Does Network Health Cover Orlistat (Xenical, Alli)

Find out if Network Health covers Orlistat, how to secure coverage, its costs without insurance, and answers to common questions on Orlistat.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Network Health Coverage for Orlistat

 

  • Network Health may cover Orlistat (Xenical, Alli) based on medical necessity. Prescription is required.
  •  

  • Eligibility often necessitates a BMI of 30 or higher, or 27 with weight-related conditions like hypertension or diabetes.
  •  

  • Documentation from healthcare providers is typically necessary, illustrating previous weight loss attempts or interventions.
  •  

  • Pre-authorization is usually required; consult Network Health's formulary guide or contact them for specific criteria and procedures.
  •  

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 Orlistat (Xenical, Alli) Coverage with Network Health

 

Check Network Health Plan Details

 

  • Review your current Network Health insurance plan's coverage details to determine if weight management medications like Orlistat (Xenical, Alli) are included.
  •  

  • Visit the Network Health website or contact their customer service for specific information on pharmacy benefits related to weight loss medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the suitability of Orlistat for your weight management needs. Ensure they are aware of your insurance plan details.
  •  

  • Request a written prescription for Orlistat if your doctor agrees it is appropriate for you.

 

Verify Prior Authorization Requirements

 

  • Contact Network Health to determine if prior authorization is required for Orlistat coverage. This step is crucial to avoid unexpected out-of-pocket expenses.
  •  

  • Ask your doctor to assist you with the prior authorization process if it's required. They may need to provide clinical documentation to support your case.

 

Submit a Claim

 

  • Once you have the prior authorization (if needed), fill the prescription at a pharmacy in your network.
  •  

  • If required, submit a claim to Network Health for reimbursement. Make sure to include all necessary documentation, such as the prescription and any prior authorization approval.

 

Review Coverage and Out-of-pocket Costs

 

  • Examine any coverage limits, co-pays, or deductible requirements associated with your plan's prescription drug benefit for Orlistat.
  •  

  • Discuss alternative options with your healthcare provider if costs are prohibitive or if Orlistat is not covered by your plan.

 

Appeal Denied Claims

 

  • If your claim for Orlistat coverage is denied, review the denial letter carefully to understand the reason.
  •  

  • Work with your healthcare provider to gather additional information or supporting documentation that may be required for an appeal.
  •  

  • Submit an appeal to Network Health, adhering to their specified process and deadlines.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Network Health Cover Orlistat (Xenical, Alli)

Find out if Network Health covers Orlistat, how to secure coverage, its costs without insurance, and answers to common questions on Orlistat.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Network Health

 

Network Health Coverage for Orlistat

 

  • Network Health may cover Orlistat (Xenical, Alli) based on medical necessity. Prescription is required.
  •  

  • Eligibility often necessitates a BMI of 30 or higher, or 27 with weight-related conditions like hypertension or diabetes.
  •  

  • Documentation from healthcare providers is typically necessary, illustrating previous weight loss attempts or interventions.
  •  

  • Pre-authorization is usually required; consult Network Health's formulary guide or contact them for specific criteria and procedures.
  •  

A weight management program tailored to you

Start with Curex

Network Health's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Criteria for Orlistat (Xenical, Alli) Coverage

 

  • **Body Mass Index (BMI) Requirements**: Candidates must have a BMI of 30 kg/m² or greater. Or individuals with a BMI of 27 kg/m² or greater with at least one weight-related comorbid condition, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Attempted Weight Loss**: Applicants should provide evidence of unsuccessful weight loss attempts through diet and exercise over the past six months.
  •  

  • **Clinical Assessment**: A healthcare provider must document the individual's risk factors and the clinical necessity for Orlistat. This involves a comprehensive assessment of potential benefits versus risks for initiating treatment.
  •  

  • **Age Criteria**: The patient must be an adult aged 18 years or older. Orlistat is not typically recommended for pediatric use except under special medical advisement.
  •  

  • **Dietary Guidelines**: Coverage requires adherence to an appropriate reduced-calorie, low-fat diet concurrent with Orlistat treatment. Patients must exhibit readiness to adhere to recommended dietary guidelines.
  •  

  • **Program Enrollment**: Eligibility may be contingent upon enrollment in an associated weight management program or support group to ensure proper dietary and exercise frameworks are followed during treatment.
  •  

  • **Healthcare Provider Monitoring**: Regular monitoring and follow-up appointments with a healthcare provider are required to track the efficacy and safety of the treatment, with results documented and submitted as needed.
  •  

  • **Contraindication Screening**: A review of contraindications, such as chronic malabsorption syndrome or cholestasis, is necessary prior to coverage approval to ensure Orlistat is a medically sound choice for the patient.
  •  

 

Why Network Health Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons Network Health Might Deny Orlistat Coverage

 

  • **Non-Approved Medical Diagnoses:** Orlistat is typically covered for individuals who meet specific health criteria such as a certain body mass index (BMI) or other weight-related health conditions. Coverage may be denied if these criteria are not met.
  •  

  • **Lack of Evidence for Long-term Efficacy:** If there isn't sufficient evidence showing the long-term benefits and safety of Orlistat use for a particular patient, Network Health may choose not to cover the medication.
  •  

  • **Use of Non-Preferred Medication:** If Orlistat is not listed as a preferred medication on the Network Health formulary, and there are effective, less costly alternatives available, the coverage might be denied.
  •  

  • **Non-compliance with Lifestyle Modification Requirements:** Orlistat is often prescribed in conjunction with lifestyle modifications like diet and exercise. Coverage might be denied if there's a failure to comply with these complementary health strategies.
  •  

  • **Absence of Prior Authorization:** Some plans require prior authorization for certain medications, including Orlistat. If the necessary authorization isn't obtained before purchasing the medication, coverage could be denied.
  •  

  • **Exceedance of Prescribed Dosage:** Use of Orlistat beyond the prescribed dosage or duration might lead to a denial of coverage, as it's essential to follow the medical guidelines provided.

 

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

How Much Does Orlistat (Xenical, Alli) Cost without Insurance?

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

  • Xenical: The brand-name Orlistat, Xenical, can be quite expensive without insurance. Typically, the cost is around $800 to $1,000 for a supply of 90 capsules, with each capsule being 120 mg.
  •  

  • Alli: The over-the-counter version, Alli, is generally less expensive than its prescription counterpart. The price for Alli ranges from $50 to $100 for a supply of 120 capsules, with each capsule being 60 mg.
  •  

  • Generic Orlistat: While generic options may be available, they usually do not offer significant savings over the brand-name versions. The prices for generic Orlistat are often comparable to those of Alli, varying from $50 to $100 for a similar quantity.
  •  

  • Shopping Tips: Prices can vary depending on the pharmacy, location, and availability. Consider using pharmacy discount cards, online coupons, or comparing prices at different pharmacies to obtain the best deal.
  •  

  • Considerations: Always consult a healthcare provider before starting Orlistat, and discuss any potential insurance coverage or assistance programs they might recommend.

 

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 Orlistat (Xenical, Alli) Coverage with Network Health

 

Check Network Health Plan Details

 

  • Review your current Network Health insurance plan's coverage details to determine if weight management medications like Orlistat (Xenical, Alli) are included.
  •  

  • Visit the Network Health website or contact their customer service for specific information on pharmacy benefits related to weight loss medications.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the suitability of Orlistat for your weight management needs. Ensure they are aware of your insurance plan details.
  •  

  • Request a written prescription for Orlistat if your doctor agrees it is appropriate for you.

 

Verify Prior Authorization Requirements

 

  • Contact Network Health to determine if prior authorization is required for Orlistat coverage. This step is crucial to avoid unexpected out-of-pocket expenses.
  •  

  • Ask your doctor to assist you with the prior authorization process if it's required. They may need to provide clinical documentation to support your case.

 

Submit a Claim

 

  • Once you have the prior authorization (if needed), fill the prescription at a pharmacy in your network.
  •  

  • If required, submit a claim to Network Health for reimbursement. Make sure to include all necessary documentation, such as the prescription and any prior authorization approval.

 

Review Coverage and Out-of-pocket Costs

 

  • Examine any coverage limits, co-pays, or deductible requirements associated with your plan's prescription drug benefit for Orlistat.
  •  

  • Discuss alternative options with your healthcare provider if costs are prohibitive or if Orlistat is not covered by your plan.

 

Appeal Denied Claims

 

  • If your claim for Orlistat coverage is denied, review the denial letter carefully to understand the reason.
  •  

  • Work with your healthcare provider to gather additional information or supporting documentation that may be required for an appeal.
  •  

  • Submit an appeal to Network Health, adhering to their specified process and deadlines.

 

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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

  • Gastrointestinal issues: Common effects include oily or fatty stools, increased defecation, and the urgent or difficult need to control bowel movements.
  •  

  • Abdominal discomfort: Some users experience pain or discomfort in the abdomen region.
  •  

  • Reduced absorption of fat-soluble vitamins: Orlistat can interfere with the absorption of vitamins A, D, E, and K. A multivitamin supplement is often recommended.
  •  

  • Allergic reactions: Though rare, symptoms may include itching, rash, or swelling, especially of the face, tongue, or throat.
  •  

  • Others: Some users report headaches, back pain, or flu-like symptoms.

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

  • Orlistat aids weight loss by blocking the absorption of fats from the diet, reducing caloric intake. It can block approximately 25-30% of dietary fat.
  •  

  • Clinical studies suggest that Orlistat use for one year can result in an average weight loss of about 5-10% of initial body weight, when combined with a calorie-reduced diet.
  •  

  • It promotes modest weight loss over time and helps maintain weight loss. The effectiveness can improve with lifestyle changes such as increased physical activity and diet modifications.
  •  

  • Orlistat also has beneficial effects on cholesterol levels and may help reduce blood pressure.

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

  • Orlistat is available in two forms: prescription strength (Xenical) and over-the-counter (Alli).
  •  

  • **Xenical**: This is the 120 mg version and requires a doctor's prescription. It's typically used for patients with a higher body mass index (BMI) or more specific medical conditions.
  •  

  • **Alli**: The 60 mg variant can be purchased over the counter in many countries, including the United States and the UK.
  •  

  • Even though Alli is accessible without a prescription, it is advised to consult with a healthcare professional before starting, to discuss its suitability and ensure proper usage.
  •  

 

Considerations Before Using Orlistat

 

  • Proper dietary changes are necessary when taking Orlistat to maximize effectiveness and reduce side effects.
  •  

  • Discuss your complete medical history and any other medications you are taking with your healthcare provider.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

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.

Made in Webflow