Does Oscar Health Cover Liraglutide (Saxenda)

Explore coverage of Liraglutide (Saxenda) by Oscar Health, reasons for denial, obtaining coverage steps, costs without insurance, and FAQs.
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Oscar Health Coverage for Saxenda

 

  • Oscar Health may cover Liraglutide (Saxenda) for individuals diagnosed with obesity or overweight with related health conditions.
  •  

  • Coverage often requires prior authorization, meaning the prescriber must confirm that Saxenda is medically necessary for the patient.
  •  

  • The patient typically must have a BMI of 30 or greater, or 27 or greater with additional weight-related conditions like type 2 diabetes or hypertension.
  •  

  • Doctors must provide documentation supporting attempts at weight loss through diet and exercise before approving medication coverage.
  •  

  • Patients might need to demonstrate improvement with the drug's use for continued coverage after initial approval.

 

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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 Liraglutide (Saxenda) Coverage with Oscar Health

 

Get Started with Oscar Health for Liraglutide (Saxenda) Coverage

 

  • Visit the Oscar Health website and log in to your member account. If you don't have an account, you'll need to create one.
  •  

  • Navigating the website, locate the pharmacy or prescription drug coverage section to understand your options and plan benefits.

 

Check Your Plan Details

 

  • Review your health insurance plan to see if Liraglutide (Saxenda) is covered under your prescription benefits. Look for details about specific tiers and any copayment requirements.
  •  

  • If you are unsure, contact Oscar Health directly through their customer service or chat function to confirm Liraglutide (Saxenda) coverage in your plan.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the need for Liraglutide (Saxenda) as part of your treatment plan.
  •  

  • Ensure your provider is aware of your insurance details and can provide any needed documentation or justification for the prescription.

 

Obtain Prior Authorization

 

  • Work with your healthcare provider to obtain prior authorization if required by Oscar Health for Liraglutide (Saxenda). This typically involves your provider submitting necessary documents and reasons for the medication request.
  •  

  • Follow up with your provider and Oscar Health to ensure that the prior authorization process is completed, reducing any delays in receiving your medication.

 

Explore Financial Assistance Options

 

  • If you find that Liraglutide (Saxenda) has high out-of-pocket costs, research patient assistance programs or coupons offered by the manufacturer or third-party organizations.
  •  

  • Discuss these options with your pharmacist when filling the prescription to ensure you receive any applicable discounts.

 

Continually Monitor Your Coverage

 

  • Regularly check your Oscar Health insurance updates to stay informed about any changes in coverage for Liraglutide (Saxenda) or any other medications.
  •  

  • Keep communication lines open with both your healthcare provider and Oscar Health to address any potential issues swiftly.

 

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FAQs

Does Oscar Health Cover Liraglutide (Saxenda)

Explore coverage of Liraglutide (Saxenda) by Oscar Health, reasons for denial, obtaining coverage steps, costs without insurance, and FAQs.
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Is Liraglutide (Saxenda) Covered by Oscar Health

 

Oscar Health Coverage for Saxenda

 

  • Oscar Health may cover Liraglutide (Saxenda) for individuals diagnosed with obesity or overweight with related health conditions.
  •  

  • Coverage often requires prior authorization, meaning the prescriber must confirm that Saxenda is medically necessary for the patient.
  •  

  • The patient typically must have a BMI of 30 or greater, or 27 or greater with additional weight-related conditions like type 2 diabetes or hypertension.
  •  

  • Doctors must provide documentation supporting attempts at weight loss through diet and exercise before approving medication coverage.
  •  

  • Patients might need to demonstrate improvement with the drug's use for continued coverage after initial approval.

 

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Oscar Health's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Eligibility Criteria for Liraglutide (Saxenda) Coverage

 

  • **Age Requirement:** The patient must be 18 years of age or older.
  •  

  • **Diagnosis of Obesity or Overweight:** The patient must have a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with at least one weight-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • **Lifestyle Modification:** The patient must be participating in a structured weight management program that includes both nutritional intervention and physical activity counseling.
  •  

  • **Documentation of Previous Weight Loss Interventions:** The patient should have documented evidence of failure to achieve significant weight loss with at least one other prior weight management treatment or therapy.
  •  

  • **Evaluation by a Healthcare Professional:** The patient's healthcare provider must assess and provide documentation indicating that Liraglutide is deemed medically necessary for the patient's condition and weight management needs.
  •  

  • **Absence of Contraindications:** The patient must not have any health conditions or contraindications that would preclude the use of Liraglutide, as determined by a healthcare provider.
  •  

  • **Continuous Monitoring:** The patient must agree to regular follow-up appointments with their healthcare provider to monitor the effectiveness and any potential side effects of the treatment.
  •  

 

Why Oscar Health Might Deny Liraglutide (Saxenda) Coverage

 

Criteria for Denial of Liraglutide (Saxenda) Coverage by Oscar Health

 

  • **Lack of Prior Authorization:** Liraglutide (Saxenda) may be denied if prior authorization is not obtained before the prescription. Patients must ensure that the necessary authorizations are in place to avoid denials.
  •  

  • **Non-Medically Necessary:** Coverage may be denied if Oscar Health determines that the use of Liraglutide (Saxenda) is not medically necessary according to their clinical guidelines.
  •  

  • **Off-Label Use:** If Liraglutide (Saxenda) is prescribed for an off-label use not recognized by Oscar Health’s policies, coverage may be denied. It must conform to approved and customary uses.
  •  

  • **Non-Preferred Drug Status:** Liraglutide (Saxenda) might be classified as a non-preferred drug, and Oscar Health may deny coverage if alternative preferred treatments are available and have not been tried first.
  •  

  • **Policy Exclusions:** If Liraglutide (Saxenda) is listed under any policy exclusions in Oscar Health’s insurance policy documents, it will not be covered.
  •  

  • **Insufficient Medical Documentation:** Failure to provide sufficient medical documentation supporting the use of Liraglutide (Saxenda) may result in coverage denial. Proper documentation must justify its necessity.
  •  

  • **Age Restrictions:** If the patient does not meet any specified age restrictions outlined by Oscar Health for Liraglutide (Saxenda) use, coverage may be denied.
  •  

  • **Weight Loss Without Comorbid Conditions:** Coverage might be denied if the patient is prescribed Liraglutide (Saxenda) solely for weight loss without the presence of comorbid conditions such as Type 2 diabetes.

 

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

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 Liraglutide (Saxenda) Coverage with Oscar Health

 

Get Started with Oscar Health for Liraglutide (Saxenda) Coverage

 

  • Visit the Oscar Health website and log in to your member account. If you don't have an account, you'll need to create one.
  •  

  • Navigating the website, locate the pharmacy or prescription drug coverage section to understand your options and plan benefits.

 

Check Your Plan Details

 

  • Review your health insurance plan to see if Liraglutide (Saxenda) is covered under your prescription benefits. Look for details about specific tiers and any copayment requirements.
  •  

  • If you are unsure, contact Oscar Health directly through their customer service or chat function to confirm Liraglutide (Saxenda) coverage in your plan.

 

Consult with Your Healthcare Provider

 

  • Schedule a consultation with your healthcare provider to discuss the need for Liraglutide (Saxenda) as part of your treatment plan.
  •  

  • Ensure your provider is aware of your insurance details and can provide any needed documentation or justification for the prescription.

 

Obtain Prior Authorization

 

  • Work with your healthcare provider to obtain prior authorization if required by Oscar Health for Liraglutide (Saxenda). This typically involves your provider submitting necessary documents and reasons for the medication request.
  •  

  • Follow up with your provider and Oscar Health to ensure that the prior authorization process is completed, reducing any delays in receiving your medication.

 

Explore Financial Assistance Options

 

  • If you find that Liraglutide (Saxenda) has high out-of-pocket costs, research patient assistance programs or coupons offered by the manufacturer or third-party organizations.
  •  

  • Discuss these options with your pharmacist when filling the prescription to ensure you receive any applicable discounts.

 

Continually Monitor Your Coverage

 

  • Regularly check your Oscar Health insurance updates to stay informed about any changes in coverage for Liraglutide (Saxenda) or any other medications.
  •  

  • Keep communication lines open with both your healthcare provider and Oscar Health to address any potential issues swiftly.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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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