Does Scripps Health Cover Orlistat (Xenical, Alli)

Learn about Orlistat coverage with Scripps Health, reasons for denial, ways to obtain coverage, costs without insurance, and answers to common questions.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Orlistat (Xenical, Alli)

 

  • Scripps Health covers Orlistat (Xenical, Alli) under specific circumstances, typically when it is medically necessary for weight management in adults with obesity-related conditions.
  •  

  • To qualify, patients often need a Body Mass Index (BMI) of 30 or higher, or 27 and higher with associated risk factors like hypertension or diabetes.

 

Basic Criteria for Coverage

 

  • Prescription by a licensed healthcare provider is required to substantiate medical necessity.
  •  

  • Patients may need to demonstrate prior attempts at weight loss through diet and exercise without sufficient results.
  •  

  • A pre-authorization process is usually necessary to confirm eligibility and ensure coverage of the medication.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 Orlistat (Xenical, Alli) Coverage with Scripps Health

 

Contact Scripps Health Customer Service

 

  • Begin by reaching out to Scripps Health customer service to inquire about coverage options for Orlistat.
  •  

  • Prepare your insurance ID and personal information to provide if necessary for verification.

 

Review Your Insurance Policy

 

  • Carefully examine your current health plan documentation to determine if Orlistat (Xenical, Alli) is included in the list of covered medications.
  •  

  • If the medication is not listed explicitly, check for any general coverage of weight management drugs.

 

Consult with a Scripps Health Physician

 

  • Schedule an appointment with a certified health professional within the Scripps Health network to discuss your health requirements and the necessity of Orlistat.
  •  

  • Ensure the physician provides a letter of medical necessity if needed for insurance purposes.

 

Obtain a Prescription

 

  • Once approved by your physician, obtain a legitimate prescription for Orlistat (Xenical, Alli).
  •  

  • Ensure all prescription details comply with your insurance requirements to facilitate smooth processing.

 

Submit Prior Authorization (If Required)

 

  • If your insurance plan necessitates prior authorization for Orlistat, work with your physician and Scripps Health to submit the proper documentation.
  •  

  • Include all required forms, medical necessity letter, and any additional requested information.

 

Contact Your Pharmacy

 

  • Reach out to a participating pharmacy affiliated with Scripps Health to check the status of your prescription coverage for Orlistat.
  •  

  • Clarify any out-of-pocket expenses that might apply despite coverage.

 

Appeal Denied Coverage

 

  • If your coverage request is denied, work with Scripps Health to formally appeal the decision. Request explanations and provide any additional support documents required.
  •  

  • Maintain communication with your physician to potentially adjust your treatment plan based on feedback received.

 

Explore Financial Assistance Programs

 

  • If needed, inquire about financial assistance programs offered by Scripps Health or the medication manufacturer, especially if you face high out-of-pocket costs.
  •  

  • Investigate alternative methods such as discounts, rebates, or savings cards that might reduce expenses.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Scripps Health Cover Orlistat (Xenical, Alli)

Learn about Orlistat coverage with Scripps Health, reasons for denial, ways to obtain coverage, costs without insurance, and answers to common questions.
Curex allergy drops unboxing

Is Orlistat (Xenical, Alli) Covered by Scripps Health

 

Coverage for Orlistat (Xenical, Alli)

 

  • Scripps Health covers Orlistat (Xenical, Alli) under specific circumstances, typically when it is medically necessary for weight management in adults with obesity-related conditions.
  •  

  • To qualify, patients often need a Body Mass Index (BMI) of 30 or higher, or 27 and higher with associated risk factors like hypertension or diabetes.

 

Basic Criteria for Coverage

 

  • Prescription by a licensed healthcare provider is required to substantiate medical necessity.
  •  

  • Patients may need to demonstrate prior attempts at weight loss through diet and exercise without sufficient results.
  •  

  • A pre-authorization process is usually necessary to confirm eligibility and ensure coverage of the medication.

 

A weight management program tailored to you

Start with Curex

Scripps Health's Approved Criteria for Orlistat (Xenical, Alli) Coverage

 

Eligibility Criteria for Orlistat Coverage

 

  • The patient must have a body mass index (BMI) of at least 30 kg/m², or a BMI of 27 kg/m² or higher with obesity-related comorbidities such as diabetes, hypertension, or dyslipidemia.

 

Documentation Requirements

 

  • Clinical documentation must be provided showing previous attempts at weight loss through a structured diet and exercise program for at least 6 months, without achieving substantial weight reduction.
  • Medical records should include a detailed weight history and documentation of adherence to a comprehensive lifestyle intervention, including dietary and physical activity adjustments.

 

Prescriber Qualifications

 

  • Orlistat must be prescribed by a licensed healthcare provider with expertise in obesity management, such as an endocrinologist, bariatric specialist, or nutritionist.
  • The prescriber must document the patient's complete assessment, including laboratory results and evaluation of obesity-related conditions.

 

Continuation Criteria

 

  • The patient must demonstrate a clinically significant weight loss within the first 3 months of therapy, typically defined as at least 5% of initial body weight.
  • Regular follow-up consultations must be scheduled to monitor weight loss progress and address any side effects or concerns regarding the medication.
  • Continued coverage depends on documented effectiveness and sustained adherence to the comprehensive lifestyle changes.

 

Supplementary Patient Education

 

  • The patient must receive educational material outlining the importance of dietary adherence, specifically reducing fat intake to lessen potential gastrointestinal side effects.
  • A written plan for continued lifestyle intervention should be developed in collaboration with a dietitian or nutritionist, emphasizing the role of Orlistat as an adjunct to a calorie-reduced diet.
  • Patients should be informed about the possible side effects of Orlistat and appropriate measures to take if these occur.

 

Why Scripps Health Might Deny Orlistat (Xenical, Alli) Coverage

 

Reasons Why Scripps Health Might Deny Orlistat Coverage

 

  • **Non-Medically Necessary Usage**: Scripps Health may deny coverage if the use of Orlistat is deemed not medically necessary for the patient's condition or if the weight loss does not significantly improve health outcomes.
  •  

  • **Lack of Prior Authorization**: Orlistat may not be covered if prior authorization procedures are not followed, meaning necessary approvals or documentation from healthcare providers are not provided before the prescription is filled.
  •  

  • **Not Meeting BMI Criteria**: Coverage might be denied if the patient does not meet the specific Body Mass Index (BMI) criteria required for the prescription of weight loss medications as defined by Scripps Health policies.
  •  

  • **Failure to Demonstrate Lifestyle Changes**: Scripps Health could deny coverage if there is insufficient evidence that the patient has engaged in recommended lifestyle modifications, such as diet and exercise, which are necessary alongside medication for weight management.
  •  

  • **Exclusion of Weight Loss Medications in Policy**: If a patient's specific plan explicitly excludes weight loss medications like Orlistat, coverage will be denied despite any medical justifications.
  •  

  • **Use of Non-Approved Indications**: If Orlistat is prescribed for reasons outside of its FDA-approved indications or those recognized by Scripps Health, the medication may not be covered.

 

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

How Much Does Orlistat (Xenical, Alli) Cost without Insurance?

 

Cost of Orlistat (Xenical, Alli) Without Insurance

 

  • Xenical: The brand-name Orlistat, Xenical, can be quite expensive without insurance. Typically, the cost is around $800 to $1,000 for a supply of 90 capsules, with each capsule being 120 mg.
  •  

  • Alli: The over-the-counter version, Alli, is generally less expensive than its prescription counterpart. The price for Alli ranges from $50 to $100 for a supply of 120 capsules, with each capsule being 60 mg.
  •  

  • Generic Orlistat: While generic options may be available, they usually do not offer significant savings over the brand-name versions. The prices for generic Orlistat are often comparable to those of Alli, varying from $50 to $100 for a similar quantity.
  •  

  • Shopping Tips: Prices can vary depending on the pharmacy, location, and availability. Consider using pharmacy discount cards, online coupons, or comparing prices at different pharmacies to obtain the best deal.
  •  

  • Considerations: Always consult a healthcare provider before starting Orlistat, and discuss any potential insurance coverage or assistance programs they might recommend.

 

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 Orlistat (Xenical, Alli) Coverage with Scripps Health

 

Contact Scripps Health Customer Service

 

  • Begin by reaching out to Scripps Health customer service to inquire about coverage options for Orlistat.
  •  

  • Prepare your insurance ID and personal information to provide if necessary for verification.

 

Review Your Insurance Policy

 

  • Carefully examine your current health plan documentation to determine if Orlistat (Xenical, Alli) is included in the list of covered medications.
  •  

  • If the medication is not listed explicitly, check for any general coverage of weight management drugs.

 

Consult with a Scripps Health Physician

 

  • Schedule an appointment with a certified health professional within the Scripps Health network to discuss your health requirements and the necessity of Orlistat.
  •  

  • Ensure the physician provides a letter of medical necessity if needed for insurance purposes.

 

Obtain a Prescription

 

  • Once approved by your physician, obtain a legitimate prescription for Orlistat (Xenical, Alli).
  •  

  • Ensure all prescription details comply with your insurance requirements to facilitate smooth processing.

 

Submit Prior Authorization (If Required)

 

  • If your insurance plan necessitates prior authorization for Orlistat, work with your physician and Scripps Health to submit the proper documentation.
  •  

  • Include all required forms, medical necessity letter, and any additional requested information.

 

Contact Your Pharmacy

 

  • Reach out to a participating pharmacy affiliated with Scripps Health to check the status of your prescription coverage for Orlistat.
  •  

  • Clarify any out-of-pocket expenses that might apply despite coverage.

 

Appeal Denied Coverage

 

  • If your coverage request is denied, work with Scripps Health to formally appeal the decision. Request explanations and provide any additional support documents required.
  •  

  • Maintain communication with your physician to potentially adjust your treatment plan based on feedback received.

 

Explore Financial Assistance Programs

 

  • If needed, inquire about financial assistance programs offered by Scripps Health or the medication manufacturer, especially if you face high out-of-pocket costs.
  •  

  • Investigate alternative methods such as discounts, rebates, or savings cards that might reduce expenses.

 

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.

Orlistat (Xenical, Alli) FAQ

1. What are the side effects of taking Orlistat?

 

Possible Side Effects of Orlistat

 

  • Gastrointestinal issues: Common effects include oily or fatty stools, increased defecation, and the urgent or difficult need to control bowel movements.
  •  

  • Abdominal discomfort: Some users experience pain or discomfort in the abdomen region.
  •  

  • Reduced absorption of fat-soluble vitamins: Orlistat can interfere with the absorption of vitamins A, D, E, and K. A multivitamin supplement is often recommended.
  •  

  • Allergic reactions: Though rare, symptoms may include itching, rash, or swelling, especially of the face, tongue, or throat.
  •  

  • Others: Some users report headaches, back pain, or flu-like symptoms.

 

2. How effective is Orlistat for weight loss?

 

Effectiveness of Orlistat

 

  • Orlistat aids weight loss by blocking the absorption of fats from the diet, reducing caloric intake. It can block approximately 25-30% of dietary fat.
  •  

  • Clinical studies suggest that Orlistat use for one year can result in an average weight loss of about 5-10% of initial body weight, when combined with a calorie-reduced diet.
  •  

  • It promotes modest weight loss over time and helps maintain weight loss. The effectiveness can improve with lifestyle changes such as increased physical activity and diet modifications.
  •  

  • Orlistat also has beneficial effects on cholesterol levels and may help reduce blood pressure.

 

3. Can I buy Orlistat over the counter?

 

Can I Buy Orlistat Over the Counter?

 

  • Orlistat is available in two forms: prescription strength (Xenical) and over-the-counter (Alli).
  •  

  • **Xenical**: This is the 120 mg version and requires a doctor's prescription. It's typically used for patients with a higher body mass index (BMI) or more specific medical conditions.
  •  

  • **Alli**: The 60 mg variant can be purchased over the counter in many countries, including the United States and the UK.
  •  

  • Even though Alli is accessible without a prescription, it is advised to consult with a healthcare professional before starting, to discuss its suitability and ensure proper usage.
  •  

 

Considerations Before Using Orlistat

 

  • Proper dietary changes are necessary when taking Orlistat to maximize effectiveness and reduce side effects.
  •  

  • Discuss your complete medical history and any other medications you are taking with your healthcare provider.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

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.

Made in Webflow