Does Regence Cover Saxenda

Explore why Regence may deny Saxenda, ways to secure coverage, costs without insurance, and FAQs in this informative guide on Saxenda and Regence coverage.
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Coverage for Saxenda

 

  • Regence may cover Saxenda for weight management if deemed medically necessary.
  •  

  • Coverage typically applies to patients with a BMI of 30 or higher or a BMI of 27 with weight-related conditions like hypertension or type 2 diabetes.

 

Criteria and Requirements

 

  • Prescription from a healthcare provider is required, outlining the medical necessity for Saxenda.
  •  

  • Prior authorization might be necessary to confirm eligibility and coverage.
  •  

  • Patients usually need to demonstrate prior weight loss attempts through lifestyle changes or other medications.

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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 Saxenda Coverage with Regence

 

Verify Eligibility for Saxenda Coverage

 

  • Contact Regence customer service to confirm if Saxenda is covered under your specific plan. Be prepared with your membership ID and plan details for a more accurate response.
  •  

  • Review your plan's summary of benefits and coverage document, which is usually available on the Regence website or through your employer if you're covered under a group plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the medical necessity of Saxenda for your condition. Your provider may need to provide medical documentation that supports your need for this medication.
  •  

  • Ensure that your healthcare provider is aware of Regence’s requirements and can provide necessary documentation or go through the pre-authorization process, if necessary.

 

Submit a Prior Authorization Request

 

  • If required by Regence, work with your healthcare provider to submit a prior authorization request. This may involve filling out specific forms and providing detailed information about your medical history and treatment plan.
  •  

  • Use Regence's online portal or contact their customer service for guidance on how to properly submit the prior authorization request and to ensure that you follow the specific procedure they require.

 

Appeal If Necessary

 

  • If your initial request is denied, review the specific reasons for the denial provided by Regence. This information is typically included in the denial letter.
  •  

  • Work with your healthcare provider to address the concerns mentioned in the denial and gather additional supporting documentation to strengthen your appeal.
  •  

  • Submit an appeal in accordance with Regence’s process and deadlines. Make sure to provide any additional information or clarification that could help overturn the original denial.

 

Stay Informed and Follow Up

 

  • Regularly check the status of your request or appeal by contacting Regence customer service or using their online portal. Staying proactive can help you address any issues promptly.
  •  

  • Keep thorough records of all communications with Regence, including phone calls, emails, and any documents submitted. This documentation will be useful in case further follow-up or an additional appeal is needed.

 

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FAQs

Does Regence Cover Saxenda

Explore why Regence may deny Saxenda, ways to secure coverage, costs without insurance, and FAQs in this informative guide on Saxenda and Regence coverage.
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Is Saxenda Covered by Regence

 

Coverage for Saxenda

 

  • Regence may cover Saxenda for weight management if deemed medically necessary.
  •  

  • Coverage typically applies to patients with a BMI of 30 or higher or a BMI of 27 with weight-related conditions like hypertension or type 2 diabetes.

 

Criteria and Requirements

 

  • Prescription from a healthcare provider is required, outlining the medical necessity for Saxenda.
  •  

  • Prior authorization might be necessary to confirm eligibility and coverage.
  •  

  • Patients usually need to demonstrate prior weight loss attempts through lifestyle changes or other medications.

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Regence's Approved Criteria for Saxenda Coverage

 

Regence's Approved Criteria for Saxenda Coverage

 

  • The patient is 18 years of age or older.
  •  

  • Saxenda is prescribed by a healthcare professional experienced in obesity management, such as an endocrinologist or a specialist in weight management.
  •  

  • The patient has a Body Mass Index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related co-morbidity (e.g., hypertension, type 2 diabetes, dyslipidemia).
  •  

  • Prior attempts at weight reduction through diet and physical activity have been unsuccessful, as documented in the patient's medical history.
  •  

  • The patient commits to following a reduced-calorie diet and increased physical activity regimen as part of the therapy plan while taking Saxenda.
  •  

  • The prescription of Saxenda aligns with the FDA-approved indications and dosage recommendations.
  •  

  • Continuation of Saxenda treatment may depend on achieving specific weight loss milestones, typically within the first 16 weeks of therapy, as determined by the patient's healthcare provider.

 

Why Regence Might Deny Saxenda Coverage

 

Reasons Regence Might Deny Saxenda Coverage

 

  • Only FDA-approved uses are considered for coverage, and Regence may deny Saxenda if used for non-approved purposes or off-label use.
  •  

  • Requests not meeting medical necessity criteria, including specific weight or BMI thresholds and documented weight-related comorbidities, might be denied coverage.
  •  

  • Inadequate documentation of prior weight management attempts, such as lifestyle changes or alternative medications, could lead to a denial.
  •  

  • Failure to show documented evidence of sustained weight loss efforts within a predetermined timeframe may result in denial.
  •  

  • Continued coverage may be refused if initial treatment response criteria, like a certain percent of weight loss, are not met within a specific period.
  •  

  • Lack of compliance with required follow-up evaluations or health care provider assessments can result in coverage denial.
  •  

  • Coverage might be denied if there are concurrent treatments or medications that Regence does not approve while using Saxenda.
  •  

  • Duplicate therapy situations, where a member is already receiving similar therapeutic agents, could lead to a refusal of coverage.

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with Regence

 

Verify Eligibility for Saxenda Coverage

 

  • Contact Regence customer service to confirm if Saxenda is covered under your specific plan. Be prepared with your membership ID and plan details for a more accurate response.
  •  

  • Review your plan's summary of benefits and coverage document, which is usually available on the Regence website or through your employer if you're covered under a group plan.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the medical necessity of Saxenda for your condition. Your provider may need to provide medical documentation that supports your need for this medication.
  •  

  • Ensure that your healthcare provider is aware of Regence’s requirements and can provide necessary documentation or go through the pre-authorization process, if necessary.

 

Submit a Prior Authorization Request

 

  • If required by Regence, work with your healthcare provider to submit a prior authorization request. This may involve filling out specific forms and providing detailed information about your medical history and treatment plan.
  •  

  • Use Regence's online portal or contact their customer service for guidance on how to properly submit the prior authorization request and to ensure that you follow the specific procedure they require.

 

Appeal If Necessary

 

  • If your initial request is denied, review the specific reasons for the denial provided by Regence. This information is typically included in the denial letter.
  •  

  • Work with your healthcare provider to address the concerns mentioned in the denial and gather additional supporting documentation to strengthen your appeal.
  •  

  • Submit an appeal in accordance with Regence’s process and deadlines. Make sure to provide any additional information or clarification that could help overturn the original denial.

 

Stay Informed and Follow Up

 

  • Regularly check the status of your request or appeal by contacting Regence customer service or using their online portal. Staying proactive can help you address any issues promptly.
  •  

  • Keep thorough records of all communications with Regence, including phone calls, emails, and any documents submitted. This documentation will be useful in case further follow-up or an additional appeal is needed.

 

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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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