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Does Security Health Plan Cover Contrave

Explore Security Health Plan's Contrave coverage, reasons for denial, tips to secure coverage, costs without insurance, and FAQs in this insightful guide.
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Does Security Health Plan Cover Contrave?

 

  • Security Health Plan may cover Contrave, a weight-loss medication, under specific circumstances. Coverage often requires meeting certain clinical criteria.

    •  

  • Patients typically must demonstrate a medical necessity for weight loss prescription treatments.

    •  

  • Common requirements include a BMI over a specific threshold, usually 30 or higher, or 27 with associated health conditions such as hypertension, diabetes, or dyslipidemia.

    •  

  • Prior authorization from Security Health Plan is often mandatory before receiving coverage.

    •  

  • It's essential to provide comprehensive medical documentation supporting the need for Contrave to maximize the chances of coverage.

    •  

  • Patients should verify plan benefits and consult with their healthcare provider and Security Health Plan for the most accurate and personalized information.

 

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Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Contrave Coverage with Security Health Plan

 

Enroll with Security Health Plan

 

  • Begin by visiting the official Security Health Plan website to explore available health plan options.

    •  

  • Contact a customer service representative to assist you with selecting a plan that offers prescription coverage, and specifically inquire about the inclusion of weight loss medications like Contrave.

    •  

  • Ensure you fully understand the plan’s benefits, including any deductibles, copayments, or specific pharmacy network requirements related to prescription drug coverage.

 

Confirm Medication Coverage

 

  • Review your plan’s formulary, a list detailing medications covered under your plan. You can usually find this information on the Security Health Plan’s website or through customer service.

    •  

  • If Contrave is not listed in the formulary, inquire about the process for obtaining prior authorization or an exception to have it covered.

    •  

  • Ask for information on any required documentation or criteria, such as a physician’s letter or medical necessity, which may support your request for coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave as part of your weight management plan.

    •  

  • Your provider should be aware of the documentation needed by Security Health Plan and be able to assist in providing any necessary medical records or justification for the prescription.

    •  

  • Ensure your provider sends any required documentation directly to Security Health Plan to expedite the coverage approval process.

 

Submit a Request for Coverage

 

  • Once you’ve gathered all necessary documents, formally submit a request for Contrave coverage through Security Health Plan’s designated process.

    •  

  • This may involve completing and submitting a prior authorization form or request for drug coverage exception.

    •  

  • Make sure all information is accurate and complete to avoid delays in the review process.

 

Follow Up and Stay Informed

 

  • After submission, contact Security Health Plan to confirm receipt of your request and inquire about the expected timeline for a decision.

    •  

  • If the coverage is approved, verify the details of your plan’s coverage for Contrave, including any applicable copay or pharmacy restrictions.

    •  

  • In case of denial, review the reasons for denial, and work with your healthcare provider to address any concerns or re-submit additional information if necessary.

 

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FAQs

Does Security Health Plan Cover Contrave

Explore Security Health Plan's Contrave coverage, reasons for denial, tips to secure coverage, costs without insurance, and FAQs in this insightful guide.
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Is Contrave Covered by Security Health Plan

 

Does Security Health Plan Cover Contrave?

 

  • Security Health Plan may cover Contrave, a weight-loss medication, under specific circumstances. Coverage often requires meeting certain clinical criteria.

    •  

  • Patients typically must demonstrate a medical necessity for weight loss prescription treatments.

    •  

  • Common requirements include a BMI over a specific threshold, usually 30 or higher, or 27 with associated health conditions such as hypertension, diabetes, or dyslipidemia.

    •  

  • Prior authorization from Security Health Plan is often mandatory before receiving coverage.

    •  

  • It's essential to provide comprehensive medical documentation supporting the need for Contrave to maximize the chances of coverage.

    •  

  • Patients should verify plan benefits and consult with their healthcare provider and Security Health Plan for the most accurate and personalized information.

 

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Security Health Plan's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • The patient must be 18 years or older.

    •  

  • The patient should have a body mass index (BMI) of 30 or greater, which classifies as obesity.

    •  

  • Alternatively, a BMI of 27 or greater is considered eligible if associated with at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.

 

Medical History Evaluation

 

  • Previous attempts at weight loss through diet, exercise, and/or lifestyle changes must be documented, indicating insufficient outcomes with these methods alone.

    •  

  • The prescribing physician must perform a thorough medical evaluation to rule out any contraindications to Contrave therapy.

 

Physician's Prescription

 

  • Coverage is contingent upon a prescription from a licensed healthcare provider with expertise in weight management.

    •  

  • The prescription must include an initial treatment plan with clearly stated goals for weight loss and management.

 

Treatment Follow-Up

 

  • Patients are required to schedule routine follow-up appointments to assess effectiveness, side effects, and overall progress on Contrave therapy.

    •  

  • During follow-up visits, healthcare providers should review the patient’s adherence to treatment, modifications of lifestyle, and inspective clinical benefits or complications.

 

Continued Coverage

 

  • Continuation of coverage beyond the initial treatment phase requires documented evidence of clinically significant weight loss, generally defined as a loss of at least 5% of initial body weight within 12 weeks of starting treatment.

    •  

  • The prescribing physician must support that continued therapy is medically necessary for ongoing weight loss or maintenance.

 

Pharmacological Considerations

 

  • Medications prescribed must comply with the standard dosing recommendations and guidelines as per the prescribing information of Contrave.

    •  

  • Any dosage adjustments should be clinically justified and documented in the medical record.

 

Why Security Health Plan Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage

 

  • Security Health Plan may deny Contrave coverage if the medication is prescribed for purposes not approved by the FDA.

    •  

  • Coverage may be denied if the patient does not meet the required body mass index (BMI) criteria outlined by the plan's policy guidelines.

    •  

  • Security Health Plan typically excludes coverage if the patient has not completed prior diagnostic requirements or trials of alternative weight management therapies, as stipulated in the plan.

    •  

  • Patients with specific contraindications to Contrave, such as those involving substance abuse or certain psychological conditions, may face coverage denial.

    •  

  • Security Health Plan might deny coverage if there are pre-existing conditions or co-morbidities that are deemed incompatible with Contrave use, according to their policy guidelines.

    •  

  • Lack of prior authorization could result in denied coverage, especially if the plan requires it for all weight management medications.

    •  

  • Security Health Plan may not cover Contrave if it is prescribed outside the network of approved healthcare providers or pharmacies.

 

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

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

 

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Contrave Coverage with Security Health Plan

 

Enroll with Security Health Plan

 

  • Begin by visiting the official Security Health Plan website to explore available health plan options.

    •  

  • Contact a customer service representative to assist you with selecting a plan that offers prescription coverage, and specifically inquire about the inclusion of weight loss medications like Contrave.

    •  

  • Ensure you fully understand the plan’s benefits, including any deductibles, copayments, or specific pharmacy network requirements related to prescription drug coverage.

 

Confirm Medication Coverage

 

  • Review your plan’s formulary, a list detailing medications covered under your plan. You can usually find this information on the Security Health Plan’s website or through customer service.

    •  

  • If Contrave is not listed in the formulary, inquire about the process for obtaining prior authorization or an exception to have it covered.

    •  

  • Ask for information on any required documentation or criteria, such as a physician’s letter or medical necessity, which may support your request for coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Contrave as part of your weight management plan.

    •  

  • Your provider should be aware of the documentation needed by Security Health Plan and be able to assist in providing any necessary medical records or justification for the prescription.

    •  

  • Ensure your provider sends any required documentation directly to Security Health Plan to expedite the coverage approval process.

 

Submit a Request for Coverage

 

  • Once you’ve gathered all necessary documents, formally submit a request for Contrave coverage through Security Health Plan’s designated process.

    •  

  • This may involve completing and submitting a prior authorization form or request for drug coverage exception.

    •  

  • Make sure all information is accurate and complete to avoid delays in the review process.

 

Follow Up and Stay Informed

 

  • After submission, contact Security Health Plan to confirm receipt of your request and inquire about the expected timeline for a decision.

    •  

  • If the coverage is approved, verify the details of your plan’s coverage for Contrave, including any applicable copay or pharmacy restrictions.

    •  

  • In case of denial, review the reasons for denial, and work with your healthcare provider to address any concerns or re-submit additional information if necessary.

 

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.

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

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

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

 

Less Common Side Effects

 

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

 

Serious Side Effects

 

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

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

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

    •  

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

 

Factors Affecting Weight Loss

 

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

    •  

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

    •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

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

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

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

    •  

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

 

Recommendations

 

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

    •  

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

    •  

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

 

Have questions left?

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A weight management program tailored to you

Initial Dosage

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

Titration

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

Additional Treatments

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

Got questions? We have answers.

Do your plans include prescriptions and medications?

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

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

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

What medications do your providers prescribe?

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

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

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

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

Will I be prescribed semaglutide if I sign up?

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

What is compounded medication?

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

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

Is compounded medication the same as generic medication?

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

Is insurance required?

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

Can I pay with an FSA or HSA card?

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

How much does treatment cost?

Semaglutide Injections:

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

Tirzepatide Injections:

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

Semaglutide Tablets:

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

Tirzepatide Tablets:

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

‍

Can you prescribe Ozempic®* or Wegovy®*?

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

Are video visits with a provider required?

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

What states do you serve?

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

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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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