Does Regence Cover Phendimetrazine

Explore Regence coverage for Phendimetrazine, learn how to secure it, uncover costs without insurance, and get answers to common questions in this detailed guide.
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Regence Coverage for Phendimetrazine

 

  • Phendimetrazine is covered under specific conditions, primarily for weight management in cases where other methods have failed.
  •  

  • Coverage typically requires the patient to have a BMI over a certain threshold (usually 30 or more, or 27 with related health conditions).
  •  

  • Often, prior authorization is required. This involves a healthcare provider submitting documentation proving the necessity of Phendimetrazine for the patient’s health.
  •  

  • Regence may request submission of a treatment plan that includes lifestyle interventions, such as diet and exercise, demonstrating commitment to comprehensive weight management strategies.
  •  

  • Regular monitoring by the healthcare provider might be necessary to ensure the medication is yielding positive results and to continue coverage.
  •  

  • Coverage details can vary based on the specific Regence plan, so it’s crucial for subscribers to directly consult Regence for specific policy information and criteria.

 

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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.

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 Phendimetrazine Coverage with Regence

 

Verify Coverage Criteria

 

  • Check Regence's medication coverage policies. Look up the specific requirements for Phendimetrazine, including dosage and medical necessity criteria.
  •  

  • Consult the Regence drug formulary, which lists medications covered under their plans. Confirm Phendimetrazine is listed and note any restrictions or preferred brands.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about your need for Phendimetrazine. Obtain a medically justified prescription that complies with Regence’s coverage criteria.
  •  

  • Ask your healthcare provider to include any necessary documentation that outlines the medical necessity if required by Regence.

 

Prepare for Prior Authorization

 

  • Determine if Regence requires prior authorization for Phendimetrazine. Gather any specific forms or documentation needed to submit a request.
  •  

  • Have your healthcare provider submit the prior authorization request on your behalf to Regence for evaluation.

 

Contact Regence Customer Support

 

  • Call the Regence member services phone number listed on your insurance card for any coverage questions you might have.
  •  

  • Inquire about the status of your prior authorization if it was submitted, and gather information on next steps in case of delays.

 

Review Your Prescription Benefits

 

  • Log into your Regence member portal to review your prescription drug benefits and to check the status of claims or authorizations.
  •  

  • Understand and confirm any out-of-pocket costs associated with filling your prescription for Phendimetrazine.

 

Fill Your Prescription

 

  • Once authorization is obtained, take your prescription to a pharmacy within Regence’s network to have it filled.
  •  

  • Provide your Regence insurance information to ensure the prescription coverage is applied properly at checkout.

 

Appeal if Necessary

 

  • If coverage is denied, review the denial reasons and prepare an appeal. Work with your doctor to provide additional supporting information if needed for Regence’s reconsideration.
  •  

  • File the appeal within the deadline specified by Regence and follow up regularly on the appeal status.

 

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FAQs

Does Regence Cover Phendimetrazine

Explore Regence coverage for Phendimetrazine, learn how to secure it, uncover costs without insurance, and get answers to common questions in this detailed guide.
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Is Phendimetrazine Covered by Regence

 

Regence Coverage for Phendimetrazine

 

  • Phendimetrazine is covered under specific conditions, primarily for weight management in cases where other methods have failed.
  •  

  • Coverage typically requires the patient to have a BMI over a certain threshold (usually 30 or more, or 27 with related health conditions).
  •  

  • Often, prior authorization is required. This involves a healthcare provider submitting documentation proving the necessity of Phendimetrazine for the patient’s health.
  •  

  • Regence may request submission of a treatment plan that includes lifestyle interventions, such as diet and exercise, demonstrating commitment to comprehensive weight management strategies.
  •  

  • Regular monitoring by the healthcare provider might be necessary to ensure the medication is yielding positive results and to continue coverage.
  •  

  • Coverage details can vary based on the specific Regence plan, so it’s crucial for subscribers to directly consult Regence for specific policy information and criteria.

 

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Regence's Approved Criteria for Phendimetrazine Coverage

 

Eligibility Criteria for Phendimetrazine Coverage

 

  • The patient must have a documented diagnosis of obesity and a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with additional risk factors such as hypertension, diabetes, or dyslipidemia.
  •  

  • Phendimetrazine is intended for use as an adjunct to a comprehensive weight management program, including exercise, behavioral changes, and caloric restriction.

 

Duration of Coverage

 

  • Initial coverage is typically provided for a period of up to 12 weeks. The patient may need to demonstrate a minimum weight loss requirement for continued therapy beyond this period.
  •  

  • Renewal of coverage is contingent upon meeting ongoing weight loss goals as defined by the healthcare provider.

 

Prior Authorization Requirements

 

  • A prior authorization may be required to ensure that the patient meets all specific criteria for coverage.
  •  

  • The healthcare provider must provide documentation and a clinical assessment that supports the medical necessity for prescribing Phendimetrazine.

 

Monitoring and Follow-up

 

  • Regular follow-up appointments with the healthcare provider are essential to assess the effectiveness and safety of the treatment.
  •  

  • The healthcare provider should evaluate the patient’s progress, adherence to the weight management program, and any potential side effects of the medication.

 

Prescriber Restrictions

 

  • Phendimetrazine should be prescribed by or in consultation with a healthcare provider specialized in managing obesity or related conditions.
  •  

  • The prescriber must also ensure that the patient is a suitable candidate for pharmacotherapy as part of their weight management plan.

 

Why Regence Might Deny Phendimetrazine Coverage

 

Situations Where Regence Might Deny Phendimetrazine Coverage

 

  • Regence may deny coverage for Phendimetrazine if it is prescribed for unapproved or off-label uses that do not fall under their covered medical conditions.
  •  

  • If the patient doesn't meet the specific body mass index (BMI) criteria established by Regence, such as not reaching the BMI threshold associated with coverage.
  •  

  • In cases where there is insufficient documentation to demonstrate that alternative weight management therapies have already been attempted and were ineffective.
  •  

  • If Phendimetrazine is prescribed as a first-line treatment without documented trials of other weight management medications that Regence considers more suitable for initial intervention.
  •  

  • When there is an absence of a comprehensive weight management plan that includes diet, exercise, and behavioral modifications alongside the prescription, as per Regence policy requirements.
  •  

  • For patients who do not have a documented obesity-related comorbidity that justifies the use of Phendimetrazine under Regence's guidelines.
  •  

  • If there is any indication of abuse or misuse of the medication or any lack of adherence to usage restrictions specified in the policy.
  •  

  • Regence might deny coverage if the medication is not being prescribed by a recognized healthcare provider as specified in their policy.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Regence

 

Verify Coverage Criteria

 

  • Check Regence's medication coverage policies. Look up the specific requirements for Phendimetrazine, including dosage and medical necessity criteria.
  •  

  • Consult the Regence drug formulary, which lists medications covered under their plans. Confirm Phendimetrazine is listed and note any restrictions or preferred brands.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about your need for Phendimetrazine. Obtain a medically justified prescription that complies with Regence’s coverage criteria.
  •  

  • Ask your healthcare provider to include any necessary documentation that outlines the medical necessity if required by Regence.

 

Prepare for Prior Authorization

 

  • Determine if Regence requires prior authorization for Phendimetrazine. Gather any specific forms or documentation needed to submit a request.
  •  

  • Have your healthcare provider submit the prior authorization request on your behalf to Regence for evaluation.

 

Contact Regence Customer Support

 

  • Call the Regence member services phone number listed on your insurance card for any coverage questions you might have.
  •  

  • Inquire about the status of your prior authorization if it was submitted, and gather information on next steps in case of delays.

 

Review Your Prescription Benefits

 

  • Log into your Regence member portal to review your prescription drug benefits and to check the status of claims or authorizations.
  •  

  • Understand and confirm any out-of-pocket costs associated with filling your prescription for Phendimetrazine.

 

Fill Your Prescription

 

  • Once authorization is obtained, take your prescription to a pharmacy within Regence’s network to have it filled.
  •  

  • Provide your Regence insurance information to ensure the prescription coverage is applied properly at checkout.

 

Appeal if Necessary

 

  • If coverage is denied, review the denial reasons and prepare an appeal. Work with your doctor to provide additional supporting information if needed for Regence’s reconsideration.
  •  

  • File the appeal within the deadline specified by Regence and follow up regularly on the appeal status.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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.

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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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