Does Priority Health Cover Diethylpropion (Tenuate)

Explore Priority Health's coverage for Diethylpropion, tips for securing coverage, cost details without insurance, and FAQs.
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Priority Health Coverage for Diethylpropion (Tenuate)

 

  • Diethylpropion (Tenuate) may be covered by Priority Health under specific circumstances when prescribed for weight management in patients with certain health conditions.
  •  

  • Coverage often requires prior authorization, demonstrating the patient's medical necessity for the medication.
  •  

  • Patients usually need to have a documented BMI (Body Mass Index) above the specified threshold or obesity-related health conditions to qualify.
  •  

  • Ongoing coverage might require proof of treatment effectiveness, such as a certain percentage of weight loss within a predetermined timeframe.
  •  

  • Policy specifics, including any co-pays or deductibles, can vary based on the individual's health plan and location.

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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 Diethylpropion (Tenuate) Coverage with Priority Health

 

Understand Priority Health's Coverage Policies

 

  • Visit the Priority Health official website to review their policy documents regarding medication coverage.
  •  
  • Look for sections dedicated to weight management or prescription diet pills coverage.
  •  
  • Read about any prerequisites or conditions that must be met for medication coverage, such as prior authorization or step therapy.

 

Consult Your Physician

 

  • Schedule an appointment with your healthcare provider to discuss your weight management goals and the need for Diethylpropion (Tenuate).
  •  
  • Ask your doctor to provide medical justification for prescribing Diethylpropion, especially if other treatments have been ineffective.
  •  
  • Ensure that your physician is familiar with Priority Health’s requirements for prescribing weight management medications.

 

Gather Necessary Documentation

 

  • Collect all medical records that demonstrate your history of treatments for weight management.
  •  
  • Get a detailed prescription from your doctor, including dosage and duration of treatment.
  •  
  • Prepare any additional documents that Priority Health may require, such as a letter of medical necessity from your physician.

 

Contact Priority Health

 

  • Call Priority Health customer service to discuss your insurance plan's specifics and whether Diethylpropion is covered under your policy.
  •  
  • Inquire about the process for obtaining coverage, including any paperwork or forms that you need to complete.
  •  
  • Ask about timelines for approval and if there is an appeal process if initially denied.

 

Submit a Prior Authorization Request

 

  • Fill out any required forms, such as a prior authorization form, to request coverage for Diethylpropion.
  •  
  • Attach all the gathered documentation, including your doctor’s prescription and any letters of medical necessity.
  •  
  • Submit the request through the means specified by Priority Health, whether online, by fax, or mail.

 

Follow Up

 

  • Monitor the status of your prior authorization request regularly to ensure it is being processed.
  •  
  • Contact Priority Health for updates if there are delays beyond the usual processing time.
  •  
  • Be prepared to provide additional information if requested by Priority Health to support your coverage request.

 

Handle Denials Appropriately

 

  • If your request for coverage is denied, review Priority Health's Explanation of Benefits (EOB) to understand the reasons.
  •  
  • Consult with your physician to address the reasons for denial and gather additional evidence to support your case.
  •  
  • File an appeal with Priority Health following their appeals process, attaching any new or additional documentation.

 

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FAQs

Does Priority Health Cover Diethylpropion (Tenuate)

Explore Priority Health's coverage for Diethylpropion, tips for securing coverage, cost details without insurance, and FAQs.
Curex allergy drops unboxing

Is Diethylpropion (Tenuate) Covered by Priority Health

 

Priority Health Coverage for Diethylpropion (Tenuate)

 

  • Diethylpropion (Tenuate) may be covered by Priority Health under specific circumstances when prescribed for weight management in patients with certain health conditions.
  •  

  • Coverage often requires prior authorization, demonstrating the patient's medical necessity for the medication.
  •  

  • Patients usually need to have a documented BMI (Body Mass Index) above the specified threshold or obesity-related health conditions to qualify.
  •  

  • Ongoing coverage might require proof of treatment effectiveness, such as a certain percentage of weight loss within a predetermined timeframe.
  •  

  • Policy specifics, including any co-pays or deductibles, can vary based on the individual's health plan and location.

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Priority Health's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility Criteria for Diethylpropion (Tenuate)

 

  • Diethylpropion is covered when prescribed for patients with a body mass index (BMI) greater than or equal to 30 kg/m², or a BMI greater than or equal to 27 kg/m² with documented weight-related comorbidities such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient must have a documented history of unsuccessful weight loss attempts with lifestyle changes, such as diet and exercise modifications, prior to the prescription of Diethylpropion.
  •  

 

Age and Medical Assessment Requirement

 

  • Coverage is approved for patients aged 16 years and older.
  •  

  • A comprehensive physical examination and medical assessment, including blood pressure, heart rate, and EKG, if indicated, must be completed before initiating treatment.
  •  

 

Documentation Requirements

 

  • Physicians must provide clinical documentation of the patient's BMI and any weight-related comorbidities, as well as records of prior weight loss strategies.
  •  

  • A detailed plan for weight management, incorporating Diethylpropion, lifestyle modifications, and scheduled follow-up visits, needs to be outlined in the patient’s medical records.
  •  

 

Follow-Up and Treatment Review

 

  • Continued coverage requires periodic evaluation of the patient's progress. Physicians must document the patient's weight loss progress and any adverse effects at follow-up visits.
  •  

  • A reassessment of therapy effectiveness and medication necessity is mandatory if significant weight loss is not observed within the first 12 weeks of treatment.
  •  

 

Duration and Renewal of Coverage

 

  • Initial coverage may be approved for up to 12 weeks. Further coverage is contingent on documented weight loss of at least 5% of initial body weight, assessed after the first 12 weeks.
  •  

  • Subsequent prescriptions require re-evaluation of the patient's weight management plan and confirmation of ongoing benefit from the medication.

 

Why Priority Health Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Denial of Diethylpropion (Tenuate) Coverage by Priority Health

 

  • Priority Health does not cover Diethylpropion if the patient has not met the required body mass index (BMI) criteria. Patients must typically have a BMI of 30 or greater, or 27 with weight-related comorbidities.
  •  

  • The medication will not be covered if the patient has not attempted and documented an adequate trial of at least three months of a supervised weight reduction program within the past 5 years.
  •  

  • Diethylpropion is not covered for patients with a history of cardiovascular disease, including but not limited to conditions such as uncontrolled hypertension, coronary artery disease, heart arrhythmias, or stroke.
  •  

  • Priority Health may deny coverage if the patient has a history of substance abuse, or if there is suspicion of potential medication misuse or abuse.
  •  

  • The coverage is not provided if Diethylpropion is deemed not to be medically necessary based on a comprehensive evaluation of the patient's overall health and weight management goals.
  •  

  • Patients who are on medications that have known severe interactions with Diethylpropion, or who have contraindications based on their current medication list, will be denied coverage.
  •  

  • Coverage will not be approved if the patient has previously not adhered to medical advice regarding weight management or failed to comply with previously prescribed weight loss treatments.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Priority Health

 

Understand Priority Health's Coverage Policies

 

  • Visit the Priority Health official website to review their policy documents regarding medication coverage.
  •  
  • Look for sections dedicated to weight management or prescription diet pills coverage.
  •  
  • Read about any prerequisites or conditions that must be met for medication coverage, such as prior authorization or step therapy.

 

Consult Your Physician

 

  • Schedule an appointment with your healthcare provider to discuss your weight management goals and the need for Diethylpropion (Tenuate).
  •  
  • Ask your doctor to provide medical justification for prescribing Diethylpropion, especially if other treatments have been ineffective.
  •  
  • Ensure that your physician is familiar with Priority Health’s requirements for prescribing weight management medications.

 

Gather Necessary Documentation

 

  • Collect all medical records that demonstrate your history of treatments for weight management.
  •  
  • Get a detailed prescription from your doctor, including dosage and duration of treatment.
  •  
  • Prepare any additional documents that Priority Health may require, such as a letter of medical necessity from your physician.

 

Contact Priority Health

 

  • Call Priority Health customer service to discuss your insurance plan's specifics and whether Diethylpropion is covered under your policy.
  •  
  • Inquire about the process for obtaining coverage, including any paperwork or forms that you need to complete.
  •  
  • Ask about timelines for approval and if there is an appeal process if initially denied.

 

Submit a Prior Authorization Request

 

  • Fill out any required forms, such as a prior authorization form, to request coverage for Diethylpropion.
  •  
  • Attach all the gathered documentation, including your doctor’s prescription and any letters of medical necessity.
  •  
  • Submit the request through the means specified by Priority Health, whether online, by fax, or mail.

 

Follow Up

 

  • Monitor the status of your prior authorization request regularly to ensure it is being processed.
  •  
  • Contact Priority Health for updates if there are delays beyond the usual processing time.
  •  
  • Be prepared to provide additional information if requested by Priority Health to support your coverage request.

 

Handle Denials Appropriately

 

  • If your request for coverage is denied, review Priority Health's Explanation of Benefits (EOB) to understand the reasons.
  •  
  • Consult with your physician to address the reasons for denial and gather additional evidence to support your case.
  •  
  • File an appeal with Priority Health following their appeals process, attaching any new or additional documentation.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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.

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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