Does Oscar Health Cover Orlistat (Xenical, Alli)

Discover if Oscar Health covers Orlistat, understand possible coverage denials, and explore costs and FAQs about obtaining Orlistat without insurance.
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Oscar Health Coverage for Orlistat (Xenical, Alli)

 

  • Orlistat coverage under Oscar Health may vary based on your specific plan. It is essential to review your policy details or contact customer service for confirmation.
  •  

  • Typically, Orlistat is covered when prescribed by a healthcare provider for specific weight-related conditions or obesity management.
  •  

  • Insurance coverage often requires documentation of the patient’s medical necessity, previous weight management attempts, and a healthcare provider’s recommendation.
  •  

  • Some plans may require prior authorization, ensuring that the treatment aligns with necessary medical criteria before approval.
  •  

  • Co-pays or co-insurance fees may apply depending on your plan’s prescription drug benefits tier.
  •  

  • Always check the preferred pharmacy network for Oscar Health to potentially reduce out-of-pocket expenses for medications like Orlistat.

 

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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.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Orlistat (Xenical, Alli) Coverage with Oscar Health

 

Starting Coverage with Oscar Health

 

  • Visit the official Oscar Health website to explore their insurance plans and verify if they currently offer coverage for prescription medications like Orlistat (Xenical, Alli).
  •  

  • Contact Oscar Health's customer service through their website, phone number, or mobile app to inquire about specific medication coverage. Speak to a representative for detailed information.

 

Verify Your Oscar Health Plan Benefits

 

  • Log into your Oscar Health account online, or refer to your policy documents to determine the specifics of your prescription benefits. Look for details on covered medications and any associated costs or restrictions.
  •  

  • If unsure, consult with your assigned health insurance agent or the Oscar Health member support team for clarity on coverage details.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Orlistat. Ensure your provider is aware of Oscar Health's requirements and willing to submit necessary documentation or prior authorization if required by your plan.
  •  

  • Request a prescription for Orlistat, while discussing potential generic options, which might be more readily covered by insurance.

 

Submit a Pharmacy Claim or Request Prior Authorization

 

  • Once you have a prescription, visit a participating pharmacy within your Oscar Health network to fill the prescription. Ensure they have your updated insurance information on file.
  •  

  • If required, request the pharmacist to submit a prior authorization to Oscar Health. This step is sometimes necessary for medications like Orlistat, depending on your specific plan.

 

Follow Up with Oscar Health

 

  • Contact Oscar Health after a few days to confirm receipt and approval of the prior authorization (if applicable). Verify that Orlistat is covered under your policy and understand any co-pays or deductibles.
  •  

  • Should any issues arise, work with your healthcare provider or Oscar Health's customer support to address them promptly.

 

Review and Appeal if Necessary

 

  • If you receive a denial of coverage, carefully review the explanation provided by Oscar Health. Gather supporting documentation from your healthcare provider to strengthen your case for coverage.
  •  

  • File an appeal with Oscar Health following their formal process, providing all necessary documentation and additional justifications for why Orlistat should be covered under your health plan.

 

Maintain Regular Communication

 

  • Stay in contact with Oscar Health and your pharmacy to ensure continuous coverage, especially if your plan or medication needs change over time.
  •  

  • Keep records of all communications, prescriptions, and authorizations for future reference.

 

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FAQs

Does Oscar Health Cover Orlistat (Xenical, Alli)

Discover if Oscar Health covers Orlistat, understand possible coverage denials, and explore costs and FAQs about obtaining Orlistat without insurance.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Oscar Health

 

Oscar Health Coverage for Orlistat (Xenical, Alli)

 

  • Orlistat coverage under Oscar Health may vary based on your specific plan. It is essential to review your policy details or contact customer service for confirmation.
  •  

  • Typically, Orlistat is covered when prescribed by a healthcare provider for specific weight-related conditions or obesity management.
  •  

  • Insurance coverage often requires documentation of the patient’s medical necessity, previous weight management attempts, and a healthcare provider’s recommendation.
  •  

  • Some plans may require prior authorization, ensuring that the treatment aligns with necessary medical criteria before approval.
  •  

  • Co-pays or co-insurance fees may apply depending on your plan’s prescription drug benefits tier.
  •  

  • Always check the preferred pharmacy network for Oscar Health to potentially reduce out-of-pocket expenses for medications like Orlistat.

 

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

 

Eligibility Criteria for Orlistat Coverage

 

  • The patient must be at least 18 years old.
  •  

  • The patient has a Body Mass Index (BMI) of 30 kg/m² or greater, indicating obesity, or
  •  

  • The patient has a BMI of 27 kg/m² or greater with at least one weight-related comorbidity such as diabetes, hypertension, or dyslipidemia.
  •  

  • The patient should have completed a six-month trial of a comprehensive lifestyle intervention program, including diet, physical activity, and behavior changes, without successful weight reduction.

 

Prescription Requirements

 

  • The prescription must be written by a licensed healthcare provider, such as a general practitioner, endocrinologist, or obesity specialist.
  •  

  • The healthcare provider should provide documentation indicating that the patient meets the eligibility criteria for Orlistat as a medically necessary treatment.

 

Continuation of Therapy

 

  • The patient must demonstrate a clinically significant weight loss of at least 5% of total body weight within the first 12 weeks of therapy to continue receiving coverage for Orlistat.
  •  

  • Ongoing therapy requires periodic documentation of weight loss progress and continued participation in lifestyle modification programs.

 

Additional Considerations

 

  • Coverage may include Orlistat formulations as approved by the FDA, such as Xenical (prescription) or Alli (over-the-counter), based on the healthcare provider's recommendation.
  •  

  • All necessary pre-authorization documentation and forms must be completed and submitted as required by Oscar Health insurance policy guidelines.

 

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

 

Reasons Oscar Health Might Deny Orlistat Coverage

 

  • The medication is intended for off-label use or not FDA-approved for the specific condition for which it is prescribed.
  •  

  • The prescription does not meet Oscar Health's clinical guidelines or the patient does not meet the necessary health conditions outlined by Oscar Health for Orlistat coverage.
  •  

  • The patient has not completed the required prior authorization process before obtaining the medication.
  •  

  • The patient has not demonstrated a history of trying and failing other less costly weight-loss medications or therapies before seeking coverage for Orlistat.
  •  

  • The patient does not meet the body mass index (BMI) criteria or other specific health metrics set by Oscar Health for the prescription of the medication.
  •  

  • There is insufficient documentation of the patient's medical necessity for the use of Orlistat as required by Oscar Health policies.
  •  

  • The prescribing physician is not within the Oscar Health network, or the prescription is filled by a pharmacy not approved by Oscar Health.
  •  

  • The medication is considered a non-covered benefit under the patient's specific health plan or policy with Oscar Health.

 

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

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

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

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

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

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

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

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Orlistat (Xenical, Alli) Coverage with Oscar Health

 

Starting Coverage with Oscar Health

 

  • Visit the official Oscar Health website to explore their insurance plans and verify if they currently offer coverage for prescription medications like Orlistat (Xenical, Alli).
  •  

  • Contact Oscar Health's customer service through their website, phone number, or mobile app to inquire about specific medication coverage. Speak to a representative for detailed information.

 

Verify Your Oscar Health Plan Benefits

 

  • Log into your Oscar Health account online, or refer to your policy documents to determine the specifics of your prescription benefits. Look for details on covered medications and any associated costs or restrictions.
  •  

  • If unsure, consult with your assigned health insurance agent or the Oscar Health member support team for clarity on coverage details.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Orlistat. Ensure your provider is aware of Oscar Health's requirements and willing to submit necessary documentation or prior authorization if required by your plan.
  •  

  • Request a prescription for Orlistat, while discussing potential generic options, which might be more readily covered by insurance.

 

Submit a Pharmacy Claim or Request Prior Authorization

 

  • Once you have a prescription, visit a participating pharmacy within your Oscar Health network to fill the prescription. Ensure they have your updated insurance information on file.
  •  

  • If required, request the pharmacist to submit a prior authorization to Oscar Health. This step is sometimes necessary for medications like Orlistat, depending on your specific plan.

 

Follow Up with Oscar Health

 

  • Contact Oscar Health after a few days to confirm receipt and approval of the prior authorization (if applicable). Verify that Orlistat is covered under your policy and understand any co-pays or deductibles.
  •  

  • Should any issues arise, work with your healthcare provider or Oscar Health's customer support to address them promptly.

 

Review and Appeal if Necessary

 

  • If you receive a denial of coverage, carefully review the explanation provided by Oscar Health. Gather supporting documentation from your healthcare provider to strengthen your case for coverage.
  •  

  • File an appeal with Oscar Health following their formal process, providing all necessary documentation and additional justifications for why Orlistat should be covered under your health plan.

 

Maintain Regular Communication

 

  • Stay in contact with Oscar Health and your pharmacy to ensure continuous coverage, especially if your plan or medication needs change over time.
  •  

  • Keep records of all communications, prescriptions, and authorizations for future reference.

 

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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.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

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

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

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

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

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

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

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

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

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

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

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

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

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

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

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

 

Considerations Before Using Orlistat

 

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

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

 

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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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