Does Scripps Health Cover Liraglutide (Saxenda)

Learn Scripps Health's coverage policy for Liraglutide (Saxenda), reasons for denial, cost without insurance, and tips for obtaining coverage.
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Liraglutide (Saxenda) Coverage by Scripps Health

 

  • Scripps Health may cover Saxenda for weight management if certain criteria are met. Coverage typically requires a documented clinical diagnosis of obesity or overweight with related health conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Patients usually need to demonstrate that they've previously attempted weight loss through diet and exercise without achieving significant results.
  •  

  • Prior authorization is generally required, meaning that a healthcare provider must submit documentation to verify that the patient meets the necessary clinical guidelines for coverage.
  •  

  • Coverage may also depend on the specific health insurance policy held by the patient within Scripps Health, as different plans can have varying formularies and benefit structures.

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Liraglutide (Saxenda) Coverage with Scripps Health

 

Contact Scripps Health Customer Service

 

  • Dial the Scripps Health customer service number found on your insurance card, or visit their website to locate contact information.
  •  

  • Inquire if your plan includes coverage for weight management medications like Liraglutide (Saxenda).

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your eligibility and medical necessity for Liraglutide.
  •  

  • Request documentation from your provider supporting the need for Liraglutide as part of your treatment plan.

 

Verify Pharmacy Benefits

 

  • Access your pharmacy benefits through Scripps Health's online member portal or contact their pharmacy department if needed.
  •  

  • Verify if Liraglutide is included in your formulary and understand any prior authorization requirements.

 

Complete Prior Authorization

 

  • If necessary, have your healthcare provider initiate a prior authorization request for Liraglutide with the supporting documentation.
  •  

  • Ensure all required forms and evidence are submitted to Scripps Health for processing and approval.

 

Monitor Approval Status

 

  • Follow up with Scripps Health to check the status of your prior authorization request.
  •  

  • Maintain regular communication with your healthcare provider in case additional information is required.

 

Fill Your Prescription

 

  • Once approved, head to an in-network pharmacy to fill your Liraglutide prescription.
  •  

  • Present your insurance card and pay any applicable copay or coinsurance at the time of pickup.

 

Manage Your Treatment Plan

 

  • Adhere to the treatment plan and dosage instructions provided by your healthcare provider.
  •  

  • Schedule regular follow-up appointments to monitor your progress and any potential side effects.

 

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FAQs

Does Scripps Health Cover Liraglutide (Saxenda)

Learn Scripps Health's coverage policy for Liraglutide (Saxenda), reasons for denial, cost without insurance, and tips for obtaining coverage.
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Is Liraglutide (Saxenda) Covered by Scripps Health

 

Liraglutide (Saxenda) Coverage by Scripps Health

 

  • Scripps Health may cover Saxenda for weight management if certain criteria are met. Coverage typically requires a documented clinical diagnosis of obesity or overweight with related health conditions such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Patients usually need to demonstrate that they've previously attempted weight loss through diet and exercise without achieving significant results.
  •  

  • Prior authorization is generally required, meaning that a healthcare provider must submit documentation to verify that the patient meets the necessary clinical guidelines for coverage.
  •  

  • Coverage may also depend on the specific health insurance policy held by the patient within Scripps Health, as different plans can have varying formularies and benefit structures.

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Scripps Health's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Scripps Health's Approved Criteria for Liraglutide (Saxenda) Coverage

 

  • Diagnosis of obesity, determined by a body mass index (BMI) of 30 kg/m² or greater.
  •  

  • Overweight status, identified by a BMI of 27 kg/m² or greater, accompanied by at least one weight-related comorbid condition such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • A documented and failed attempt of at least six months in a comprehensive weight management program, including lifestyle modifications such as diet and exercise.
  •  

  • A written recommendation from the primary treating physician indicating the need for pharmacological intervention for weight management due to insufficient progress with lifestyle modifications alone.
  •  

  • Assessment of the patient's commitment to ongoing lifestyle interventions in conjunction with Liraglutide, ensuring dietary, physical, and behavioral health changes are continued.
  •  

  • The prescribing healthcare provider must have appropriate qualifications and experience in managing obesity and related disorders, ensuring regular follow-ups and monitoring of the patient's progress and response to Liraglutide treatment.

Why Scripps Health Might Deny Liraglutide (Saxenda) Coverage

 

Scripps Health Denial Criteria for Liraglutide (Saxenda) Coverage

 

  • Scripps Health may deny coverage for Liraglutide (Saxenda) if it is prescribed for a condition not recognized within their approved use cases. If Saxenda is being used for a purpose other than the management of chronic weight conditions, coverage may be declined.
  •  

  • Requests for Saxenda might be denied if the patient does not meet the required BMI threshold. Scripps Health typically requires specific BMI criteria to justify the necessity for coverage.
  •  

  • If the patient has not demonstrated prior unsuccessful attempts with other weight management programs or medications, Scripps Health may not cover Saxenda, as it is often considered a medication for cases where other interventions have failed.
  •  

  • Scripps Health might also refuse coverage if there is a lack of adequate documentation regarding the patient's weight management history or insufficient evidence supporting the medical need for Saxenda.
  •  

  • Coverage can be denied if there are contraindications in the patient's medical history for using Saxenda, such as specific pre-existing health conditions that are flagged in their coverage policy.
  •  

  • Claims may be rejected if Saxenda is prescribed in dosages or frequencies that fall outside the typical guidelines, unless justified by exceptional circumstances noted in the patient's medical records.
  •  

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

How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

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

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

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

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

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

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Liraglutide (Saxenda) Coverage with Scripps Health

 

Contact Scripps Health Customer Service

 

  • Dial the Scripps Health customer service number found on your insurance card, or visit their website to locate contact information.
  •  

  • Inquire if your plan includes coverage for weight management medications like Liraglutide (Saxenda).

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your eligibility and medical necessity for Liraglutide.
  •  

  • Request documentation from your provider supporting the need for Liraglutide as part of your treatment plan.

 

Verify Pharmacy Benefits

 

  • Access your pharmacy benefits through Scripps Health's online member portal or contact their pharmacy department if needed.
  •  

  • Verify if Liraglutide is included in your formulary and understand any prior authorization requirements.

 

Complete Prior Authorization

 

  • If necessary, have your healthcare provider initiate a prior authorization request for Liraglutide with the supporting documentation.
  •  

  • Ensure all required forms and evidence are submitted to Scripps Health for processing and approval.

 

Monitor Approval Status

 

  • Follow up with Scripps Health to check the status of your prior authorization request.
  •  

  • Maintain regular communication with your healthcare provider in case additional information is required.

 

Fill Your Prescription

 

  • Once approved, head to an in-network pharmacy to fill your Liraglutide prescription.
  •  

  • Present your insurance card and pay any applicable copay or coinsurance at the time of pickup.

 

Manage Your Treatment Plan

 

  • Adhere to the treatment plan and dosage instructions provided by your healthcare provider.
  •  

  • Schedule regular follow-up appointments to monitor your progress and any potential side effects.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

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

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

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

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

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

What are the side effects of Liraglutide?

 

Common Side Effects

 

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

 

Serious Side Effects

 

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

 

Recommendations

 

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

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

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

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

 

Appetite Suppression

 

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

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

 

Additional Benefits

 

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

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

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

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

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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