Does Scripps Health Cover Phendimetrazine

Learn why Scripps Health might deny Phendimetrazine, tips on securing coverage, cost without insurance, and get answers to common questions.
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Does Scripps Health Cover Phendimetrazine?

 

  • Scripps Health may cover Phendimetrazine as part of a medically supervised weight loss program. Coverage depends on the individual's specific health plan and medical necessity as prescribed by a healthcare provider.
  •  

  • Phendimetrazine is typically covered when it's part of an obesity treatment plan that includes diet, exercise, and behavioral therapy.
  •  

  • Patients must provide documentation of their medical necessity, such as a body mass index (BMI) of 30 or higher, or 27 with associated risk factors like diabetes, hypertension, or sleep apnea.
  •  

  • Coverage eligibility requires prior authorization from the patient's healthcare provider, who must detail the patient's weight loss history and previous attempts.
  •  

  • Some plans may require stepping through other treatments before approving Phendimetrazine.
  •  

  • Patients are encouraged to contact Scripps Health’s customer service to confirm specific coverage details and requirements under their health plan.

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

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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.

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

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

Kayla Mardaga, NP

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

How to Get Phendimetrazine Coverage with Scripps Health

 

Assess Your Coverage Needs

 

  • Determine if Phendimetrazine is a recommended treatment for your condition as prescribed by your healthcare provider.
  • Check if you have an existing health plan with Scripps Health and review the prescription drug coverage section of your policy documents.

 

Contact Scripps Health Customer Service

 

  • Reach out to Scripps Health Member Services via phone or through their online portal for personalized assistance.
  • Inquire specifically about the coverage details for Phendimetrazine under your current health insurance plan.
  • Request information about any prescription drug tiers, co-pays, or prior authorization requirements related to Phendimetrazine.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Phendimetrazine with your healthcare provider to ensure it's medically necessary and documented.
  • Request that your provider include necessary details about your condition and the prescribed medication in your medical records for insurance purposes.

 

Verify Formulary Coverage

 

  • Review the Scripps Health drug formulary, which is typically available through their website or member portal.
  • Look for Phendimetrazine within the formulary to confirm if it's covered and note any specific requirements or limitations.

 

Obtain a Prior Authorization, if Necessary

 

  • If Phendimetrazine requires prior authorization, have your provider submit the necessary documentation to Scripps Health.
  • Ensure that all required information, such as dosage, medical necessity, and alternative treatments tried, is included in the authorization request.

 

Appeal a Denied Claim

 

  • If coverage for Phendimetrazine is denied, review the denial letter for specific reasons and instructions on how to appeal the decision.
  • Work with your healthcare provider to provide additional documentation or justification as part of the appeal process.

 

Stay Informed About Policy Changes

 

  • Keep track of any changes to your health insurance policy that may affect your prescription drug coverage.
  • Regularly visit the Scripps Health website or contact their customer service to stay updated on any changes affecting your coverage for medications like Phendimetrazine.

 

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FAQs

Does Scripps Health Cover Phendimetrazine

Learn why Scripps Health might deny Phendimetrazine, tips on securing coverage, cost without insurance, and get answers to common questions.
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Is Phendimetrazine Covered by Scripps Health

 

Does Scripps Health Cover Phendimetrazine?

 

  • Scripps Health may cover Phendimetrazine as part of a medically supervised weight loss program. Coverage depends on the individual's specific health plan and medical necessity as prescribed by a healthcare provider.
  •  

  • Phendimetrazine is typically covered when it's part of an obesity treatment plan that includes diet, exercise, and behavioral therapy.
  •  

  • Patients must provide documentation of their medical necessity, such as a body mass index (BMI) of 30 or higher, or 27 with associated risk factors like diabetes, hypertension, or sleep apnea.
  •  

  • Coverage eligibility requires prior authorization from the patient's healthcare provider, who must detail the patient's weight loss history and previous attempts.
  •  

  • Some plans may require stepping through other treatments before approving Phendimetrazine.
  •  

  • Patients are encouraged to contact Scripps Health’s customer service to confirm specific coverage details and requirements under their health plan.

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Scripps Health's Approved Criteria for Phendimetrazine Coverage

 

Approved Criteria for Phendimetrazine Coverage

 

  • The patient must have a documented Body Mass Index (BMI) of 30 or greater, indicating clinical obesity, or a BMI of 27 or greater with associated comorbidities such as hypertension, diabetes, or dyslipidemia.
  •  

  • The patient must have attempted to lose weight through lifestyle intervention including diet and exercise before requesting medication. Documentation of previous supervised weight loss pursuits is necessary.
  •  

  • The prescribing physician must provide a written recommendation for Phendimetrazine, including a specific treatment plan that features ongoing, regular supervision by the healthcare provider to monitor effectiveness and manage any side effects.
  •  

  • Continued coverage is contingent on the patient demonstrating measurable progress in weight loss consistent with the physician’s treatment plan and goals. Periodic reassessment by the healthcare professional is required to confirm efficacy and safety.

 

Exclusions to Note (Summarized)

 

  • Coverage is typically not extended for patients with a history of substance abuse, and each case is reviewed individually based on the clinician's evaluation of the patient’s risk profile.
  •  

  • Patients must not use Phendimetrazine in combination with other weight loss medications unless specifically authorized by the healthcare provider and endorsed by Scripps Health review board.

 

Why Scripps Health Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage by Scripps Health

 

  • Phendimetrazine may not be covered if it is prescribed for conditions not approved by the FDA or outside its approved indications for use.
  •  

  • If the prescribed use does not meet the criteria established by Scripps Health’s formulary guidelines, coverage might be denied.
  •  

  • Coverage may be refused if the patient does not have a history of trying and failing to lose weight through diet and exercise alone.
  •  

  • Phendimetrazine might not be covered for patients who have a documented history of drug or substance abuse, given its potential for dependency.
  •  

  • Scripps Health could deny coverage in situations where the doctor prescribing the medication does not specialize in weight management or obesity treatment.
  •  

  • The drug may not be covered if prescribed in conjunction with other weight-loss medications, unless it's a combination approved by Scripps Health.
  •  

  • If prior authorization requirements are not fulfilled or if incorrect documentation is submitted, coverage might be denied.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

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

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

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

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

 

Factors Affecting Price

 

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

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

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

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

 

Conclusion

 

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

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

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Phendimetrazine Coverage with Scripps Health

 

Assess Your Coverage Needs

 

  • Determine if Phendimetrazine is a recommended treatment for your condition as prescribed by your healthcare provider.
  • Check if you have an existing health plan with Scripps Health and review the prescription drug coverage section of your policy documents.

 

Contact Scripps Health Customer Service

 

  • Reach out to Scripps Health Member Services via phone or through their online portal for personalized assistance.
  • Inquire specifically about the coverage details for Phendimetrazine under your current health insurance plan.
  • Request information about any prescription drug tiers, co-pays, or prior authorization requirements related to Phendimetrazine.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Phendimetrazine with your healthcare provider to ensure it's medically necessary and documented.
  • Request that your provider include necessary details about your condition and the prescribed medication in your medical records for insurance purposes.

 

Verify Formulary Coverage

 

  • Review the Scripps Health drug formulary, which is typically available through their website or member portal.
  • Look for Phendimetrazine within the formulary to confirm if it's covered and note any specific requirements or limitations.

 

Obtain a Prior Authorization, if Necessary

 

  • If Phendimetrazine requires prior authorization, have your provider submit the necessary documentation to Scripps Health.
  • Ensure that all required information, such as dosage, medical necessity, and alternative treatments tried, is included in the authorization request.

 

Appeal a Denied Claim

 

  • If coverage for Phendimetrazine is denied, review the denial letter for specific reasons and instructions on how to appeal the decision.
  • Work with your healthcare provider to provide additional documentation or justification as part of the appeal process.

 

Stay Informed About Policy Changes

 

  • Keep track of any changes to your health insurance policy that may affect your prescription drug coverage.
  • Regularly visit the Scripps Health website or contact their customer service to stay updated on any changes affecting your coverage for medications like Phendimetrazine.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

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

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

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

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

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

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

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

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

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

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

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

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

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

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

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

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

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

 

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Titration

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

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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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