Does Priority Health Cover Contrave

Explore Priority Health's coverage of Contrave, learn denial reasons, discover ways to gain coverage, and understand costs without insurance in this informative guide.
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Does Priority Health Cover Contrave?

 

  • Coverage for Contrave, a weight management prescription medication, depends on your individual Priority Health plan. Not all plans may cover this medication.
  •  

  • Generally, coverage is available for those meeting specific medical criteria, such as being over a certain BMI or having weight-related health conditions.
  •  

  • Contrave coverage may require prior authorization, meaning your healthcare provider must verify medical necessity before the plan approves benefits.
  •  

  • Patients may need to try other weight loss methods or medications before insurance approves Contrave, per step therapy protocols.
  •  

  • You may incur copayments, coinsurance, or deductibles, depending on your plan's policies on prescription medications.

 

Steps to Confirm Coverage

 

  • Review your Priority Health plan documents or contact customer service to confirm if Contrave is covered.
  •  

  • Consult with your healthcare provider about the necessary medical criteria and obtain prior authorization if required.
  •  

  • Check if there are any preferred pharmacies that could influence cost and coverage.

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Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Contrave Coverage with Priority Health

 

Understanding Your Coverage

 

  • First, sign in to your Priority Health member account on their official website. This will give you access to detailed information about your current health plan and its prescription coverage specifics.
  •  

  • Review your plan documents specifically under the pharmacy or prescription drug section to check if Contrave is listed as a covered medication.
  •  

  • If your plan’s documentation isn’t available online, consider contacting Priority Health customer service for clarification on whether Contrave is covered.

 

Talking to Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity and benefits of Contrave for your condition.
  •  

  • Ask your doctor if they have experience with submitting prior authorization requests to Priority Health. If they do, they can provide you with helpful insights on the process.

 

Obtaining Prior Authorization

 

  • If Contrave requires prior authorization, your healthcare provider will need to submit a request to Priority Health on your behalf. This request typically includes documentation supporting the medical necessity of Contrave.
  •  

  • Ensure that your healthcare provider includes all required information and medical history that supports the need for this particular medication.
  •  

  • Follow up with your doctor’s office to ensure that the request is submitted promptly and ask for confirmation once it is sent.

 

Follow Up with Priority Health

 

  • Contact Priority Health to confirm receipt of the prior authorization request. During this call, inquire about the estimated timeline for a decision.
  •  

  • After submission, monitor your Priority Health account online regularly to check for updates or approvals concerning your prior authorization request.

 

Appealing a Denial

 

  • If your coverage for Contrave was denied, review the denial letter carefully to understand the reasons provided by Priority Health.
  •  

  • Collaborate with your healthcare provider to gather additional information or documentation that might strengthen your case for an appeal.
  •  

  • Submit an appeal to Priority Health, specifically addressing the reasons for denial and providing any new evidence or documentation to support your appeal.
  •  

  • Maintain regular contact with Priority Health throughout the appeal process and check for updates online.

 

Consider Other Options

 

  • If coverage for Contrave remains elusive, discuss alternative medications or treatments with your healthcare provider that might be more readily covered by your insurance plan.
  •  

  • Explore available manufacturer discounts or patient assistance programs for Contrave, which may help in reducing out-of-pocket expenses.

 

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FAQs

Does Priority Health Cover Contrave

Explore Priority Health's coverage of Contrave, learn denial reasons, discover ways to gain coverage, and understand costs without insurance in this informative guide.
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Is Contrave Covered by Priority Health

 

Does Priority Health Cover Contrave?

 

  • Coverage for Contrave, a weight management prescription medication, depends on your individual Priority Health plan. Not all plans may cover this medication.
  •  

  • Generally, coverage is available for those meeting specific medical criteria, such as being over a certain BMI or having weight-related health conditions.
  •  

  • Contrave coverage may require prior authorization, meaning your healthcare provider must verify medical necessity before the plan approves benefits.
  •  

  • Patients may need to try other weight loss methods or medications before insurance approves Contrave, per step therapy protocols.
  •  

  • You may incur copayments, coinsurance, or deductibles, depending on your plan's policies on prescription medications.

 

Steps to Confirm Coverage

 

  • Review your Priority Health plan documents or contact customer service to confirm if Contrave is covered.
  •  

  • Consult with your healthcare provider about the necessary medical criteria and obtain prior authorization if required.
  •  

  • Check if there are any preferred pharmacies that could influence cost and coverage.

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Priority Health's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Individuals must be 18 years of age or older.
  • Coverage is available for those diagnosed with obesity (BMI of 30 or greater) or overweight (BMI of 27 or greater with at least one weight-related comorbidity such as type 2 diabetes, dyslipidemia, or hypertension).

 

Documentation Requirements

 

  • Submission of relevant medical records that indicate the patient's BMI and any associated comorbid conditions.
  • Evidence of previous weight management efforts, including diet and physical activity, documented by a healthcare provider.

 

Prior Authorization Criteria

 

  • A healthcare provider must initiate a request for prior authorization, providing justification for the necessity of Contrave therapy based on the patient's health profile.
  • The request should include a treatment plan involving lifestyle modification and regular follow-up assessments.

 

Duration of Coverage

 

  • Initial coverage may be provided for a trial period of three months.
  • Continuation of coverage is subject to documented weight loss progress and adherence to the treatment plan evaluated at each follow-up visit.

 

Provider Network Requirements

 

  • Services must be administered by healthcare providers within the Priority Health network, unless otherwise authorized.
  • Any necessary referrals or consultations should be coordinated through network providers.

 

Why Priority Health Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage by Priority Health

 

  • If the prescribed use of Contrave does not meet the medical necessity criteria established by Priority Health. Medical necessity is often determined by factors such as BMI thresholds, previous attempts at weight loss, or other health conditions.
  •  

  • Contrave prescriptions that are not aligned with FDA-approved indications might be denied. This includes uses that are experimental or off-label.
  •  

  • Requests submitted without the necessary documentation or completed medical evaluations as required by Priority Health’s policy can lead to a denial.
  •  

  • If there is no prior authorization before obtaining the prescription, which is a common requirement for coverage of medications like Contrave.
  •  

  • Prescriptions for individuals who have contraindications or health conditions that the use of Contrave may adversely affect. These conditions are generally outlined in the medication guide.
  •  

  • Claims exceeding the predefined limits in the member's plan, such as quantity or dosage limits set by Priority Health.
  •  

  • Coverage might be denied due to exclusion in specific plan types, such as plans not covering certain weight management medications or treatments.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with Priority Health

 

Understanding Your Coverage

 

  • First, sign in to your Priority Health member account on their official website. This will give you access to detailed information about your current health plan and its prescription coverage specifics.
  •  

  • Review your plan documents specifically under the pharmacy or prescription drug section to check if Contrave is listed as a covered medication.
  •  

  • If your plan’s documentation isn’t available online, consider contacting Priority Health customer service for clarification on whether Contrave is covered.

 

Talking to Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity and benefits of Contrave for your condition.
  •  

  • Ask your doctor if they have experience with submitting prior authorization requests to Priority Health. If they do, they can provide you with helpful insights on the process.

 

Obtaining Prior Authorization

 

  • If Contrave requires prior authorization, your healthcare provider will need to submit a request to Priority Health on your behalf. This request typically includes documentation supporting the medical necessity of Contrave.
  •  

  • Ensure that your healthcare provider includes all required information and medical history that supports the need for this particular medication.
  •  

  • Follow up with your doctor’s office to ensure that the request is submitted promptly and ask for confirmation once it is sent.

 

Follow Up with Priority Health

 

  • Contact Priority Health to confirm receipt of the prior authorization request. During this call, inquire about the estimated timeline for a decision.
  •  

  • After submission, monitor your Priority Health account online regularly to check for updates or approvals concerning your prior authorization request.

 

Appealing a Denial

 

  • If your coverage for Contrave was denied, review the denial letter carefully to understand the reasons provided by Priority Health.
  •  

  • Collaborate with your healthcare provider to gather additional information or documentation that might strengthen your case for an appeal.
  •  

  • Submit an appeal to Priority Health, specifically addressing the reasons for denial and providing any new evidence or documentation to support your appeal.
  •  

  • Maintain regular contact with Priority Health throughout the appeal process and check for updates online.

 

Consider Other Options

 

  • If coverage for Contrave remains elusive, discuss alternative medications or treatments with your healthcare provider that might be more readily covered by your insurance plan.
  •  

  • Explore available manufacturer discounts or patient assistance programs for Contrave, which may help in reducing out-of-pocket expenses.

 

Premium Medication you can trust

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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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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