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Does Network Health Cover Phentermine (Adipex-P, Lomaira)

Explore if Network Health covers Phentermine. Learn reasons for denial, tips for coverage, costs without insurance, and FAQs in this detailed guide.
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Coverage for Phentermine (Adipex-P, Lomaira)

 

  • Network Health may cover Phentermine, a weight-loss medication, in certain situations. Coverage typically depends on the member's health plan and specific medical necessity.

    •  

  • To qualify, the patient usually needs to meet certain BMI criteria or have obesity-related conditions like hypertension or diabetes. Prior authorization is often required.

 

Criteria for Coverage

 

  • Documentation from a healthcare provider supporting the medical need for Phentermine is usually needed.

    •  

  • Patients might need to have tried other weight-loss methods without success before Phentermine is approved.

    •  

  • Regular follow-ups and monitoring may be necessary to continue receiving coverage under Network Health.

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Clinical Support

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 Network Health

 

Start with Network Health

 

  • Contact Network Health. Reach out to Network Health customer service to inquire about prescription drug coverage for Phentermine (Adipex-P, Lomaira). You can find contact information on their website or in your member materials.

    •  

  • Request a copy of your drug formulary. This is a list of drugs covered by Network Health, which can help determine if Phentermine is included.

 

Verify Coverage Policies

 

  • Review the formulary. Check if Phentermine (Adipex-P, Lomaira) is listed under the Network Health drug formulary. If not explicitly listed, check for generic equivalents or similar medications.

    •  

  • Understand coverage requirements. Some medications may require prior authorization or may be tiered, affecting copay amounts. Determine if any of these conditions apply to Phentermine.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor. Make an appointment to talk about your need for Phentermine. Your healthcare provider can help submit required documents or explain the medical necessity to Network Health.

    •  

  • Request provider support. Ask your doctor to write a letter of medical necessity, which can be crucial if the medication requires prior authorization.

 

Submit Prior Authorization

 

  • Complete authorization forms. If required, your healthcare provider will need to fill out and submit prior authorization forms to Network Health.

    •  

  • Follow up regularly. Check the status of the prior authorization request with Network Health and your healthcare provider to ensure there are no delays.

 

Review and Appeal if Necessary

 

  • Check for approval. Once submitted, pay close attention to notifications from Network Health regarding the decision on your coverage.

    •  

  • Prepare to appeal. If coverage is denied, review the denial letter carefully. Utilize Network Health's appeal process to submit additional information or clarification.

 

Explore Alternative Options

 

  • Investigate alternative medications. If Phentermine is not covered, discuss alternatives with your healthcare provider that may be more easily covered by insurance.

    •  

  • Seek a discount or assistance programs. Consider manufacturer coupons, discount pharmacies, or assistance programs as options to reduce the out-of-pocket cost of Phentermine.
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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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

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FAQs

Does Network Health Cover Phentermine (Adipex-P, Lomaira)

Explore if Network Health covers Phentermine. Learn reasons for denial, tips for coverage, costs without insurance, and FAQs in this detailed guide.
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Is Phentermine (Adipex-P, Lomaira) Covered by Network Health

 

Coverage for Phentermine (Adipex-P, Lomaira)

 

  • Network Health may cover Phentermine, a weight-loss medication, in certain situations. Coverage typically depends on the member's health plan and specific medical necessity.

    •  

  • To qualify, the patient usually needs to meet certain BMI criteria or have obesity-related conditions like hypertension or diabetes. Prior authorization is often required.

 

Criteria for Coverage

 

  • Documentation from a healthcare provider supporting the medical need for Phentermine is usually needed.

    •  

  • Patients might need to have tried other weight-loss methods without success before Phentermine is approved.

    •  

  • Regular follow-ups and monitoring may be necessary to continue receiving coverage under Network Health.

A weight management program tailored to you

Start with Curex

Network Health's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Network Health's Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

  • The patient has a recorded Body Mass Index (BMI) of 30 kg/m2 or greater. Alternatively, a BMI of 27 kg/m2 or greater with comorbidity conditions such as hypertension, diabetes, or dyslipidemia.

    •  

  • The patient has documented evidence of failure or intolerance to lifestyle modifications such as diet and physical activity as a previous method of weight management.

    •  

  • The patient has met with a healthcare professional to engage in a structured weight management program which includes dietary changes, increased physical activity, and behavioral strategies.

    •  

  • Request is supported by detailed documentation from the requesting healthcare provider, including objective measurements and progress reports related to the patient's weight management journey.

    •  

  • The prescribing healthcare professional has attested to monitoring the patient for cardiovascular or psychological complications, as these can be associated with the use of Phentermine.

    •  

  • Patients must not have a history of drug abuse and have been evaluated for conditions that could contraindicate the therapy, including but not limited to uncontrolled hypertension or hyperthyroidism.

    •  

  • Request for coverage must be in compliance with FDA guidelines, ensuring that the duration of the Phentermine therapy does not exceed 12 continuous weeks.

 

Why Network Health Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons for Coverage Denial of Phentermine

 

  • Phentermine is not covered when it is prescribed for cosmetic weight loss. Network Health does not cover medications solely for the purpose of changing physical appearance.

    •  

  • The medication will be denied if prescribed alongside other weight loss drugs not approved by the FDA. Network Health prioritizes safety and adherence to FDA guidelines.

    •  

  • Coverage is not provided if the patient has a history of cardiovascular disease. Network Health considers the risks involved with such pre-existing conditions.

    •  

  • Phentermine will be denied if the patient has previously shown an adverse reaction to the drug. Safety histories are taken into account in prescription approvals.

    •  

  • Network Health does not cover Phentermine if there is no documented history of weight reduction and behavior modification efforts. Lifestyle changes must be attempted before medication is considered.

    •  

  • Phentermine is denied when prescribed for children or adolescents as it is not approved for use in individuals under 16 years of age.

    •  

  • Certain coverage plans exclude medications like Phentermine for weight management, based on specific plan policies and guidelines.

 

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

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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.

 

Clinical Support

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 Network Health

 

Start with Network Health

 

  • Contact Network Health. Reach out to Network Health customer service to inquire about prescription drug coverage for Phentermine (Adipex-P, Lomaira). You can find contact information on their website or in your member materials.

    •  

  • Request a copy of your drug formulary. This is a list of drugs covered by Network Health, which can help determine if Phentermine is included.

 

Verify Coverage Policies

 

  • Review the formulary. Check if Phentermine (Adipex-P, Lomaira) is listed under the Network Health drug formulary. If not explicitly listed, check for generic equivalents or similar medications.

    •  

  • Understand coverage requirements. Some medications may require prior authorization or may be tiered, affecting copay amounts. Determine if any of these conditions apply to Phentermine.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor. Make an appointment to talk about your need for Phentermine. Your healthcare provider can help submit required documents or explain the medical necessity to Network Health.

    •  

  • Request provider support. Ask your doctor to write a letter of medical necessity, which can be crucial if the medication requires prior authorization.

 

Submit Prior Authorization

 

  • Complete authorization forms. If required, your healthcare provider will need to fill out and submit prior authorization forms to Network Health.

    •  

  • Follow up regularly. Check the status of the prior authorization request with Network Health and your healthcare provider to ensure there are no delays.

 

Review and Appeal if Necessary

 

  • Check for approval. Once submitted, pay close attention to notifications from Network Health regarding the decision on your coverage.

    •  

  • Prepare to appeal. If coverage is denied, review the denial letter carefully. Utilize Network Health's appeal process to submit additional information or clarification.

 

Explore Alternative Options

 

  • Investigate alternative medications. If Phentermine is not covered, discuss alternatives with your healthcare provider that may be more easily covered by insurance.

    •  

  • Seek a discount or assistance programs. Consider manufacturer coupons, discount pharmacies, or assistance programs as options to reduce the out-of-pocket cost of Phentermine.

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.

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.

 

Have questions left?

‍

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

‍

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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