Does Priority Health Cover Naltrexone/Bupropion (Contrave)

Explore if Priority Health covers Naltrexone/Bupropion (Contrave), cost insights, coverage tips, and FAQs in our detailed guide.
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Coverage for Naltrexone/Bupropion (Contrave)

 

  • Priority Health generally covers Naltrexone/Bupropion (Contrave) under its prescription drug program for weight management.
  •  

  • Coverage typically applies to individuals with a body mass index (BMI) of 30 or higher, or 27 with associated comorbidities.

 

Basic Rules and Criteria

 

  • Prior authorization may be required to confirm medical necessity.
  •  

  • Patients may need to demonstrate unsuccessful weight loss with diet and exercise alone before the medication is approved.
  •  

  • Continuation of coverage could be dependent on achieving specific weight loss targets within a certain timeframe.
  •  

  • Copayment, coinsurance, or deductible may apply depending on the individual policy terms.

 

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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 Naltrexone/Bupropion (Contrave) Coverage with Priority Health

 

Verify Eligibility

 

  • Contact Priority Health customer service to confirm your plan's coverage for prescription medications.
  •  

  • Inquire specifically about weight loss treatments and any requirements for prior authorization or tier exceptions for Naltrexone/Bupropion (Contrave).

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the possibility of starting Naltrexone/Bupropion for weight management.
  •  

  • Ensure your provider is aware of Priority Health's requirements for coverage, such as documentation of medical necessity or previous weight loss attempts.

 

Obtain Prior Authorization

 

  • Your healthcare provider should fill out and submit any required prior authorization forms to Priority Health. This process ensures that the medication is deemed medically necessary for you.
  •  

  • Provide supporting documentation, such as your BMI, medical history, and any previous weight loss treatments tried, to strengthen the prior authorization request.

 

Check the Formulary

 

  • Review Priority Health’s online drug formulary to ensure Naltrexone/Bupropion is listed and to understand any co-pay levels or restrictions.
  •  

  • If the drug is not listed, discuss alternatives or exceptions with your healthcare provider and the insurance company.

 

Explore Tier Exceptions

 

  • If Naltrexone/Bupropion is categorized on a higher, more expensive tier, inquire about the possibility of a tier exception to lower your out-of-pocket costs.
  •  

  • Your provider may need to submit additional documentation to justify the necessity of this medication over cheaper alternatives.

 

Follow Up

 

  • Regularly follow up with Priority Health to monitor the status of your prior authorization request or tier exception application.
  •  

  • Be prepared to provide additional information or documentation if requested by the insurance company.

 

Review Approval and Coverage Terms

 

  • Once approved, carefully review the terms of coverage including co-payments, refill stipulations, and any requirement for continuous reauthorization.
  •  

  • Maintain communication with both your pharmacy and Priority Health for smooth processing of your prescriptions.

 

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FAQs

Does Priority Health Cover Naltrexone/Bupropion (Contrave)

Explore if Priority Health covers Naltrexone/Bupropion (Contrave), cost insights, coverage tips, and FAQs in our detailed guide.
Curex allergy drops unboxing

Is Naltrexone/Bupropion (Contrave) Covered by Priority Health

 

Coverage for Naltrexone/Bupropion (Contrave)

 

  • Priority Health generally covers Naltrexone/Bupropion (Contrave) under its prescription drug program for weight management.
  •  

  • Coverage typically applies to individuals with a body mass index (BMI) of 30 or higher, or 27 with associated comorbidities.

 

Basic Rules and Criteria

 

  • Prior authorization may be required to confirm medical necessity.
  •  

  • Patients may need to demonstrate unsuccessful weight loss with diet and exercise alone before the medication is approved.
  •  

  • Continuation of coverage could be dependent on achieving specific weight loss targets within a certain timeframe.
  •  

  • Copayment, coinsurance, or deductible may apply depending on the individual policy terms.

 

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Priority Health's Approved Criteria for Naltrexone/Bupropion (Contrave) Coverage

 

Coverage Criteria for Naltrexone/Bupropion (Contrave)

 

  • **Patient Eligibility:** The patient must be 18 years of age or older for coverage consideration.
  •  

  • **Body Mass Index (BMI) Requirement:** Coverage is provided when the patient's BMI is one of the following:
    • Greater than or equal to 30 kg/m² (obese), or
    • Greater than or equal to 27 kg/m² (overweight) in the presence of at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • **Documentation of Previous Weight Loss Efforts:** The healthcare provider must document that the patient has failed to achieve and maintain weight loss through lifestyle and dietary modifications alone.
  •  

  • **Provider Prescription:** A prescription for Naltrexone/Bupropion (Contrave) must be initiated by a healthcare provider who specializes in obesity management or a primary care provider experienced with weight management treatments.
  •  

  • **Adherence to Lifestyle Modifications:** Continuous engagement in a comprehensive weight management program that includes dietary changes, physical activity, and behavioral modification is required.
  •  

  • **Initial Evaluation and Follow-up:** Patients must undergo an initial evaluation and regular follow-ups to assess tolerance and effectiveness, as well as to monitor for any potential adverse effects of the medication.
  •  

  • **Use in Combination with Other Weight Loss Therapies:** Naltrexone/Bupropion should not be used in combination with other prescription weight loss products unless approved by the healthcare provider based on specific clinical indications.
  •  

  • **Continuation of Treatment:** Treatment effectiveness should be assessed after 16 weeks. If the patient has not lost at least 5% of baseline body weight, the continuation of the medication should be re-evaluated.
  •  

 

Why Priority Health Might Deny Naltrexone/Bupropion (Contrave) Coverage

 

Situations Where Priority Health Might Deny Coverage for Naltrexone/Bupropion (Contrave)

 

  • The medication is being requested for a condition that is not covered under Priority Health's benefits plan. For example, if Contrave is prescribed for conditions other than weight management or obesity, coverage might be denied.
  •  

  • The patient has not met the required criteria for coverage, such as lacking documented evidence of prior weight management attempts or not meeting the specified BMI threshold as outlined by Priority Health.
  •  

  • There is a lack of necessary documentation or prior authorizations that confirm the medical necessity of the treatment. Priority Health may deny coverage if these prerequisites are not properly submitted.
  •  

  • Contrave is not being prescribed by an in-network provider, or the provider does not have the necessary qualifications or specialties recognized by Priority Health.
  •  

  • The patient has a contraindication as specified in Priority Health guidelines, such as a history of certain medical conditions that may render the use of Contrave unsafe or ineffective.
  •  

  • The medication is deemed experimental, investigational, or for research use, and is not an FDA-approved indication for Contrave according to Priority Health policy guidelines.
  •  

  • The patient's current medication formulary does not include Contrave, or there is a suitable and more cost-effective alternative medication available that Priority Health favors.

 

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How Much Does Naltrexone/Bupropion (Contrave) Cost without Insurance?

 

Cost of Naltrexone/Bupropion (Contrave) Without Insurance

 

  • The cost of Naltrexone/Bupropion (Contrave) without insurance can vary significantly depending on the pharmacy you visit. On average, you might expect to pay around $100 to $300 for a 30-day supply.
  •  

  • The price can differ between pharmacies, so it may be beneficial to shop around or use a pharmacy discount card to potentially reduce the cost.
  •  

  • Coupons or discount programs offered by manufacturers or online platforms might further lower the expense, sometimes making it more affordable than the average cash price.
  •  

  • Factors such as generic availability or quantity prescribed also influence the price, with larger prescriptions potentially offering a lower cost per unit.

 

Ways to Lower Your Cost

 

  • Check online resources or discount programs that provide coupons applicable at various pharmacies to potentially save money.
  •  

  • Discuss with your healthcare provider about any potential lower-cost alternatives or generics, if available, which could lower your expenses.
  •  

  • Consider pharmacy loyalty programs or memberships, which often provide discounts on prescriptions.
  •  

  • Consult with your pharmacy about any special savings programs or payment plans they might offer, which can reduce financial burden.

 

Conclusion

 

  • Naltrexone/Bupropion (Contrave) is a medication whose price can vary widely without insurance, typically costing around $100 to $300 per month.
  •  

  • Utilize discounts, coupons, and comparison shopping to find the most cost-effective option.
  •  

  • Consult with healthcare professionals for advice on managing these costs and addressing any financial concerns related to prescriptions.

 

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 Naltrexone/Bupropion (Contrave) Coverage with Priority Health

 

Verify Eligibility

 

  • Contact Priority Health customer service to confirm your plan's coverage for prescription medications.
  •  

  • Inquire specifically about weight loss treatments and any requirements for prior authorization or tier exceptions for Naltrexone/Bupropion (Contrave).

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the possibility of starting Naltrexone/Bupropion for weight management.
  •  

  • Ensure your provider is aware of Priority Health's requirements for coverage, such as documentation of medical necessity or previous weight loss attempts.

 

Obtain Prior Authorization

 

  • Your healthcare provider should fill out and submit any required prior authorization forms to Priority Health. This process ensures that the medication is deemed medically necessary for you.
  •  

  • Provide supporting documentation, such as your BMI, medical history, and any previous weight loss treatments tried, to strengthen the prior authorization request.

 

Check the Formulary

 

  • Review Priority Health’s online drug formulary to ensure Naltrexone/Bupropion is listed and to understand any co-pay levels or restrictions.
  •  

  • If the drug is not listed, discuss alternatives or exceptions with your healthcare provider and the insurance company.

 

Explore Tier Exceptions

 

  • If Naltrexone/Bupropion is categorized on a higher, more expensive tier, inquire about the possibility of a tier exception to lower your out-of-pocket costs.
  •  

  • Your provider may need to submit additional documentation to justify the necessity of this medication over cheaper alternatives.

 

Follow Up

 

  • Regularly follow up with Priority Health to monitor the status of your prior authorization request or tier exception application.
  •  

  • Be prepared to provide additional information or documentation if requested by the insurance company.

 

Review Approval and Coverage Terms

 

  • Once approved, carefully review the terms of coverage including co-payments, refill stipulations, and any requirement for continuous reauthorization.
  •  

  • Maintain communication with both your pharmacy and Priority Health for smooth processing of your prescriptions.

 

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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.

Naltrexone/Bupropion (Contrave) FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting can occur, often diminishing over time.
  • Headaches or dizziness are also common, especially early in treatment.
  • Constipation or diarrhea may affect some users.
  • Insomnia and a higher heart rate can occur with usage.

 

Serious Side Effects

 

  • Risk of seizures, especially if there's a history of seizures.
  • Suicidal thoughts or behaviors can increase in some individuals.
  • Increased blood pressure; monitoring is advised.
  • Allergic reactions are possible, presenting as rash, itching, or swelling.

 

Precautions

 

  • Ensure no history of seizure disorders before starting.
  • Disclose any mental health history to your healthcare provider.
  • Assess any medications for potential interactions.
  • Regularly monitor blood pressure when on this medication.

 

How fast can you lose weight with Contrave?

 

What is Contrave?

 

  • Contrave is a combination of naltrexone and bupropion, approved for chronic weight management in adults.

 

How Fast Can You Lose Weight?

 

  • Clinical studies show patients can lose 5-10% of their body weight over 12-24 weeks.
  • Weight loss varies due to individual factors like diet, exercise, and adherence.
  • Initial results might be seen in 4 weeks, with more significant loss over months.

 

Important Considerations

 

  • Must be combined with a reduced-calorie diet and increased physical activity.
  • Not suitable for everyone; consult your healthcare provider before starting.
  • Monitoring for side effects like nausea or dizziness is crucial.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Drinking alcohol while taking Contrave is generally not recommended. Contrave contains naltrexone and bupropion, which may interact negatively with alcohol.
  •  

  • Naltrexone may increase the risk of liver damage when combined with alcohol, and bupropion may heighten seizure risk, both exacerbated by alcohol consumption.
  •  

  • Alcohol can counteract Contrave's effects on weight management and addiction control, undermining its efficacy.
  •  

  • Consult your healthcare provider for personalized advice, as they can determine safe alcohol usage considering your specific health conditions and medication dosage.

 

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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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