Does Priority Health Cover Phentermine (Adipex-P, Lomaira)

Explore if Priority Health covers Phentermine, reasons for denial, how to secure coverage, cost without insurance, and answers to common FAQs.
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Does Priority Health Cover Phentermine (Adipex-P, Lomaira)?

 

  • **Coverage Eligibility:** Phentermine may be covered for eligible members diagnosed with obesity or weight-related health conditions.
  •  

  • **Medical Necessity:** A healthcare provider must determine the prescription's medical necessity and provide proper documentation.
  •  

  • **Prior Authorization:** Typically required before coverage is granted. Priority Health will assess the request based on medical history and treatment necessity.
  •  

  • **Duration of Use:** Coverage may be limited to short-term use, often no more than a few weeks, due to safety and efficacy guidelines.
  •  

  • **Individual Plan Variations:** Coverage specifics can vary, so it's essential to review your individual health plan or contact Priority Health directly for detailed information.

 

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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.

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 Phentermine (Adipex-P, Lomaira) Coverage with Priority Health

 

Start by Reviewing Your Insurance Plan

 

  • Contact Priority Health to determine if Phentermine (Adipex-P, Lomaira) is included in your current plan's formulary. Speak with a customer service representative for detailed explanations.
  •  

  • Check the Priority Health website or your member portal for information on drug coverage, including details about any necessary pre-authorization.
  •  

  • Review any specific requirements or criteria that must be met for Phentermine to be covered under your policy.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider the importance of Phentermine for your weight management or health condition.
  •  

  • Ensure your healthcare provider understands the coverage requirements of Priority Health for Phentermine prescriptions.
  •  

  • Request comprehensive documentation from your provider supporting the medical necessity of Phentermine for your treatment.

 

Submit a Pre-authorization Request

 

  • Work with your healthcare provider to complete and submit a pre-authorization request to Priority Health.
  •  

  • Include all necessary documentation, including medical records, your provider’s reasoning for prescribing Phentermine, and any prior weight loss attempts.
  •  

  • Follow up with Priority Health to ensure your pre-authorization request is under review and provide any additional information if requested.

 

Understand Your Plan’s Requirements

 

  • Identify any specific criteria your plan might require for coverage, such as trying other medications first or meeting a certain body mass index (BMI) threshold.
  •  

  • Ensure compliance with any medical management protocols outlined by Priority Health for Phentermine coverage.

 

Appeal if Necessary

 

  • If your request for coverage is denied, file an appeal with Priority Health. Gather additional supporting documentation from your healthcare provider if needed.
  •  

  • Include a personal statement that outlines your experiences and efforts in managing your health condition.
  •  

  • Continue to follow up on the status of your appeal and be prepared to provide further evidence or answer questions from the insurer.

 

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FAQs

Does Priority Health Cover Phentermine (Adipex-P, Lomaira)

Explore if Priority Health covers Phentermine, reasons for denial, how to secure coverage, cost without insurance, and answers to common FAQs.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Priority Health

 

Does Priority Health Cover Phentermine (Adipex-P, Lomaira)?

 

  • **Coverage Eligibility:** Phentermine may be covered for eligible members diagnosed with obesity or weight-related health conditions.
  •  

  • **Medical Necessity:** A healthcare provider must determine the prescription's medical necessity and provide proper documentation.
  •  

  • **Prior Authorization:** Typically required before coverage is granted. Priority Health will assess the request based on medical history and treatment necessity.
  •  

  • **Duration of Use:** Coverage may be limited to short-term use, often no more than a few weeks, due to safety and efficacy guidelines.
  •  

  • **Individual Plan Variations:** Coverage specifics can vary, so it's essential to review your individual health plan or contact Priority Health directly for detailed information.

 

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Priority Health's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Criteria for Phentermine Coverage

 

  • Applicant must be medically diagnosed as obese, with a body mass index (BMI) of 30 kg/m² or higher.
  •  

  • Individual may also qualify if they are overweight with a BMI of 27 kg/m² or higher and present with an associated weight-related condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Prior documented unsuccessful weight loss attempts, which must include, but not limited to, lifestyle modifications like diet and exercise.
  •  

 

Age and Medical Stability Requirements

 

  • Individuals must be at least 16 years old to qualify for coverage under Priority Health.
  •  

  • Medical clearance is required from a healthcare professional confirming the absence of contraindications for phentermine treatment, like history of cardiovascular disease or hyperthyroidism.
  •  

  • Applicant should not be pregnant, planning to become pregnant, or nursing during therapy.
  •  

 

Physician's Prescription and Plan of Care

 

  • A licensed healthcare provider must prescribe phentermine, emphasizing it as part of a comprehensive weight management plan, which includes physical activity, diet, and behavioral practices.
  •  

  • Prescription should clearly document the necessity of the therapy for weight management purposes.
  •  

 

Follow-Up and Monitoring

 

  • Coverage may be contingent upon regularly scheduled follow-ups with the prescribing healthcare provider to monitor progress, efficacy, and any potential side effects.
  •  

  • Periodic evaluation of the treatment's effectiveness and any required adjustments to the comprehensive weight management plan are necessary.
  •  

 

Why Priority Health Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Non-medically Necessary Usage

 

  • Phentermine is not covered when prescribed without adherence to medically necessary criteria, focusing more on convenience rather than true health needs.

 

Non-compliance with BMI Requirements

 

  • Priority Health may deny coverage if the individual's body mass index (BMI) does not meet specific thresholds for obesity treatment.

 

Lack of Comprehensive Weight Loss Plan

 

  • Coverage may be denied if there is no documented comprehensive weight management plan that includes diet, exercise, and behavioral modifications alongside Phentermine use.

 

Previous Non-compliance

 

  • Individuals with a history of non-compliance with previous weight loss or treatment programs may not be covered.

 

Prolonged Usage Beyond Approved Duration

 

  • Phentermine is not covered if used beyond the approved short-term duration for therapy, as it is intended for temporary weight management support.

 

Medical Contraindications

 

  • The drug is not covered for individuals with health conditions that contraindicate the use of Phentermine, based on Priority Health's safety guidelines.

 

Off-label Use

 

  • Usage for conditions or in methods not approved by regulatory bodies (i.e., off-label) will not be covered.

 

Age Restrictions

 

  • Priority Health might deny coverage if the patient falls outside the approved age range for treatment with Phentermine.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Priority Health

 

Start by Reviewing Your Insurance Plan

 

  • Contact Priority Health to determine if Phentermine (Adipex-P, Lomaira) is included in your current plan's formulary. Speak with a customer service representative for detailed explanations.
  •  

  • Check the Priority Health website or your member portal for information on drug coverage, including details about any necessary pre-authorization.
  •  

  • Review any specific requirements or criteria that must be met for Phentermine to be covered under your policy.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider the importance of Phentermine for your weight management or health condition.
  •  

  • Ensure your healthcare provider understands the coverage requirements of Priority Health for Phentermine prescriptions.
  •  

  • Request comprehensive documentation from your provider supporting the medical necessity of Phentermine for your treatment.

 

Submit a Pre-authorization Request

 

  • Work with your healthcare provider to complete and submit a pre-authorization request to Priority Health.
  •  

  • Include all necessary documentation, including medical records, your provider’s reasoning for prescribing Phentermine, and any prior weight loss attempts.
  •  

  • Follow up with Priority Health to ensure your pre-authorization request is under review and provide any additional information if requested.

 

Understand Your Plan’s Requirements

 

  • Identify any specific criteria your plan might require for coverage, such as trying other medications first or meeting a certain body mass index (BMI) threshold.
  •  

  • Ensure compliance with any medical management protocols outlined by Priority Health for Phentermine coverage.

 

Appeal if Necessary

 

  • If your request for coverage is denied, file an appeal with Priority Health. Gather additional supporting documentation from your healthcare provider if needed.
  •  

  • Include a personal statement that outlines your experiences and efforts in managing your health condition.
  •  

  • Continue to follow up on the status of your appeal and be prepared to provide further evidence or answer questions from the insurer.

 

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Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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