Does Scripps Health Cover Phentermine (Adipex-P, Lomaira)

Explore Scripps Health's coverage details for Phentermine, reasons for denials, costs without insurance, and tips on securing coverage.
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Coverage for Phentermine

 

  • Scripps Health may cover Phentermine (Adipex-P, Lomaira) if it is deemed medically necessary for the treatment of obesity.
  •  

  • Coverage is usually considered for patients who have a Body Mass Index (BMI) ≥ 30, or ≥ 27 with weight-related health issues.

 

Criteria for Approval

 

  • Doctor's prescription and documentation are required, demonstrating the necessity based on the patient’s health condition.
  •  

  • Typically, patients must show attempts at weight loss through diet and exercise before medication approval is granted.
  •  

  • Continued coverage might be conditional on meeting weight loss goals established by the healthcare provider.

 

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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.

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 Phentermine (Adipex-P, Lomaira) Coverage with Scripps Health

 

Verify Eligibility with Scripps Health

 

  • Contact Scripps Health customer service to confirm if your current plan covers prescription medications, specifically weight loss drugs like Phentermine (Adipex-P, Lomaira).
  •  

  • Inquire about any specific requirements or criteria to fulfill eligibility for Phentermine coverage.

 

Consult with Your Primary Care Physician

 

  • Schedule an appointment with your primary care physician (PCP) within the Scripps Health network to discuss your need for Phentermine.
  •  

  • Ensure your PCP documents your weight-related health issues and potential benefits of Phentermine in your medical record.

 

Obtain a Prescription

 

  • If deemed appropriate, obtain a prescription for Phentermine from your PCP. Ensure it is specifically documented which formulation (Adipex-P or Lomaira) and dosage is recommended.
  •  

  • Discuss alternative medications if Phentermine is not suitable due to medical history or potential drug interactions.

 

Contact Scripps Health Pharmacy Services

 

  • Reach out to Scripps Health pharmacy services to confirm they have the prescribed Phentermine formulation in stock.
  •  

  • Ask for detailed information on copays and out-of-pocket costs associated with the medication under your health plan.

 

Submit Prior Authorization, if Required

 

  • Some insurance plans may require prior authorization for coverage of Phentermine. Work with your physician to complete this process, providing any necessary medical documentation.
  •  

  • Follow up with both Scripps Health and your physician’s office to ensure the prior authorization request is processed and approved.

 

Refill and Monitor Progress

 

  • Once approved, fill your Phentermine prescription at a Scripps Health-affiliated pharmacy to ensure coverage.
  •  

  • Regularly review your progress with your PCP and adjust treatment as necessary in collaboration with your healthcare team.

 

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FAQs

Does Scripps Health Cover Phentermine (Adipex-P, Lomaira)

Explore Scripps Health's coverage details for Phentermine, reasons for denials, costs without insurance, and tips on securing coverage.
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Is Phentermine (Adipex-P, Lomaira) Covered by Scripps Health

 

Coverage for Phentermine

 

  • Scripps Health may cover Phentermine (Adipex-P, Lomaira) if it is deemed medically necessary for the treatment of obesity.
  •  

  • Coverage is usually considered for patients who have a Body Mass Index (BMI) ≥ 30, or ≥ 27 with weight-related health issues.

 

Criteria for Approval

 

  • Doctor's prescription and documentation are required, demonstrating the necessity based on the patient’s health condition.
  •  

  • Typically, patients must show attempts at weight loss through diet and exercise before medication approval is granted.
  •  

  • Continued coverage might be conditional on meeting weight loss goals established by the healthcare provider.

 

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Scripps Health's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Requirements

 

  • Members must be 18 years of age or older to qualify for Phentermine (Adipex-P, Lomaira) coverage.
  •  

  • Demonstrated clinical necessity for weight management as part of a comprehensive weight loss program, supervised by a healthcare provider.
  •  

  • Body Mass Index (BMI) of 30 kg/m² or higher, indicating obesity, or BMI of 27 kg/m² or higher with at least one weight-related condition such as hypertension, type 2 diabetes, or dyslipidemia.

 

Trial and Previous Treatments

 

  • Documented history of unsuccessful weight loss through a supervised diet and exercise program, typically lasting at least 6 months.
  •  

  • Consideration for coverage of Phentermine only if the member has not achieved significant weight reduction or maintenance through previous weight loss medications, unless contraindicated or not tolerated.

 

Exclusions and Limitations

 

  • Coverage for Phentermine is generally limited to an initial 12-week period. Subsequent extension requires demonstrated weight loss of at least 5% of initial body weight and no serious adverse effects.
  •  

  • Treatment with Phentermine must be part of a documented comprehensive weight management program, including nutritional and behavioral counseling.

 

Ongoing Assessment and Monitoring

 

  • Regular follow-up appointments with the prescribing healthcare provider to monitor weight loss progress, ensure medication efficacy, and evaluate any potential side effects.
  •  

  • Documentation of continued program participation and compliance with dietary, exercise, and behavioral change efforts.

 

Why Scripps Health Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons for Denial of Phentermine Coverage by Scripps Health

 

  • The patient does not meet the minimum BMI requirement established by Scripps Health criteria for obesity medications, which is typically a BMI of 30 or higher, or a BMI of 27 with comorbid conditions such as hypertension or diabetes.
  •  

  • The patient has a history of cardiovascular disease, including advanced arteriosclerosis or hyperthyroidism, which contraindicates the use of Phentermine.
  •  

  • The patient has a past or current history of drug abuse or addiction, making them unsuitable for treatment with an amphetamine-like medication.
  •  

  • There is no documented evidence of failed weight loss through diet and exercise alone, making the prescription of Phentermine unjustified under their policy.
  •  

  • The patient is currently using or has recently used other central nervous system stimulants or monoamine oxidase inhibitors, which could lead to serious drug interactions.
  •  

  • Existence of contraindications like pregnancy or nursing, as Phentermine poses potential risks to the fetus or infant and is thus not covered.
  •  

  • Non-compliance with follow-up and monitoring requirements set forth by Scripps Health, which ensure patient safety and medication effectiveness, resulting in denial of coverage.

 

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How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Scripps Health

 

Verify Eligibility with Scripps Health

 

  • Contact Scripps Health customer service to confirm if your current plan covers prescription medications, specifically weight loss drugs like Phentermine (Adipex-P, Lomaira).
  •  

  • Inquire about any specific requirements or criteria to fulfill eligibility for Phentermine coverage.

 

Consult with Your Primary Care Physician

 

  • Schedule an appointment with your primary care physician (PCP) within the Scripps Health network to discuss your need for Phentermine.
  •  

  • Ensure your PCP documents your weight-related health issues and potential benefits of Phentermine in your medical record.

 

Obtain a Prescription

 

  • If deemed appropriate, obtain a prescription for Phentermine from your PCP. Ensure it is specifically documented which formulation (Adipex-P or Lomaira) and dosage is recommended.
  •  

  • Discuss alternative medications if Phentermine is not suitable due to medical history or potential drug interactions.

 

Contact Scripps Health Pharmacy Services

 

  • Reach out to Scripps Health pharmacy services to confirm they have the prescribed Phentermine formulation in stock.
  •  

  • Ask for detailed information on copays and out-of-pocket costs associated with the medication under your health plan.

 

Submit Prior Authorization, if Required

 

  • Some insurance plans may require prior authorization for coverage of Phentermine. Work with your physician to complete this process, providing any necessary medical documentation.
  •  

  • Follow up with both Scripps Health and your physician’s office to ensure the prior authorization request is processed and approved.

 

Refill and Monitor Progress

 

  • Once approved, fill your Phentermine prescription at a Scripps Health-affiliated pharmacy to ensure coverage.
  •  

  • Regularly review your progress with your PCP and adjust treatment as necessary in collaboration with your healthcare team.

 

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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.

Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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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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