Does Oscar Health Cover Diethylpropion (Tenuate)

Explore Oscar Health's coverage for Diethylpropion (Tenuate), reasons for denial, coverage tips, costs without insurance, and FAQs.
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Coverage for Diethylpropion (Tenuate) with Oscar Health

 

  • Oscar Health coverage for Diethylpropion (Tenuate) may vary depending on the specific health plan and state regulations. It's important to verify coverage by reviewing the plan details or contacting Oscar Health directly.
  •  

  • Coverage is often subject to certain criteria, including the necessity for weight management in patients with obesity-related conditions.
  •  

  • To enhance chances of coverage, a healthcare provider needs to demonstrate that Diethylpropion is medically necessary, typically after other weight loss treatments have been considered or tried.

 

Steps to Ensure Coverage

 

  • Consult with a healthcare provider to discuss the necessity and possible alternatives for using Diethylpropion.
  •  

  • Request prior authorization if required by your specific Oscar Health plan to avoid unexpected costs.
  •  

  • Verify with Oscar Health customer service or their online portal to understand your plan's specific coverage policies and any potential out-of-pocket costs.

 

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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 Diethylpropion (Tenuate) Coverage with Oscar Health

 

Verify Coverage for Diethylpropion (Tenuate) with Oscar Health

 

  • Log in to your Oscar Health account via their website or mobile app. If you don't have an account, consider signing up at their official site.
  •  

  • Navigate to the "Prescription Drugs" section, usually accessible under your health plan details or member resources.
  •  

  • Search for Diethylpropion (Tenuate) on their formulary, Oscar Health’s list of covered medications. Check if it is listed and what tier it falls under, as this can affect the co-pay or prior authorization requirements.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Diethylpropion (Tenuate) for your condition.
  •  

  • Request your healthcare provider to provide documentation if Oscar Health requires prior authorization or proof of necessity for coverage.

 

Request Prior Authorization

 

  • If Diethylpropion requires prior authorization, work with your healthcare provider to submit the necessary paperwork to Oscar Health.
  •  

  • Oscar Health typically has forms available on their website; ensure these forms are filled out correctly and include all required information.

 

Contact Oscar Health Member Services

 

  • Reach out to Oscar Health member services if you need additional assistance. They can verify drug coverage and explain your plan’s benefits, potential co-pays, and coverage limits.
  •  

  • Member services may guide you in obtaining detailed coverage information and can assist in resolving any issues related to authorization or benefits.

 

Submit Claims If Necessary

 

  • If you pay out-of-pocket for Diethylpropion due to any coverage issues, keep your receipts and submit a claim to Oscar Health. You may find claim forms and instructions in your member portal or by contacting member services.
  •  

  • Ensure that you provide all necessary documentation, including billing codes, receipt copies, and a detailed description of the medication and dosage.

 

Appeal Denials If Required

 

  • If your request for coverage is denied or if you face difficulties in getting authorization, consider appealing the decision. Oscar Health will have a formal appeal process detailed in your plan documents.
  •  

  • Gather additional supportive documents from your healthcare provider to strengthen your appeal.

 

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FAQs

Does Oscar Health Cover Diethylpropion (Tenuate)

Explore Oscar Health's coverage for Diethylpropion (Tenuate), reasons for denial, coverage tips, costs without insurance, and FAQs.
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Is Diethylpropion (Tenuate) Covered by Oscar Health

 

Coverage for Diethylpropion (Tenuate) with Oscar Health

 

  • Oscar Health coverage for Diethylpropion (Tenuate) may vary depending on the specific health plan and state regulations. It's important to verify coverage by reviewing the plan details or contacting Oscar Health directly.
  •  

  • Coverage is often subject to certain criteria, including the necessity for weight management in patients with obesity-related conditions.
  •  

  • To enhance chances of coverage, a healthcare provider needs to demonstrate that Diethylpropion is medically necessary, typically after other weight loss treatments have been considered or tried.

 

Steps to Ensure Coverage

 

  • Consult with a healthcare provider to discuss the necessity and possible alternatives for using Diethylpropion.
  •  

  • Request prior authorization if required by your specific Oscar Health plan to avoid unexpected costs.
  •  

  • Verify with Oscar Health customer service or their online portal to understand your plan's specific coverage policies and any potential out-of-pocket costs.

 

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Oscar Health's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Oscar Health's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

  • Diethylpropion (Tenuate) is approved for coverage in individuals over 16 years old with a Body Mass Index (BMI) of 30 or greater, indicating obesity.
  •  

  • Coverage is applicable for individuals with a BMI of 27 or greater if accompanied by at least one obesity-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must have tried and failed to achieve or maintain meaningful weight loss with a comprehensive lifestyle intervention, including diet, exercise, and behavioral modification, prior to starting Diethylpropion.
  •  

  • A prescription for Diethylpropion must be written by a licensed healthcare professional specializing in weight management or obesity treatment.
  •  

  • Continued coverage of Diethylpropion is typically contingent upon demonstrating at least a 4% weight reduction from baseline at the end of 12 weeks. Treatment efficacy and patient safety must be evaluated regularly to justify ongoing therapy.
  •  

  • The therapy must be part of a comprehensive weight management program incorporating caloric restriction, increased physical activity, and behavioral therapy.
  •  

  • Diethylpropion is covered only as short-term adjunct therapy to aid weight reduction. Use is typically intended for a few weeks under professional guidance, ensuring the absence of contraindications or potential drug interactions.

 

Why Oscar Health Might Deny Diethylpropion (Tenuate) Coverage

 

Oscar Health's Criteria for Denying Diethylpropion (Tenuate) Coverage

 

  • Diethylpropion is prescribed for non-FDA-approved uses or conditions not recognized as effective in peer-reviewed medical literature.
  •  

  • The patient has not met specific clinical criteria, such as a documented diagnosis of obesity (BMI ≥ 30), or a BMI ≥ 27 with concurrent comorbid conditions like hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Evidence of previous unsuccessful weight loss attempts, including dietary, physical activity, and behavioral changes, has not been adequately documented.
  •  

  • The prescribed dosage exceeds the recommended therapeutic dosage limits established by relevant authorities or regulatory agencies.
  •  

  • Failure to demonstrate a weight loss of at least 5% of the initial body weight within a set trial period, typically 12 weeks, when taking Diethylpropion as prescribed.
  •  

  • Continued use despite adverse effects that outweigh potential benefits, including cardiovascular complications or psychiatric concerns associated with Diethylpropion use.
  •  

  • The medication is a part of a combination therapy not supported by sufficient clinical evidence regarding safety and effectiveness.
  •  

  • Diethylpropion is used concurrently with other anorectic agents, and such combination therapy is not considered standard care.
  •  

  • Prescription of Diethylpropion is inconsistent with the patient’s age restrictions or guidelines, such as prescriptions to patients under a specific age threshold not widely accepted in medical practice.
  •  

  • Oscar Health's formulary does not include Diethylpropion, indicating it may not be part of their covered medications list.
  •  

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Oscar Health

 

Verify Coverage for Diethylpropion (Tenuate) with Oscar Health

 

  • Log in to your Oscar Health account via their website or mobile app. If you don't have an account, consider signing up at their official site.
  •  

  • Navigate to the "Prescription Drugs" section, usually accessible under your health plan details or member resources.
  •  

  • Search for Diethylpropion (Tenuate) on their formulary, Oscar Health’s list of covered medications. Check if it is listed and what tier it falls under, as this can affect the co-pay or prior authorization requirements.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Diethylpropion (Tenuate) for your condition.
  •  

  • Request your healthcare provider to provide documentation if Oscar Health requires prior authorization or proof of necessity for coverage.

 

Request Prior Authorization

 

  • If Diethylpropion requires prior authorization, work with your healthcare provider to submit the necessary paperwork to Oscar Health.
  •  

  • Oscar Health typically has forms available on their website; ensure these forms are filled out correctly and include all required information.

 

Contact Oscar Health Member Services

 

  • Reach out to Oscar Health member services if you need additional assistance. They can verify drug coverage and explain your plan’s benefits, potential co-pays, and coverage limits.
  •  

  • Member services may guide you in obtaining detailed coverage information and can assist in resolving any issues related to authorization or benefits.

 

Submit Claims If Necessary

 

  • If you pay out-of-pocket for Diethylpropion due to any coverage issues, keep your receipts and submit a claim to Oscar Health. You may find claim forms and instructions in your member portal or by contacting member services.
  •  

  • Ensure that you provide all necessary documentation, including billing codes, receipt copies, and a detailed description of the medication and dosage.

 

Appeal Denials If Required

 

  • If your request for coverage is denied or if you face difficulties in getting authorization, consider appealing the decision. Oscar Health will have a formal appeal process detailed in your plan documents.
  •  

  • Gather additional supportive documents from your healthcare provider to strengthen your appeal.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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Titration

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

Additional Treatments

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

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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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