informed of potential side effects and risk factors.

 

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

 

Reasons for Molina Healthcare Denial of Phentermine Coverage

 

  • Phentermine is prescribed for cosmetic weight loss or for purposes that are not medically necessary.
  •  

  • The patient does not meet the clinical criteria for obesity as defined by Molina Healthcare. This may include BMI requirements or other health conditions that must be present.
  •  

  • Prescription is intended for long-term use. Phentermine is generally intended for short-term use and extended usage may not be covered.
  •  

  • The patient has a history of cardiovascular diseases or other contraindicated conditions that make the usage of Phentermine medically inadvisable.
  •  

  • There is a lack of documentation supporting the need for Phentermine as a part of a comprehensive weight management program that includes diet, exercise, and behavioral modifications.
  •  

  • The patient has not tried or exhausted other weight management strategies or medications that are considered safer or more cost-effective.
  •  

  • Phentermine is prescribed in combination with other drugs in a way that is not approved or that enhances the potential for misuse or adverse effects.

 

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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 Molina Healthcare

 

Determine Eligibility with Molina Healthcare

 

  • Check your Molina Healthcare plan details to see if it includes weight management medications.
  •  

  • Verify any prerequisites for prescription coverage, such as clinical trials or lifestyle program participation.
  •  

  • Consult your Molina Healthcare policy or contact customer support for detailed coverage information.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the potential benefits and risks of taking Phentermine (Adipex-P, Lomaira).
  •  

  • Request your doctor to provide documentation or medical justification if Molina Healthcare requires it for coverage.
  •  

  • Ensure your healthcare provider is aware of Molina Healthcare's specific requirements and procedures for prescription coverage.

 

Obtain Prior Authorization

 

  • Contact Molina Healthcare to determine if prior authorization is necessary for Phentermine coverage.
  •  

  • If required, have your healthcare provider submit a prior authorization request on your behalf.
  •  

  • Include all necessary medical documentation and justification along with the prior authorization request.

 

Verify Pharmacy Network

 

  • Check if your preferred pharmacy is within Molina Healthcare's network to avoid additional costs.
  •  

  • Consult Molina Healthcare's website or customer support to find in-network pharmacies for your prescription.
  •  

  • Inform the pharmacy about your insurance plan to ensure the medication is processed with coverage.

 

Submit a Claim if Necessary

 

  • If required, follow Molina Healthcare’s procedures for submitting a claim for the Phentermine prescription.
  •  

  • Gather all essential documents, such as receipts and prescription details, to include with your claim.
  •  

  • Track your claim status through Molina Healthcare’s online portal or customer service to ensure proper processing.

 

Appeal Denials if Required

 

  • In case of a denial, review the denial letter to understand the specific reasons for the decision.
  •  

  • Consult your healthcare provider to gather additional evidence or documentation to support your appeal.
  •  

  • Submit an appeal to Molina Healthcare following their specific procedures, along with any supporting documentation.

 

Maintain Continuous Communication

 

  • Regularly communicate with your healthcare provider regarding treatment progress and any side effects from Phentermine.
  •  

  • Stay in touch with Molina Healthcare for updates on your coverage or if any issues arise.
  •  

  • Be prepared to renew authorization or address any changes to your coverage annually or as required.

 

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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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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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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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