Does Quartz Health Solutions Cover Semaglutide (Wegovy)

Discover if Quartz Health covers Semaglutide (Wegovy), denial reasons, coverage tips, cost without insurance, and answers to frequently asked questions.
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Does Quartz Health Solutions Cover Semaglutide (Wegovy)?

 

  • Coverage for Semaglutide (Wegovy) under Quartz Health Solutions may vary depending on the specific plan and state regulations.
  •  

  • Generally, it covers circumstances where Semaglutide is considered medically necessary for obesity management in adults.
  •  

  • Approval criteria often include a Body Mass Index (BMI) of 30 kg/m2 or greater, or 27 kg/m2 with at least one weight-related condition such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • Patients may require prior authorization, meaning a healthcare provider must demonstrate the necessity for Wegovy based on the patient's health status and treatment history.
  •  

  • Patients may need to have tried other weight management therapies without success before Semaglutide is approved.
  •  

  • Some plans may require the patient to participate in a comprehensive weight management program during treatment.

 

Key Steps to Ensure Coverage

 

  • Contact Quartz Health Solutions directly for the most accurate and up-to-date information on coverage specifics.
  •  

  • Consult your healthcare provider to ensure all medical criteria and documentation are in order.

 

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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.

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.

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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 Semaglutide (Wegovy) Coverage with Quartz Health Solutions

 

Check Your Insurance Plan

 

  • Review your Quartz Health Solutions insurance policy documents to understand the details of your prescription coverage. Look for sections related to medications and specialty drugs.
  •  

  • Reach out to Quartz customer service directly to verify if Semaglutide (Wegovy) is included in your prescription drug plan.

 

Consult With Your Physician

 

  • Schedule an appointment with your healthcare provider to discuss Semaglutide (Wegovy) as a treatment option. Ensure your provider documents the medical necessity of Wegovy for your condition.
  •  

  • Get the prescription written by your healthcare provider, including any required justification for its necessity, such as health conditions or past treatments.

 

Obtain Prior Authorization

 

  • Verify with Quartz Health Solutions if prior authorization is needed for Semaglutide (Wegovy). Most insurance plans require prior authorization for specialty drugs.
  •  

  • If required, work with your healthcare provider to submit the necessary prior authorization forms to Quartz, along with supporting medical documentation.
  •  

  • Follow up regularly with both your healthcare provider and Quartz to track the status of your prior authorization request.

 

Explore Alternative Coverage Options

 

  • If Semaglutide (Wegovy) is not covered under your current plan, inquire about the possibility of enrolling in a different plan available during the open enrollment period that includes coverage for such medications.
  •  

  • Consider manufacturer patient assistance programs or savings options if your current coverage is inadequate. Check if Novo Nordisk, the manufacturer, offers support programs.

 

File an Appeal if Necessary

 

  • If coverage for Wegovy is denied after prior authorization, ask Quartz Health Solutions for the detailed reasons and obtain instructions on how to file an appeal.
  •  

  • Prepare a comprehensive appeal letter with your healthcare provider, addressing the denial reasons and providing additional medical information to support your case.
  •  

  • Submit the appeal promptly and keep copies of all correspondence related to the appeal process.

 

Stay Informed and Follow Up

 

  • Continuously monitor any updates or changes in coverage policies from Quartz Health Solutions, as these might affect your benefits.
  •  

  • Stay in touch with your healthcare provider about further prescription options and updates during the coverage process.

 

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FAQs

Does Quartz Health Solutions Cover Semaglutide (Wegovy)

Discover if Quartz Health covers Semaglutide (Wegovy), denial reasons, coverage tips, cost without insurance, and answers to frequently asked questions.
Curex allergy drops unboxing

Is Semaglutide (Wegovy) Covered by Quartz Health Solutions

 

Does Quartz Health Solutions Cover Semaglutide (Wegovy)?

 

  • Coverage for Semaglutide (Wegovy) under Quartz Health Solutions may vary depending on the specific plan and state regulations.
  •  

  • Generally, it covers circumstances where Semaglutide is considered medically necessary for obesity management in adults.
  •  

  • Approval criteria often include a Body Mass Index (BMI) of 30 kg/m2 or greater, or 27 kg/m2 with at least one weight-related condition such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • Patients may require prior authorization, meaning a healthcare provider must demonstrate the necessity for Wegovy based on the patient's health status and treatment history.
  •  

  • Patients may need to have tried other weight management therapies without success before Semaglutide is approved.
  •  

  • Some plans may require the patient to participate in a comprehensive weight management program during treatment.

 

Key Steps to Ensure Coverage

 

  • Contact Quartz Health Solutions directly for the most accurate and up-to-date information on coverage specifics.
  •  

  • Consult your healthcare provider to ensure all medical criteria and documentation are in order.

 

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Quartz Health Solutions's Approved Criteria for Semaglutide (Wegovy) Coverage

 

Criteria for Semaglutide (Wegovy) Coverage

 

  • **Diagnosis Requirement**: A patient must have a diagnosis of obesity, which is defined as a Body Mass Index (BMI) of 30 kg/m² or greater. Alternatively, the patient may have a BMI of 27 kg/m² or greater with at least one weight-related comorbidity, such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • **Age Requirement**: The patient must be an adult aged 18 years or older to qualify for Semaglutide (Wegovy) coverage.
  •  

  • **Medical History**: The patient should have a documented history of failure to lose weight or maintain weight loss with lifestyle interventions, such as diet and exercise, prior to the consideration of pharmacotherapy with Semaglutide (Wegovy).
  •  

  • **Treatment Plan**: The prescribing physician must submit a comprehensive treatment plan that outlines the use of Semaglutide (Wegovy) as an adjunct to a reduced-calorie diet and increased physical activity.
  •  

  • **Specialist Involvement**: The prescription of Semaglutide (Wegovy) should be made by, or in consultation with, an endocrinologist, bariatric specialist, or another healthcare professional specializing in the treatment of obesity.
  •  

  • **Documentation of Lifestyle Modifications**: There must be documented evidence of lifestyle modifications, including dietary changes and physical activity. Patients should be participating in a structured weight management program.
  •  

  • **Authorization and Reauthorization**: Initial authorization may be granted for a period of up to 16 weeks. Sustained coverage is subject to reauthorization, which requires documentation of significant weight loss (usually defined as a reduction of 5% or more of initial body weight) or improvement in a weight-related comorbidity.
  •  

 

Why Quartz Health Solutions Might Deny Semaglutide (Wegovy) Coverage

 

Exclusion Criteria for Semaglutide (Wegovy)

 

  • Members who do not meet the Body Mass Index (BMI) requirements as guided by clinical recommendations for obesity treatment.
  •  

  • Requests for individuals who have a history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, as these are strict contraindications.
  •  

  • Any request for non-FDA approved indications or experimental use of Semaglutide (Wegovy).
  •  

  • Prescriptions originating from non-credentialed providers or those outside of the Quartz Health Solutions network.
  •  

  • Situations where there is inadequate documentation supporting the necessity of the treatment for obesity management.
  •  

  • If a member is participating in a similar weight loss drug therapy, concurrent claims for Semaglutide (Wegovy) may be denied.
  •  

  • Claims submitted for cosmetic weight loss or weight management purposes rather than clinically substantial obesity treatment.
  •  

  • Requests from individuals under the age specified according to the FDA approval and clinical guidelines, as pediatric use is not covered.
  •  

 

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How Much Does Semaglutide (Wegovy) Cost without Insurance?

 

Approximate Cost of Semaglutide (Wegovy) Without Insurance

 

  • The price of Semaglutide, commonly known as Wegovy, without insurance can be substantial, typically ranging between $1,200 and $1,400 for a supply that lasts approximately one month.
  •  

  • This medication is designed for long-term weight management, thus planning financially for sustained use is important if paying out of pocket.
  •  

  • It's important to note that prices can vary based on the pharmacy, geographic location, and available discounts or pharmacy loyalty programs.
  •  

  • Patients are encouraged to seek patient assistance programs or discounts to help mitigate costs. Some pharmaceutical manufacturers offer discount cards or assistance programs to help with the cost of prescription medications like Wegovy.

 

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 Semaglutide (Wegovy) Coverage with Quartz Health Solutions

 

Check Your Insurance Plan

 

  • Review your Quartz Health Solutions insurance policy documents to understand the details of your prescription coverage. Look for sections related to medications and specialty drugs.
  •  

  • Reach out to Quartz customer service directly to verify if Semaglutide (Wegovy) is included in your prescription drug plan.

 

Consult With Your Physician

 

  • Schedule an appointment with your healthcare provider to discuss Semaglutide (Wegovy) as a treatment option. Ensure your provider documents the medical necessity of Wegovy for your condition.
  •  

  • Get the prescription written by your healthcare provider, including any required justification for its necessity, such as health conditions or past treatments.

 

Obtain Prior Authorization

 

  • Verify with Quartz Health Solutions if prior authorization is needed for Semaglutide (Wegovy). Most insurance plans require prior authorization for specialty drugs.
  •  

  • If required, work with your healthcare provider to submit the necessary prior authorization forms to Quartz, along with supporting medical documentation.
  •  

  • Follow up regularly with both your healthcare provider and Quartz to track the status of your prior authorization request.

 

Explore Alternative Coverage Options

 

  • If Semaglutide (Wegovy) is not covered under your current plan, inquire about the possibility of enrolling in a different plan available during the open enrollment period that includes coverage for such medications.
  •  

  • Consider manufacturer patient assistance programs or savings options if your current coverage is inadequate. Check if Novo Nordisk, the manufacturer, offers support programs.

 

File an Appeal if Necessary

 

  • If coverage for Wegovy is denied after prior authorization, ask Quartz Health Solutions for the detailed reasons and obtain instructions on how to file an appeal.
  •  

  • Prepare a comprehensive appeal letter with your healthcare provider, addressing the denial reasons and providing additional medical information to support your case.
  •  

  • Submit the appeal promptly and keep copies of all correspondence related to the appeal process.

 

Stay Informed and Follow Up

 

  • Continuously monitor any updates or changes in coverage policies from Quartz Health Solutions, as these might affect your benefits.
  •  

  • Stay in touch with your healthcare provider about further prescription options and updates during the coverage process.

 

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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.

Semaglutide (Wegovy) FAQ

1. What are the common side effects of Semaglutide (Wegovy)?

 

Common Side Effects of Semaglutide (Wegovy)

 

  • Nausea  — Often occurs at the start of treatment and may decrease over time.
  •  

  • Vomiting  — Related to gastrointestinal upset; usually temporary.
  •  

  • Diarrhea  — Common and may vary in intensity.
  •  

  • Constipation  — It can occur alongside other digestive issues.
  •  

  • Abdominal Pain  — Includes discomfort or cramping sensation.
  •  

  • Headache  — Typically mild but can be persistent.
  •  

  • Dizziness  — May affect balance or result in vertigo-like symptoms.
  •  

  • Fatigue  — Some patients report general tiredness or lack of energy.

 

2. How much weight can I lose with Semaglutide (Wegovy)?

 

Potential Weight Loss with Semaglutide (Wegovy)

 

  • Clinical trials demonstrate that Semaglutide (Wegovy) helps individuals lose a significant amount of weight. On average, participants experienced a weight loss of about 15% of their initial body weight over 68 weeks.
  •  

  • Results vary, with some losing more and others less. Factors include adherence to medication, lifestyle changes, and individual metabolic responses.
  •  

  • Semaglutide should be part of a comprehensive weight management program, including a reduced-calorie diet and increased physical activity.
  •  

  • Consult with a healthcare professional for personalized advice and to discuss possible side effects like nausea or gastrointestinal issues.

 

3. Is Wegovy the same as Ozempic?

 

Differences Between Wegovy and Ozempic

 

  • Formulation: Both contain semaglutide, a GLP-1 receptor agonist, but are formulated for different purposes.
  •  

  • Indication: Wegovy is primarily for weight management in adults with obesity. Ozempic is prescribed for type 2 diabetes management.
  •  

  • Dosage: While both are weekly injections, Wegovy generally has higher dosing than Ozempic (up to 2.4mg vs. 1mg for Ozempic).
  •  

  • Side Effects: Common side effects overlap, including nausea, but may vary in intensity due to different dosages.

 

Conclusion

 

  • Though similar, they serve distinct medical purposes. Always consult your healthcare provider for personalized advice.

 

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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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