Does Scripps Health Cover Contrave

Learn why Scripps Health might deny Contrave, how to get coverage, cost without insurance, and more FAQ in our comprehensive article.
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Does Scripps Health Cover Contrave

 

  • Scripps Health may cover Contrave, a prescription medication for weight management, under its pharmacy benefits plan, based on medical necessity guidelines.
  •  

  • Coverage typically requires prior authorization from a healthcare provider, confirming that the patient meets specific criteria such as a body mass index (BMI) above a certain threshold and a history of unsuccessful weight loss with diet and exercise alone.
  •  

  • Patients may need to demonstrate compliance with Scripps Health's recommended weight management program to be eligible for coverage.
  •  

  • Specific coverage details, including copayments and any potential out-of-pocket costs, can vary depending on the patient's health plan tier and policy.
  •  

  • It's advisable to contact Scripps Health directly or consult their member services for the most accurate and personalized information regarding Contrave coverage.

 

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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 Contrave Coverage with Scripps Health

 

Check Scripps Health Insurance Plan

 

  • Review your current Scripps Health insurance plan details to see if weight management medications like Contrave are covered. Make sure to check if they have any specific requirements or restrictions.
  •  

  • Visit the Scripps Health website or contact their customer service for the most accurate and up-to-date information regarding coverage for prescription medications.

 

Consult with Your Physician

 

  • Schedule a consultation with your primary care doctor or a specialist who understands your health goals and medical history. Discuss the option of using Contrave for weight management and why it may be beneficial for you.
  •  

  • Ask your doctor if they have experience working with Scripps Health to obtain prior authorizations for medications like Contrave. Their guidance can be invaluable in navigating the process.

 

Obtain a Prescription

 

  • If your doctor agrees that Contrave is an appropriate treatment option, ask them to write a prescription. Ensure the prescription is valid and includes all necessary details for processing.
  •  

  • Ask your doctor if they can also provide any supporting documentation or notes that may strengthen your case when seeking insurance coverage.

 

Contact Scripps Health Member Services

 

  • Reach out to Scripps Health member services using the contact information provided on your insurance card or their official website.
  •  

  • Inquire about the process for obtaining authorization and coverage for Contrave, and request any forms or applications that may need to be completed.
  •  

  • Ask about the expected timeline for coverage decisions and keep a record of your conversation, including the representative's name and the date of the call.

 

Submit a Prior Authorization Request

 

  • Work with your doctor’s office to submit a prior authorization request to Scripps Health. This may involve completing specific forms and attaching the prescription along with any supporting documents.
  •  

  • Ensure that all submitted documents are clear, complete, and provide a compelling argument for why Contrave is necessary for your treatment.

 

Follow Up and Be Persistent

 

  • Monitor the status of your prior authorization request by calling member services or checking through any online portals provided by Scripps Health.
  •  

  • If your initial request is denied, ask for specific reasons and what additional information might be needed. Consider filing an appeal if you and your doctor still find the medication necessary.
  •  

  • Engage with your doctor's office to ensure that any requests for additional information from Scripps Health are handled quickly and efficiently.

 

Explore Alternative Options

 

  • If you face significant challenges or delays, consider checking if there are patient assistance programs offered by the manufacturer of Contrave that may help reduce costs.
  •  

  • Ask your doctor about any alternative medications or treatments covered by Scripps Health that might still meet your health needs.

 

Stay Informed

 

  • Keep yourself updated about any changes in your insurance policy regarding prescription medications. Periodically review your plan details, as policies may adjust over time.
  •  

  • Inform your health care provider of any updates or communication received from Scripps Health that may impact your treatment plan.

 

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FAQs

Does Scripps Health Cover Contrave

Learn why Scripps Health might deny Contrave, how to get coverage, cost without insurance, and more FAQ in our comprehensive article.
Curex allergy drops unboxing

Is Contrave Covered by Scripps Health

 

Does Scripps Health Cover Contrave

 

  • Scripps Health may cover Contrave, a prescription medication for weight management, under its pharmacy benefits plan, based on medical necessity guidelines.
  •  

  • Coverage typically requires prior authorization from a healthcare provider, confirming that the patient meets specific criteria such as a body mass index (BMI) above a certain threshold and a history of unsuccessful weight loss with diet and exercise alone.
  •  

  • Patients may need to demonstrate compliance with Scripps Health's recommended weight management program to be eligible for coverage.
  •  

  • Specific coverage details, including copayments and any potential out-of-pocket costs, can vary depending on the patient's health plan tier and policy.
  •  

  • It's advisable to contact Scripps Health directly or consult their member services for the most accurate and personalized information regarding Contrave coverage.

 

A weight management program tailored to you

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Scripps Health's Approved Criteria for Contrave Coverage

 

Criteria for Contrave Coverage under Scripps Health Insurance

 

  • Patients must have a Body Mass Index (BMI) of 30 kg/m² or higher, which is classified as obesity.
  •  

  • Alternatively, patients with a BMI of 27 kg/m² or higher can qualify if they have at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Prior to considering coverage for Contrave, patients must have attempted weight loss through diet and exercise for at least six months, without achieving significant weight reduction.
  •  

  • A healthcare provider must document that the patient has followed standard lifestyle interventions and that these interventions alone have proven insufficient in meeting weight-loss goals.
  •  

  • The prescribing healthcare provider must ascertain and document that the patient is motivated and committed to making necessary lifestyle changes to support weight loss.
  •  

  • There should be clear documentation indicating that the patient does not have conditions for which the use of Contrave is contraindicated, such as uncontrolled hypertension, seizure disorders, or a history of bulimia or anorexia nervosa.
  •  

  • Contrave coverage consideration requires that the patient does not have a history of hypersensitivity to bupropion or naltrexone, the active ingredients in Contrave.
  •  

  • Documentation from the healthcare provider is necessary to ensure that the patient is not currently on other bupropion-containing products to prevent drug duplication.
  •  

  • The healthcare provider must document that the patient is not using other opioid medications, as naltrexone is an opioid antagonist, which can interfere with certain pain medications.
  •  

 

Why Scripps Health Might Deny Contrave Coverage

 

Reasons Scripps Health Might Deny Contrave Coverage

 

  • Medication is intended for weight loss primarily, not for treating a diagnosed illness or condition.
  •  

  • Prescription does not align with the established medical criteria outlined by Scripps Health for weight management medications.
  •  

  • The patient has not completed necessary weight management programs prior to the prescription of Contrave.
  •  

  • Insufficient documentation of prior weight loss attempts including diet, exercise, and/or behavior therapy interventions.
  •  

  • Body Mass Index (BMI) of the patient does not meet the minimum requirement set for approval of Contrave.
  •  

  • Lack of health complications due to obesity that would necessitate the use of Contrave.
  •  

  • Safety concerns based on the patient's medical history, including possible contraindications or risk factors for using Contrave.
  •  

  • Failure to obtain pre-authorization from Scripps Health before starting the medication.
  •  

  • Medication prescribed for off-label use which does not meet the Scripps Health policy criteria.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

  • Without insurance, the approximate cost of Contrave can vary widely depending on the pharmacy and location. On average, the price is around $70 to $100 per month.
  • Prices can vary significantly, so it's beneficial to compare prices at different pharmacies or use a drug discount card to potentially lower the cost.
  • Some online services and pharmacies may offer additional discounts or payment assistance for those paying out of pocket.
  • Checking with local pharmacies for potential generic versions or alternative options might also help in reducing 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 Contrave Coverage with Scripps Health

 

Check Scripps Health Insurance Plan

 

  • Review your current Scripps Health insurance plan details to see if weight management medications like Contrave are covered. Make sure to check if they have any specific requirements or restrictions.
  •  

  • Visit the Scripps Health website or contact their customer service for the most accurate and up-to-date information regarding coverage for prescription medications.

 

Consult with Your Physician

 

  • Schedule a consultation with your primary care doctor or a specialist who understands your health goals and medical history. Discuss the option of using Contrave for weight management and why it may be beneficial for you.
  •  

  • Ask your doctor if they have experience working with Scripps Health to obtain prior authorizations for medications like Contrave. Their guidance can be invaluable in navigating the process.

 

Obtain a Prescription

 

  • If your doctor agrees that Contrave is an appropriate treatment option, ask them to write a prescription. Ensure the prescription is valid and includes all necessary details for processing.
  •  

  • Ask your doctor if they can also provide any supporting documentation or notes that may strengthen your case when seeking insurance coverage.

 

Contact Scripps Health Member Services

 

  • Reach out to Scripps Health member services using the contact information provided on your insurance card or their official website.
  •  

  • Inquire about the process for obtaining authorization and coverage for Contrave, and request any forms or applications that may need to be completed.
  •  

  • Ask about the expected timeline for coverage decisions and keep a record of your conversation, including the representative's name and the date of the call.

 

Submit a Prior Authorization Request

 

  • Work with your doctor’s office to submit a prior authorization request to Scripps Health. This may involve completing specific forms and attaching the prescription along with any supporting documents.
  •  

  • Ensure that all submitted documents are clear, complete, and provide a compelling argument for why Contrave is necessary for your treatment.

 

Follow Up and Be Persistent

 

  • Monitor the status of your prior authorization request by calling member services or checking through any online portals provided by Scripps Health.
  •  

  • If your initial request is denied, ask for specific reasons and what additional information might be needed. Consider filing an appeal if you and your doctor still find the medication necessary.
  •  

  • Engage with your doctor's office to ensure that any requests for additional information from Scripps Health are handled quickly and efficiently.

 

Explore Alternative Options

 

  • If you face significant challenges or delays, consider checking if there are patient assistance programs offered by the manufacturer of Contrave that may help reduce costs.
  •  

  • Ask your doctor about any alternative medications or treatments covered by Scripps Health that might still meet your health needs.

 

Stay Informed

 

  • Keep yourself updated about any changes in your insurance policy regarding prescription medications. Periodically review your plan details, as policies may adjust over time.
  •  

  • Inform your health care provider of any updates or communication received from Scripps Health that may impact your treatment plan.

 

Premium Medication you can trust

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.

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

  • Nausea and vomiting
  • Constipation or diarrhea
  • Dizziness or headache
  • Dry mouth
  • Insomnia

 

Less Common Side Effects

 

  • Increased blood pressure or heart rate
  • Seizures
  • Allergic reactions such as rash or itching
  • Changes in mood or behavior
  • Muscle or joint pain

 

Serious Side Effects

 

  • Severe mental health issues including depression or suicidal thoughts
  • Heart palpitations or chest pain
  • Severe headache or blurred vision
  • Trouble breathing
  • Severe allergic reactions leading to anaphylaxis

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

  • Contrave can aid in losing approximately 5% to 10% of your body weight over a year when combined with a healthy diet and exercise.
  •  

  • Weight loss varies individually and depends on factors like metabolism, adherence to lifestyle changes, and individual response to the medication.

 

Factors Affecting Weight Loss

 

  • Consistency in taking the medication and following prescribed dosages plays a crucial role.
  •  

  • Incorporating a balanced diet and regular physical activity enhances results significantly.
  •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

  • Always consult with a healthcare provider for personalized advice and to monitor progress safely.

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

  • Contrave contains two active ingredients: bupropion and naltrexone. Bupropion may lower your seizure threshold, while alcohol can increase this risk, especially in larger amounts.
  •  

  • Naltrexone blocks opioid receptors related to alcohol pleasure, potentially making drinking less enjoyable.

 

Recommendations

 

  • If you choose to drink, limit your intake to minimize risks. Binge drinking is particularly dangerous while on Contrave.
  •  

  • Be aware of increased dizziness or impaired judgment, and avoid activities requiring full alertness after consuming alcohol.
  •  

  • Consult your healthcare provider for personalized advice considering your medical history and alcohol consumption patterns.

 

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Everything you need is included:

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A weight management program tailored to you

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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