Does Oscar Health Cover Saxenda

Explore Oscar Health's Saxenda coverage, reasons for denial, tips for approval, costs without insurance, and FAQs for informed healthcare decisions.
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Oscar Health Coverage for Saxenda

 

  • Oscar Health may cover Saxenda as part of its prescription drug plan, typically under the category of weight management medications. However, the coverage is subject to your specific health plan and benefits package.
  •  

  • To qualify for coverage, clinical criteria usually require proof that Saxenda is medically necessary. Often, this includes a diagnosis of obesity with at least one weight-related condition, such as type 2 diabetes or high blood pressure.
  •  

  • Prior authorization might be required, meaning your doctor will need to provide information to justify the need for Saxenda. This process helps Oscar Health determine if coverage can be approved based on your medical history and treatment goals.
  •  

  • You may need to have tried other weight management strategies or medications before Saxenda is approved.
  •  

  • It's essential to review your specific policy documents or contact Oscar Health directly to understand the exact coverage details and any patient responsibilities, such as copayments or deductibles.

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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 Saxenda Coverage with Oscar Health

 

Research Your Plan's Drug Formulary

 

  • Visit the Oscar Health official website and navigate to the Member Resources section to access your plan’s drug formulary.
  •  

  • Identify if Saxenda (liraglutide) is listed as a covered medication. Note any specific coverage criteria or requirements.

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Saxenda for weight management.
  •  

  • Ensure they document your medical need for Saxenda and provide any required supporting information for insurance purposes.

 

Pre-Authorization Requirements

 

  • Contact Oscar Health’s customer service to inquire about pre-authorization requirements for Saxenda.
  •  

  • Gather all necessary documentation, including a letter of medical necessity from your healthcare provider if required.

 

Submit Pre-Authorization Request

 

  • Work with your healthcare provider to submit a pre-authorization request to Oscar Health. Include all supporting documents and information.
  •  

  • Follow up with Oscar Health regularly to track the status of your pre-authorization request.

 

Review Authorization Outcome

 

  • If your pre-authorization request is approved, confirm the coverage details such as copayments and any specific conditions for Saxenda use.
  •  

  • If the request is denied, review the reasons provided by Oscar Health and consider filing an appeal if you believe Saxenda is medically necessary.

 

Appeal Process if Denied

 

  • Gather additional supporting information from your healthcare provider to strengthen your case for an appeal.
  •  

  • Follow Oscar Health’s specified procedures for submitting an appeal. Include any new medical information or clarification of Saxenda’s necessity.

 

Enroll in Oscar Health’s Patient Assistance Program

 

  • If applicable, inquire about any patient assistance programs through Oscar Health when facing high out-of-pocket costs for Saxenda.
  •  

  • Enroll in these programs to help supplement the cost while ensuring you adhere to treatment plans prescribed by your healthcare provider.

 

Pharmacy Coordination

 

  • Once coverage is established, work with a network pharmacy to fill your Saxenda prescription under your Oscar Health plan.
  •  

  • Ensure you continue to meet any ongoing requirements from Oscar Health for coverage, such as periodic assessments by your provider.

 

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FAQs

Does Oscar Health Cover Saxenda

Explore Oscar Health's Saxenda coverage, reasons for denial, tips for approval, costs without insurance, and FAQs for informed healthcare decisions.
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Is Saxenda Covered by Oscar Health

 

Oscar Health Coverage for Saxenda

 

  • Oscar Health may cover Saxenda as part of its prescription drug plan, typically under the category of weight management medications. However, the coverage is subject to your specific health plan and benefits package.
  •  

  • To qualify for coverage, clinical criteria usually require proof that Saxenda is medically necessary. Often, this includes a diagnosis of obesity with at least one weight-related condition, such as type 2 diabetes or high blood pressure.
  •  

  • Prior authorization might be required, meaning your doctor will need to provide information to justify the need for Saxenda. This process helps Oscar Health determine if coverage can be approved based on your medical history and treatment goals.
  •  

  • You may need to have tried other weight management strategies or medications before Saxenda is approved.
  •  

  • It's essential to review your specific policy documents or contact Oscar Health directly to understand the exact coverage details and any patient responsibilities, such as copayments or deductibles.

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Oscar Health's Approved Criteria for Saxenda Coverage

 

Saxenda Coverage Criteria with Oscar Health

 

  • The patient must have a documented Body Mass Index (BMI) greater than or equal to 30 kg/m², categorizing them as obese.
  •  

  • Alternatively, the patient can qualify with a BMI greater than or equal to 27 kg/m² if they have at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must demonstrate previous unsuccessful attempts at weight loss through lifestyle interventions, which include diet and exercise. Thorough documentation of these efforts from healthcare providers is required.
  •  

  • Saxenda should be prescribed as part of an overall weight management program that includes guidance on reduced-calorie diets and increased physical activity.
  •  

  • The prescriber must be a healthcare professional with experience managing obesity, ensuring that the patient receives comprehensive care and monitoring throughout the treatment process.
  •  

 

Why Oscar Health Might Deny Saxenda Coverage

 

Reasons Oscar Health Might Deny Saxenda Coverage

 

  • Prescription of Saxenda for uses not approved by the FDA. Oscar Health may not cover Saxenda if it is prescribed for non-approved uses or conditions that Saxenda is not FDA-approved to treat.
  •  

  • Absence of diagnosed obesity or insufficient evidence of need. Coverage might be denied if the patient's BMI does not meet the criteria indicating obesity, or if there's a lack of medical documentation supporting the necessity of Saxenda for weight management.
  •  

  • Lack of prior authorization from Oscar Health. If the prescribing physician has not obtained required prior authorization, Oscar Health may decline coverage for Saxenda.
  •  

  • Failure to comply with Oscar Health's step therapy protocol. If alternative medications have not been tried first, or if the patient has not demonstrated the need for Saxenda according to Oscar’s guidelines, coverage may be denied.
  •  

  • Policy exclusions specific to weight management drugs. Some Oscar Health plans may have outright exclusions for weight management medications, including Saxenda, regardless of the circumstances.
  •  

  • Non-conformance with the health plan's medical policy criteria. If the use of Saxenda does not align with the specific medical policy criteria defined by Oscar Health, coverage could be refused.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Saxenda Coverage with Oscar Health

 

Research Your Plan's Drug Formulary

 

  • Visit the Oscar Health official website and navigate to the Member Resources section to access your plan’s drug formulary.
  •  

  • Identify if Saxenda (liraglutide) is listed as a covered medication. Note any specific coverage criteria or requirements.

 

Consult With Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Saxenda for weight management.
  •  

  • Ensure they document your medical need for Saxenda and provide any required supporting information for insurance purposes.

 

Pre-Authorization Requirements

 

  • Contact Oscar Health’s customer service to inquire about pre-authorization requirements for Saxenda.
  •  

  • Gather all necessary documentation, including a letter of medical necessity from your healthcare provider if required.

 

Submit Pre-Authorization Request

 

  • Work with your healthcare provider to submit a pre-authorization request to Oscar Health. Include all supporting documents and information.
  •  

  • Follow up with Oscar Health regularly to track the status of your pre-authorization request.

 

Review Authorization Outcome

 

  • If your pre-authorization request is approved, confirm the coverage details such as copayments and any specific conditions for Saxenda use.
  •  

  • If the request is denied, review the reasons provided by Oscar Health and consider filing an appeal if you believe Saxenda is medically necessary.

 

Appeal Process if Denied

 

  • Gather additional supporting information from your healthcare provider to strengthen your case for an appeal.
  •  

  • Follow Oscar Health’s specified procedures for submitting an appeal. Include any new medical information or clarification of Saxenda’s necessity.

 

Enroll in Oscar Health’s Patient Assistance Program

 

  • If applicable, inquire about any patient assistance programs through Oscar Health when facing high out-of-pocket costs for Saxenda.
  •  

  • Enroll in these programs to help supplement the cost while ensuring you adhere to treatment plans prescribed by your healthcare provider.

 

Pharmacy Coordination

 

  • Once coverage is established, work with a network pharmacy to fill your Saxenda prescription under your Oscar Health plan.
  •  

  • Ensure you continue to meet any ongoing requirements from Oscar Health for coverage, such as periodic assessments by your provider.

 

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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.

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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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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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