Does Presbyterian Healthcare Services Cover Phendimetrazine

Explore Phendimetrazine coverage with Presbyterian Healthcare Services, tackle possible denials, learn cost implications, and find answers to FAQs.
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Coverage for Phendimetrazine

 

  • Phendimetrazine may be covered under Presbyterian Healthcare Services if it's deemed medically necessary for treating obesity.
  •  

  • Prescription must be part of a comprehensive weight management program, including diet and exercise.

 

Criteria for Coverage

 

  • Documentation from a healthcare provider outlining the necessity of Phendimetrazine.
  •  

  • Prior authorization may be required to determine eligibility for coverage.

 

Basic Rules

 

  • Coverage can vary based on specific health plans under Presbyterian Healthcare Services.
  •  

  • Contact member services for detailed plan information and confirmation of coverage specifics.

 

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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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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 Presbyterian Healthcare Services

 

Understanding Your Plan

 

  • Review your health insurance plan details available on the Presbyterian Healthcare Services portal or any physical documents you received.
  •  

  • Determine whether Phendimetrazine is covered under your current prescription drug plan by consulting the list of covered medications, known as the formulary.

 

Consulting with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Phendimetrazine in your treatment plan.
  •  

  • Request a prescription from your provider if they agree that Phendimetrazine is medically necessary for you.

 

Contacting Presbyterian Healthcare Services

 

  • Call the customer service number on your insurance card to confirm Phendimetrazine's coverage and any prerequisites such as prior authorization or step therapy.
  •  

  • Ask about any copayment or cost-sharing responsibilities associated with Phendimetrazine.

 

Obtaining Prior Authorization

 

  • If required, work with your healthcare provider to complete any necessary prior authorization forms. This usually involves demonstrating medical necessity.
  •  

  • Submit all required documentation to Presbyterian Healthcare Services as instructed by their customer service or your healthcare provider.

 

Filling Your Prescription

 

  • Once approval is obtained, take your prescription to a participating pharmacy to have it filled.
  •  

  • Present your insurance information to ensure that the prescription is covered, and any applicable discounts or copayments are applied.

 

Dealing with Denials

 

  • If your coverage request is denied, review the reasons for denial provided by Presbyterian Healthcare Services.
  •  

  • Consult with your healthcare provider to provide additional information or appeal the decision if necessary.

 

Following Up

 

  • Follow up with your pharmacy to ensure your prescription is being filled correctly and covered by your plan.
  •  

  • Contact Presbyterian Healthcare Services again if you encounter any issues with coverage or payment after your prescription has been filled.

 

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FAQs

Does Presbyterian Healthcare Services Cover Phendimetrazine

Explore Phendimetrazine coverage with Presbyterian Healthcare Services, tackle possible denials, learn cost implications, and find answers to FAQs.
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Is Phendimetrazine Covered by Presbyterian Healthcare Services

 

Coverage for Phendimetrazine

 

  • Phendimetrazine may be covered under Presbyterian Healthcare Services if it's deemed medically necessary for treating obesity.
  •  

  • Prescription must be part of a comprehensive weight management program, including diet and exercise.

 

Criteria for Coverage

 

  • Documentation from a healthcare provider outlining the necessity of Phendimetrazine.
  •  

  • Prior authorization may be required to determine eligibility for coverage.

 

Basic Rules

 

  • Coverage can vary based on specific health plans under Presbyterian Healthcare Services.
  •  

  • Contact member services for detailed plan information and confirmation of coverage specifics.

 

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Presbyterian Healthcare Services's Approved Criteria for Phendimetrazine Coverage

 

Criteria for Initial Coverage of Phendimetrazine

 

  • Phendimetrazine is prescribed for weight loss in patients with a body mass index (BMI) of 30 kg/m² or greater, OR in those with a BMI of 27 kg/m² or greater with related comorbid conditions such as controlled hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • The patient is 16 years of age or older.
  •  

  • The patient has attempted to lose weight through diet and exercise for a minimum of 6 consecutive months before the request for medication coverage.
  •  

  • The prescribed therapy must be as an adjunct to a structured weight management program supervised by healthcare professionals.
  •  

  • Dosage and duration of therapy conform to FDA-approved guidelines and clinical pharmacology.

 

Criteria for Continuation of Therapy

 

  • The patient demonstrates significant weight loss after 12 weeks on phendimetrazine as part of a comprehensive weight reduction program, achieving at least 5% weight loss from baseline.
  •  

  • Ongoing participation in a supervised weight management program continues to be documented.
  •  

  • No serious adverse effects reported, and the benefits outweigh the risks as documented by the healthcare provider.

 

Prescription Requirements

 

  • The prescription for phendimetrazine must be initiated by or in consultation with a healthcare provider specializing in obesity management or a related field.
  •  

  • A recent assessment with documented weight, BMI, and relevant comorbid conditions is required to support the medical necessity of the prescription.
  •  

  • Phendimetrazine is prescribed in compliance with all state and federal regulations, including controlled substance laws and regulations.

 

Review and Authorization Period

 

  • Coverage is initially authorized for a period of 3 months.
  •  

  • Subsequent authorizations require documented evidence of continued efficacy and safety, as noted in follow-up consultations and assessments.
  •  

  • Continuation beyond 6 months requires reassessment by the prescribing provider to ensure ongoing benefit to the patient.

 

Why Presbyterian Healthcare Services Might Deny Phendimetrazine Coverage

 

Excluded Indications for Coverage

 

  • Phendimetrazine will not be covered for patients who do not meet the diagnostic criteria for obesity-related treatments as defined by the healthcare policy.
  •  

  • The medication is excluded for off-label uses that are not approved by the Food and Drug Administration (FDA) or are inconsistent with standard medical practice guidelines.

 

Prior Authorization and Criteria

 

  • Coverage is denied if prior authorization is not obtained, where required, before the prescription is filled.
  •  

  • The patient's medical history does not demonstrate a trial and failure of lifestyle modifications such as diet and exercise prior to initiating pharmacotherapy. Failing to meet this prerequisite may lead to denial.

 

Non-compliance with Dosage Guidelines

 

  • Presbyterian Healthcare Services does not cover dosages that exceed the recommended maximum daily dosage set by medical guidelines, unless expressly authorized.
  •  

  • Phendimetrazine prescribed for long-term use, beyond the typical short-term duration approved, may not be covered unless specific renewed authorization is provided.

 

Lack of Required Documentation

 

  • Claims submitted without the necessary medical documentation, including evidence of obesity impact on health and documented attempts at alternative weight-loss strategies, will likely be denied.
  •  

  • Failure to provide periodic re-evaluation documents proving continued eligibility and effectiveness of the treatment can result in coverage denial.

 

Contraindicated Health Conditions

 

  • Patients with pre-existing health conditions that contraindicate the use of stimulants or weight loss medication, such as uncontrolled hypertension or heart disease, might face coverage denial.
  •  

  • Documented history of drug abuse or misuse can lead to non-approval of Phendimetrazine coverage to ensure patient safety and adherence to safe prescribing practices.

 

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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 Presbyterian Healthcare Services

 

Understanding Your Plan

 

  • Review your health insurance plan details available on the Presbyterian Healthcare Services portal or any physical documents you received.
  •  

  • Determine whether Phendimetrazine is covered under your current prescription drug plan by consulting the list of covered medications, known as the formulary.

 

Consulting with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Phendimetrazine in your treatment plan.
  •  

  • Request a prescription from your provider if they agree that Phendimetrazine is medically necessary for you.

 

Contacting Presbyterian Healthcare Services

 

  • Call the customer service number on your insurance card to confirm Phendimetrazine's coverage and any prerequisites such as prior authorization or step therapy.
  •  

  • Ask about any copayment or cost-sharing responsibilities associated with Phendimetrazine.

 

Obtaining Prior Authorization

 

  • If required, work with your healthcare provider to complete any necessary prior authorization forms. This usually involves demonstrating medical necessity.
  •  

  • Submit all required documentation to Presbyterian Healthcare Services as instructed by their customer service or your healthcare provider.

 

Filling Your Prescription

 

  • Once approval is obtained, take your prescription to a participating pharmacy to have it filled.
  •  

  • Present your insurance information to ensure that the prescription is covered, and any applicable discounts or copayments are applied.

 

Dealing with Denials

 

  • If your coverage request is denied, review the reasons for denial provided by Presbyterian Healthcare Services.
  •  

  • Consult with your healthcare provider to provide additional information or appeal the decision if necessary.

 

Following Up

 

  • Follow up with your pharmacy to ensure your prescription is being filled correctly and covered by your plan.
  •  

  • Contact Presbyterian Healthcare Services again if you encounter any issues with coverage or payment after your prescription has been filled.

 

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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.

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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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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