Does Quartz Health Solutions Cover Liraglutide (Saxenda)

Explore coverage options for Liraglutide (Saxenda) with Quartz Health, learn costs without insurance, and get FAQs answered in this comprehensive guide.
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Does Quartz Health Solutions Cover Liraglutide (Saxenda)?

 

  • Quartz Health Solutions may cover Liraglutide (Saxenda) under its formulary, but coverage is not guaranteed for all plans. Specific conditions must be met for eligibility.
  •  

  • Coverage is typically available for patients with a diagnosis of obesity or overweight with weight-related comorbidities. Approval usually requires documented efforts of weight management programs or therapies.
  •  

  • The request must often include a physician's attestation of medical necessity to justify coverage of Saxenda.
  •  

  • Patients typically need to meet criteria such as a BMI of 30 kg/m² or more, or 27 kg/m² or more with related conditions like hypertension or type 2 diabetes.
  •  

  • Prior authorization is generally required, which involves a review of the patient's medical history and compliance with treatment guidelines.

 

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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 Liraglutide (Saxenda) Coverage with Quartz Health Solutions

 

Contact Quartz Health Solutions Customer Service

 

  • Begin by contacting Quartz Health Solutions customer service to clarify the coverage details for Liraglutide (Saxenda).
  •  

  • Request information about their current policy on weight management medications and specific requirements for coverage.

 

Review Prescription Drug Formulary

 

  • Access the Quartz Health Solutions formulary list through their website or request a copy from customer service. This list provides information on drugs covered and any tier classifications.
  •  

  • Check if Liraglutide (Saxenda) is included and note any restrictions or requirements for coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Liraglutide (Saxenda) based on your health conditions.
  •  

  • Ask your provider to prepare documentation supporting the need for this medication for insurance purposes.

 

Complete a Prior Authorization Form

 

  • If required, your doctor may need to submit a prior authorization form to Quartz Health Solutions, detailing why Liraglutide (Saxenda) is necessary for your treatment.
  •  

  • Ensure all medical records and justifications are included to strengthen the case for coverage approval.

 

Submit an Appeal if Necessary

 

  • If initially denied coverage, work with your healthcare provider to submit an appeal. This process often involves providing additional rationale why the medication is essential for your treatment.
  •  

  • Be proactive in following up on the appeal status with Quartz Health Solutions.

 

Verify Coverage Regularly

 

  • Periodically verify your coverage status for Liraglutide (Saxenda) with Quartz Health Solutions, as insurance plans and formularies can change.
  •  

  • Stay informed about any updates to your insurance plan that might affect medication coverage.

 

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FAQs

Does Quartz Health Solutions Cover Liraglutide (Saxenda)

Explore coverage options for Liraglutide (Saxenda) with Quartz Health, learn costs without insurance, and get FAQs answered in this comprehensive guide.
Curex allergy drops unboxing

Is Liraglutide (Saxenda) Covered by Quartz Health Solutions

 

Does Quartz Health Solutions Cover Liraglutide (Saxenda)?

 

  • Quartz Health Solutions may cover Liraglutide (Saxenda) under its formulary, but coverage is not guaranteed for all plans. Specific conditions must be met for eligibility.
  •  

  • Coverage is typically available for patients with a diagnosis of obesity or overweight with weight-related comorbidities. Approval usually requires documented efforts of weight management programs or therapies.
  •  

  • The request must often include a physician's attestation of medical necessity to justify coverage of Saxenda.
  •  

  • Patients typically need to meet criteria such as a BMI of 30 kg/m² or more, or 27 kg/m² or more with related conditions like hypertension or type 2 diabetes.
  •  

  • Prior authorization is generally required, which involves a review of the patient's medical history and compliance with treatment guidelines.

 

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Quartz Health Solutions's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Eligibility Criteria for Liraglutide (Saxenda) Coverage

 

  • Must be an adult patient aged 18 years or older with a diagnosis of obesity, defined as a body mass index (BMI) of 30 kg/m2 or greater.
  •  

  • For patients with a BMI of 27 kg/m2 or greater, coverage is approved if they have at least one weight-related comorbid condition, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Evidence of prior attempts at weight management through lifestyle modifications, such as diet and exercise, is required before approval.
  •  

  • Documentation of sustained weight loss efforts, including dietary changes and increased physical activity, prior to starting Saxenda therapy.
  •  

  • Should be under the care of a healthcare provider experienced in managing obesity or weight-related conditions.
  •  

  • Acknowledgment of required follow-up appointments with healthcare providers to monitor progress and evaluate the effectiveness of Liraglutide therapy.

 

Patient Assessment Requirements

 

  • Initial assessment by a healthcare provider that includes evaluation of the patient's weight, BMI, and comorbid conditions to confirm eligibility.
  •  

  • Discussion of weight loss goals and strategies tailored to the individual patient's needs, with documentation provided for insurance purposes.
  •  

  • Agreed-upon plan for regular monitoring and follow-up visits to assess the response to therapy and adjust treatment plans as necessary.

 

Monitoring and Follow-up

 

  • Commitment to follow a structured weight-management program that includes diet, exercise, and behavioral changes alongside Liraglutide therapy.
  •  

  • Regular appointments with healthcare providers to assess treatment efficacy, side effects, and adherence to the weight management plan.
  •  

  • Documentation of achieved weight loss milestones, typically expected to see a 4-5% reduction in body weight within the first 16 weeks of therapy for continued coverage.

 

Required Documentation for Approval

 

  • Initial prescription and associated clinical records provided by the healthcare provider, including BMI and recorded comorbid conditions.
  •  

  • Summary of prior weight management attempts, including specific methods and duration of attempts, confirming the need for pharmacological intervention.
  •  

  • Plans for ongoing weight loss maintenance, patient education on Liraglutide, and informed consent acknowledging potential side effects and expected outcomes.

 

Why Quartz Health Solutions Might Deny Liraglutide (Saxenda) Coverage

 

Non-Medically Necessary Use

 

  • Liraglutide (Saxenda) is not covered if it's deemed non-medically necessary for the individual, such as using it solely for cosmetic weight loss.

 

Non-Compliance with BMI Criteria

 

  • Coverage is typically denied if the individual's body mass index (BMI) does not meet the specified threshold required for obesity treatment with Liraglutide (Saxenda).

 

Lack of Concomitant Health Conditions

 

  • Individuals who do not have qualifying weight-related comorbid conditions like type 2 diabetes or hypertension may see a denial in coverage.

 

Off-Label Use

 

  • Liraglutide (Saxenda) is not covered when used for conditions other than those approved by the FDA and not specified by Quartz Health Solutions.

 

Failure in Lifestyle Changes

 

  • If the individual has not attempted or failed to engage in a comprehensive lifestyle intervention including diet and exercise, coverage for Liraglutide (Saxenda) might be denied.

 

Lack of Prior Authorization

 

  • Coverage can be denied if there is no prior authorization or if the authorization process is incomplete or denied due to inappropriate or insufficient information.

 

Age Restrictions

 

  • Individuals who do not meet the age criteria specified in the policy may be denied coverage for Liraglutide (Saxenda).

 

Duplicate Therapy

 

  • Use of Liraglutide (Saxenda) in conjunction with another weight loss medication without proper justification leads to denial of coverage.

 

Previous Ineffectiveness

 

  • Coverage may be denied if there is documented evidence that the individual has previously tried and not benefited from Liraglutide (Saxenda).

 

Non-Covered Indication

 

  • Instances where Liraglutide (Saxenda) is used for indications not covered under the health plan, such as for gestational diabetes, will result in denied coverage.

 

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

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 Liraglutide (Saxenda) Coverage with Quartz Health Solutions

 

Contact Quartz Health Solutions Customer Service

 

  • Begin by contacting Quartz Health Solutions customer service to clarify the coverage details for Liraglutide (Saxenda).
  •  

  • Request information about their current policy on weight management medications and specific requirements for coverage.

 

Review Prescription Drug Formulary

 

  • Access the Quartz Health Solutions formulary list through their website or request a copy from customer service. This list provides information on drugs covered and any tier classifications.
  •  

  • Check if Liraglutide (Saxenda) is included and note any restrictions or requirements for coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity of Liraglutide (Saxenda) based on your health conditions.
  •  

  • Ask your provider to prepare documentation supporting the need for this medication for insurance purposes.

 

Complete a Prior Authorization Form

 

  • If required, your doctor may need to submit a prior authorization form to Quartz Health Solutions, detailing why Liraglutide (Saxenda) is necessary for your treatment.
  •  

  • Ensure all medical records and justifications are included to strengthen the case for coverage approval.

 

Submit an Appeal if Necessary

 

  • If initially denied coverage, work with your healthcare provider to submit an appeal. This process often involves providing additional rationale why the medication is essential for your treatment.
  •  

  • Be proactive in following up on the appeal status with Quartz Health Solutions.

 

Verify Coverage Regularly

 

  • Periodically verify your coverage status for Liraglutide (Saxenda) with Quartz Health Solutions, as insurance plans and formularies can change.
  •  

  • Stay informed about any updates to your insurance plan that might affect medication coverage.

 

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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.

Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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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