Does Oscar Health Cover Phendimetrazine

Explore if Oscar Health covers Phendimetrazine, how to secure coverage, potential costs without insurance, and common questions answered.
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Does Oscar Health Cover Phendimetrazine?

 

  • Oscar Health might cover Phendimetrazine if it is deemed medically necessary. Coverage often depends on the specific plan and state regulations.
  •  

  • Prior authorization from a healthcare provider is usually required. The physician must justify the medical necessity of Phendimetrazine for the patient.
  •  

  • The patient must meet certain criteria, typically involving being significantly overweight or obese and having other health conditions that warrant weight loss medication.
  •  

  • Some plans may require trying other weight loss methods first, such as diet and exercise, before covering Phendimetrazine.
  •  

  • It's crucial to check the specific terms and conditions of the individual's Oscar Health insurance plan or consult with Oscar Health directly for precise information on coverage.

 

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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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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 Phendimetrazine Coverage with Oscar Health

 

Start by Understanding Your Prescription Needs

 

  • Consult with your healthcare provider to ensure that Phendimetrazine is the right medication for your needs and that an appropriate prescription is written.
  •  

  • Discuss your insurance coverage options with your provider, as they might have insights specific to Oscar Health.

 

Check Oscar Health's Formulary

 

  • Visit Oscar Health’s official website to access their formulary or list of covered medications.
  •  

  • Search for Phendimetrazine in the formulary to determine if it's covered under your plan.
  •  

  • If Phendimetrazine is not listed, consult the "Not covered" or "Exclusions" section to verify.

 

Contact Oscar Health Customer Support

 

  • Call the Oscar Health customer service number located on the back of your insurance card to confirm Phendimetrazine coverage.
  •  

  • Inquire about any specific prerequisites, such as prior authorization or step therapy, required to obtain coverage for Phendimetrazine.

 

Work with Your Healthcare Provider for Prior Authorization

 

  • If prior authorization is necessary, collaborate with your healthcare provider to complete and submit the required forms to Oscar Health.
  •  

  • Your provider will need to provide justification for the use of Phendimetrazine, including your medical history and the necessity of the medication.

 

Submit a Formal Request if Needed

 

  • If Phendimetrazine is not covered, consider filing a formal exception request with evidence from your healthcare provider regarding the necessity of this medication.
  •  

  • Await a response from Oscar Health, which will notify you if the exception request is approved or denied.

 

Explore Alternative Coverage Options

 

  • If coverage continues to be an issue, discuss alternative medication options with your physician that might be covered by your Oscar Health plan.
  •  

  • Consider switching to a different Oscar Health plan during the open enrollment period that offers coverage for Phendimetrazine if that's a viable option.

 

Follow Up Regularly

 

  • Keep track of all communication and submissions with Oscar Health and periodically follow up to ensure there are no delays in processing your requests.
  •  

  • Regularly review your Explanation of Benefits (EOB) to understand how much you will need to pay out of pocket for Phendimetrazine, if covered.

 

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FAQs

Does Oscar Health Cover Phendimetrazine

Explore if Oscar Health covers Phendimetrazine, how to secure coverage, potential costs without insurance, and common questions answered.
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Is Phendimetrazine Covered by Oscar Health

 

Does Oscar Health Cover Phendimetrazine?

 

  • Oscar Health might cover Phendimetrazine if it is deemed medically necessary. Coverage often depends on the specific plan and state regulations.
  •  

  • Prior authorization from a healthcare provider is usually required. The physician must justify the medical necessity of Phendimetrazine for the patient.
  •  

  • The patient must meet certain criteria, typically involving being significantly overweight or obese and having other health conditions that warrant weight loss medication.
  •  

  • Some plans may require trying other weight loss methods first, such as diet and exercise, before covering Phendimetrazine.
  •  

  • It's crucial to check the specific terms and conditions of the individual's Oscar Health insurance plan or consult with Oscar Health directly for precise information on coverage.

 

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Oscar Health's Approved Criteria for Phendimetrazine Coverage

 

Approved Criteria for Phendimetrazine Coverage

 

  • The patient must have a documented diagnosis of obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, or a BMI ≥ 27 kg/m2 with an associated weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must have attempted weight loss through a structured, supervised, or self-monitored weight-loss program, lifestyle modification, or counseling for a minimum of 6 months without significant success, documented by healthcare provider.
  •  

  • The prescription for phendimetrazine must be provided by a healthcare provider with appropriate expertise in weight management.
  •  

  • There must be a clear medical record documenting that the patient does not have contraindications such as cardiovascular disease, hyperthyroidism, glaucoma, or prior drug abuse. The patient should not be pregnant, breastfeeding, or planning to become pregnant.
  •  

  • The requested coverage must comply with FDA-approved indications and dosing guidelines for phendimetrazine use. Usually, this involves a short-term (up to 12 weeks) adjunct in a regimen of weight reduction based on caloric restriction.
  •  

  • Patient must have demonstrated compliance with the prescribed weight management regimen and must continue to be actively engaged in a multi-faceted weight loss program that includes dietary changes, physical activity, and behavior therapy.
  •  

  • Oscar Health insurers may require regular follow-up consultations to monitor efficacy and potential side effects of phendimetrazine use. This may involve routine check-ups every four weeks during treatment to assess progress and need for continued therapy.
  •  

  • There must be demonstrated cost-effectiveness and a prior approval process in place for coverage, often necessitating a step therapy or trial of other less-costly interventions prior to authorization of phendimetrazine.

 

Why Oscar Health Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage

 

  • Oscar Health may deny coverage for Phendimetrazine if the prescription does not meet their medical necessity criteria. This could include situations where alternative treatments for weight loss have not been tried or documented.
  •  

  • The medication might not be covered if it is prescribed off-label for a condition other than that approved by the FDA and not in alignment with Oscar Health's policies.
  •  

  • If the patient does not meet the BMI requirements or related medical criteria set by Oscar Health for obesity treatment, coverage for Phendimetrazine may be denied.
  •  

  • Phendimetrazine may not be covered if there is insufficient documentation or lack of detailed clinical notes justifying its necessity for weight management.
  •  

  • Oscar Health may deny coverage if the prescribed dosage or treatment duration exceeds what is typically approved under their healthcare plans.
  •  

  • Coverage might be denied if the individual has a history of substance abuse, as this could be considered a contraindication for prescribing Phendimetrazine.
  •  

  • If the medication is not listed in the specific plan's formulary or if prior authorization is required and not obtained, Oscar Health might deny coverage.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Oscar Health

 

Start by Understanding Your Prescription Needs

 

  • Consult with your healthcare provider to ensure that Phendimetrazine is the right medication for your needs and that an appropriate prescription is written.
  •  

  • Discuss your insurance coverage options with your provider, as they might have insights specific to Oscar Health.

 

Check Oscar Health's Formulary

 

  • Visit Oscar Health’s official website to access their formulary or list of covered medications.
  •  

  • Search for Phendimetrazine in the formulary to determine if it's covered under your plan.
  •  

  • If Phendimetrazine is not listed, consult the "Not covered" or "Exclusions" section to verify.

 

Contact Oscar Health Customer Support

 

  • Call the Oscar Health customer service number located on the back of your insurance card to confirm Phendimetrazine coverage.
  •  

  • Inquire about any specific prerequisites, such as prior authorization or step therapy, required to obtain coverage for Phendimetrazine.

 

Work with Your Healthcare Provider for Prior Authorization

 

  • If prior authorization is necessary, collaborate with your healthcare provider to complete and submit the required forms to Oscar Health.
  •  

  • Your provider will need to provide justification for the use of Phendimetrazine, including your medical history and the necessity of the medication.

 

Submit a Formal Request if Needed

 

  • If Phendimetrazine is not covered, consider filing a formal exception request with evidence from your healthcare provider regarding the necessity of this medication.
  •  

  • Await a response from Oscar Health, which will notify you if the exception request is approved or denied.

 

Explore Alternative Coverage Options

 

  • If coverage continues to be an issue, discuss alternative medication options with your physician that might be covered by your Oscar Health plan.
  •  

  • Consider switching to a different Oscar Health plan during the open enrollment period that offers coverage for Phendimetrazine if that's a viable option.

 

Follow Up Regularly

 

  • Keep track of all communication and submissions with Oscar Health and periodically follow up to ensure there are no delays in processing your requests.
  •  

  • Regularly review your Explanation of Benefits (EOB) to understand how much you will need to pay out of pocket for Phendimetrazine, if covered.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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Do your plans include prescriptions and medications?

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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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