Does Oscar Health Cover Contrave

Learn how to secure Contrave coverage with Oscar Health, understand denial reasons, and explore costs without insurance plus a helpful Contrave FAQ.
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Oscar Health Coverage for Contrave

 

  • Oscar Health may cover Contrave, a weight loss medication, based on your specific plan and medical necessity.
  •  

  • Coverage often requires a prior authorization, meaning your provider must prove medical necessity.
  •  

  • Your plan’s formulary will indicate coverage status, including any tier placement impacting copayment amounts.
  •  

  • Typically, coverage is granted under conditions like a diagnosis of obesity or a related health condition that requires weight management.
  •  

  • Eligibility might require attempts at weight loss through diet and exercise before medication approval.
  •  

  • The policy may cover a limited duration of use, and periodic reviews might be needed for continued coverage.

 

Steps to Ensure Coverage

 

  • Consult your healthcare provider to determine if Contrave is appropriate for your condition.
  •  

  • Check your Oscar plan's formulary or contact customer service for specific coverage details.
  •  

  • Ensure your healthcare provider submits any required documentation for prior authorization.

 

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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 Contrave Coverage with Oscar Health

 

Verify Your Prescription Coverage

 

  • First, check your Oscar Health policy documents or member portal to determine if prescription medications are covered under your plan.
  •  

  • Look for details on coverage for weight management or obesity treatments, which might include medications like Contrave.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave. They can evaluate your health condition and determine if Contrave is appropriate for you.
  •  

  • Ensure your provider documents the medical necessity for Contrave, as this may be required for insurance approval.

 

Prescription Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to Oscar Health. This involves providing medical records and documentation supporting the need for Contrave.
  •  

  • Ask your provider to include any relevant medical history and previous treatments attempted to justify the need for Contrave.

 

Contact Oscar Health Member Services

 

  • Reach out to Oscar Health member services by phone or through their member portal to inquire specifically about Contrave coverage under your policy.
  •  

  • Request information on the steps needed to get prior authorization or approval for this medication.

 

Explore Oscar Health Wellness Programs

 

  • Check if Oscar Health offers any wellness or weight management programs that may include coverage for medications like Contrave.
  •  

  • Participating in these programs might enhance the likelihood of obtaining coverage for weight loss medications.

 

Submit a Claim

 

  • If you receive a prescription for Contrave, submit a claim to Oscar Health as instructed by your healthcare provider or pharmacist.
  •  

  • Include all necessary documentation from your healthcare provider confirming the prescription and its medical necessity.

 

Check for Alternative Coverage

 

  • If Oscar Health does not cover Contrave, inquire about alternative medications that might be covered under your plan.
  •  

  • Consider discussing additional options with your healthcare provider that align with your available benefits.

 

Appeal a Denied Claim

 

  • If your claim for Contrave coverage is denied, file an appeal with Oscar Health, providing any additional documentation or medical opinions that support the necessity of the medication.
  •  

  • Follow Oscar Health's appeals process closely and adhere to any specified timelines to improve your chances of a successful appeal.

 

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FAQs

Does Oscar Health Cover Contrave

Learn how to secure Contrave coverage with Oscar Health, understand denial reasons, and explore costs without insurance plus a helpful Contrave FAQ.
Curex allergy drops unboxing

Is Contrave Covered by Oscar Health

 

Oscar Health Coverage for Contrave

 

  • Oscar Health may cover Contrave, a weight loss medication, based on your specific plan and medical necessity.
  •  

  • Coverage often requires a prior authorization, meaning your provider must prove medical necessity.
  •  

  • Your plan’s formulary will indicate coverage status, including any tier placement impacting copayment amounts.
  •  

  • Typically, coverage is granted under conditions like a diagnosis of obesity or a related health condition that requires weight management.
  •  

  • Eligibility might require attempts at weight loss through diet and exercise before medication approval.
  •  

  • The policy may cover a limited duration of use, and periodic reviews might be needed for continued coverage.

 

Steps to Ensure Coverage

 

  • Consult your healthcare provider to determine if Contrave is appropriate for your condition.
  •  

  • Check your Oscar plan's formulary or contact customer service for specific coverage details.
  •  

  • Ensure your healthcare provider submits any required documentation for prior authorization.

 

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Oscar Health's Approved Criteria for Contrave Coverage

 

Eligibility for Contrave Coverage by Oscar Health

 

  • The patient must have a Body Mass Index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater if they have at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must be 18 years of age or older.
  •  

  • There must be a documented history of dietary and lifestyle interventions that have been attempted prior to requesting Contrave prescriptions.
  •  

  • The prescribing provider must assess and document the potential benefits of treatment with Contrave, including weight loss history and response to prior weight-loss therapies.
  •  

 

Initial Prescription Authorization

 

  • Initial authorization requests must include evidence of patient eligibility and the appropriateness of treatment based on the Oscar Health guidelines.
  •  

  • Initial approval is typically granted for a 3-month period to evaluate the effectiveness and tolerance of the medication by the patient.
  •  

  • Oscar Health may require documentation of regular follow-ups and progress evaluations conducted by the prescribing provider during this initial treatment period.
  •  

 

Continuation of Therapy

 

  • For continued coverage, the patient must demonstrate a clinically significant weight loss during the initial 3-month period, typically defined as a minimum of 5% reduction in body weight.
  •  

  • There must be documentation of ongoing behavioral interventions such as a medically supervised diet, exercise plan, and counseling to sustain weight loss efforts alongside Contrave treatment.
  •  

  • Continued authorization requires regular follow-up visits and assessments by the prescribing provider to monitor progress, evaluate side effects, and ensure the presence of adherence to the prescribed therapy plan.
  •  

 

Why Oscar Health Might Deny Contrave Coverage

 

Exclusions for Contrave Coverage by Oscar Health

 

  • If the patient does not meet the specific Body Mass Index (BMI) criteria as set by their policy guidelines.
  •  

  • For individuals who have not tried a doctor-supervised weight loss program prior to requesting coverage for Contrave.
  •  

  • When Contrave is prescribed for purposes other than weight loss, such as off-label uses.
  •  

  • If the patient does not have any obesity-related health conditions like diabetes or hypertension, which might be required for coverage.
  •  

  • In cases where the patient has a history of certain medical conditions like eating disorders or seizures, which are considered contraindications for Contrave.
  •  

  • If the patient has not adhered to the medication properly as prescribed or failed to attend follow-up consultations necessary for ongoing prescription approval.
  •  

  • Exclusions due to restrictive formulary limitations or if a generic alternative is available and preferred under the plan.
  •  

  • Instances where the prescription is sought from a non-network provider or without prior authorization required by the plan.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing costs.

 

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 Contrave Coverage with Oscar Health

 

Verify Your Prescription Coverage

 

  • First, check your Oscar Health policy documents or member portal to determine if prescription medications are covered under your plan.
  •  

  • Look for details on coverage for weight management or obesity treatments, which might include medications like Contrave.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave. They can evaluate your health condition and determine if Contrave is appropriate for you.
  •  

  • Ensure your provider documents the medical necessity for Contrave, as this may be required for insurance approval.

 

Prescription Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to Oscar Health. This involves providing medical records and documentation supporting the need for Contrave.
  •  

  • Ask your provider to include any relevant medical history and previous treatments attempted to justify the need for Contrave.

 

Contact Oscar Health Member Services

 

  • Reach out to Oscar Health member services by phone or through their member portal to inquire specifically about Contrave coverage under your policy.
  •  

  • Request information on the steps needed to get prior authorization or approval for this medication.

 

Explore Oscar Health Wellness Programs

 

  • Check if Oscar Health offers any wellness or weight management programs that may include coverage for medications like Contrave.
  •  

  • Participating in these programs might enhance the likelihood of obtaining coverage for weight loss medications.

 

Submit a Claim

 

  • If you receive a prescription for Contrave, submit a claim to Oscar Health as instructed by your healthcare provider or pharmacist.
  •  

  • Include all necessary documentation from your healthcare provider confirming the prescription and its medical necessity.

 

Check for Alternative Coverage

 

  • If Oscar Health does not cover Contrave, inquire about alternative medications that might be covered under your plan.
  •  

  • Consider discussing additional options with your healthcare provider that align with your available benefits.

 

Appeal a Denied Claim

 

  • If your claim for Contrave coverage is denied, file an appeal with Oscar Health, providing any additional documentation or medical opinions that support the necessity of the medication.
  •  

  • Follow Oscar Health's appeals process closely and adhere to any specified timelines to improve your chances of a successful appeal.

 

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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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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