Does Security Health Plan Cover Orlistat (Xenical, Alli)

Discover if Security Health Plan covers Orlistat (Xenical, Alli), potential coverage reasons, out-of-pocket costs, and expert tips for securing your medication.
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Coverage Criteria for Orlistat

 

  • Security Health Plan may cover Orlistat (Xenical, Alli) when prescribed for weight loss in individuals experiencing obesity-related health issues.
  •  

  • Members typically need to meet specific Body Mass Index (BMI) criteria, often requiring a BMI of 30 or greater, or 27 with related health conditions.

 

Basic Rules for Approval

 

  • Prior authorization may be required. Physicians must demonstrate medical necessity, showing that alternative weight loss measures have not been effective.
  •  

  • Continued coverage might depend on observing effective weight loss or improvement in obesity-related conditions within a set period.
  •  

  • Members should consult Security Health Plan’s specific policy documents or customer service for detailed terms and coverage insights.

 

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Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Orlistat (Xenical, Alli) Coverage with Security Health Plan

 

Check Eligibility Requirements

 

  • Visit the Security Health Plan website or contact their customer service to review specific criteria for medication coverage.
  •  

  • Determine if a prior authorization is needed for Orlistat (Xenical, Alli), as this can influence the coverage process.
  •  

  • Ensure that you meet any necessary prerequisites, such as having a body mass index (BMI) within the range required by the plan.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat.
  •  

  • Ask your provider to provide any medical documentation or justification required by Security Health Plan to secure coverage.
  •  

  • Ensure your healthcare provider is prepared to submit a prior authorization if needed.

 

Contact Security Health Plan

 

  • Call or visit the Security Health Plan website to inquire about the specific process for getting Orlistat covered.
  •  

  • Request a list of necessary documents and forms required to submit a prescription claim for Orlistat.
  •  

  • Clarify any part of the process you do not understand to ensure a smooth application.

 

Gather Required Documentation

 

  • Collect all required documents as outlined by Security Health Plan, including your doctor's prescription and any medical records supporting the need for Orlistat.
  •  

  • If necessary, obtain a filled-out prior authorization form from your healthcare provider.
  •  

  • Ensure any insurance claim forms are accurately completed and signed.

 

Submit Your Request

 

  • Send all collected documents and forms to Security Health Plan through the specified method, whether by mail, fax, or online portal.
  •  

  • Follow up to confirm receipt of your submission and inquire about expected processing times.

 

Review Policy & Follow Up

 

  • Regularly check the status of your coverage request by contacting Security Health Plan.
  •  

  • Review any feedback or requests for additional information from the insurance provider in a timely manner.
  •  

  • Engage with your healthcare provider to expedite any additional documentation or clarifications requested by Security Health Plan.
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Does Security Health Plan Cover Orlistat (Xenical, Alli)

Discover if Security Health Plan covers Orlistat (Xenical, Alli), potential coverage reasons, out-of-pocket costs, and expert tips for securing your medication.
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Is Orlistat (Xenical, Alli) Covered by Security Health Plan

 

Coverage Criteria for Orlistat

 

  • Security Health Plan may cover Orlistat (Xenical, Alli) when prescribed for weight loss in individuals experiencing obesity-related health issues.
  •  

  • Members typically need to meet specific Body Mass Index (BMI) criteria, often requiring a BMI of 30 or greater, or 27 with related health conditions.

 

Basic Rules for Approval

 

  • Prior authorization may be required. Physicians must demonstrate medical necessity, showing that alternative weight loss measures have not been effective.
  •  

  • Continued coverage might depend on observing effective weight loss or improvement in obesity-related conditions within a set period.
  •  

  • Members should consult Security Health Plan’s specific policy documents or customer service for detailed terms and coverage insights.

 

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

 

Criteria for Orlistat (Xenical, Alli) Coverage

 

  • Orlistat is prescribed for chronic weight management, in conjunction with a reduced-calorie diet and increased physical activity.
  •  

  • The patient is 18 years of age or older.
  •  

  • The patient has a documented body mass index (BMI) of 30 kg/m² or greater. Alternatively, the patient may have a BMI of 27 kg/m² or greater if accompanied by related co-morbidities such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • The patient has demonstrated unsuccessful attempts to lose weight through diet and exercise efforts alone before the initiation of pharmacotherapy.
  •  

  • The prescribing provider confirms that the patient does not have any contraindications to Orlistat, including but not limited to, chronic malabsorption syndrome or cholestasis.
  •  

  • The use of Orlistat aligns with the FDA-approved prescribing information, specifically in terms of dosage and duration of treatment.
  •  

  • Re-assessment of treatment efficacy is conducted at regular intervals, recommending discontinuation of Orlistat if a defined percentage of weight loss is not achieved or if there are safety concerns that outweigh benefits.

 

Why Security Health Plan Might Deny Orlistat (Xenical, Alli) Coverage

 

Security Health Plan Denial of Orlistat Coverage Criteria

 

  • The prescription for Orlistat (Xenical, Alli) is for cosmetic weight loss purposes, not medically necessary weight management.
  •  

  • The member has not met the minimum documented weight or BMI requirement as specified by Security Health Plan guidelines.
  •  

  • The patient does not have a documented history of attempting a medically supervised weight loss program before seeking coverage for Orlistat.
  •  

  • The required documentation supporting the effectiveness of Orlistat for the requested medical condition is incomplete or not provided.
  •  

  • The prescription dosage exceeds the plan’s approved limitations or guidelines for Orlistat use.
  •  

  • There is a lack of compliance with the step therapy requirements, including trying and failing other weight management medications on formulary first.
  •  

  • The request is for off-label use of Orlistat that hasn't been approved or supported by sufficient clinical evidence.

 

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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 Security Health Plan

 

Check Eligibility Requirements

 

  • Visit the Security Health Plan website or contact their customer service to review specific criteria for medication coverage.
  •  

  • Determine if a prior authorization is needed for Orlistat (Xenical, Alli), as this can influence the coverage process.
  •  

  • Ensure that you meet any necessary prerequisites, such as having a body mass index (BMI) within the range required by the plan.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Orlistat.
  •  

  • Ask your provider to provide any medical documentation or justification required by Security Health Plan to secure coverage.
  •  

  • Ensure your healthcare provider is prepared to submit a prior authorization if needed.

 

Contact Security Health Plan

 

  • Call or visit the Security Health Plan website to inquire about the specific process for getting Orlistat covered.
  •  

  • Request a list of necessary documents and forms required to submit a prescription claim for Orlistat.
  •  

  • Clarify any part of the process you do not understand to ensure a smooth application.

 

Gather Required Documentation

 

  • Collect all required documents as outlined by Security Health Plan, including your doctor's prescription and any medical records supporting the need for Orlistat.
  •  

  • If necessary, obtain a filled-out prior authorization form from your healthcare provider.
  •  

  • Ensure any insurance claim forms are accurately completed and signed.

 

Submit Your Request

 

  • Send all collected documents and forms to Security Health Plan through the specified method, whether by mail, fax, or online portal.
  •  

  • Follow up to confirm receipt of your submission and inquire about expected processing times.

 

Review Policy & Follow Up

 

  • Regularly check the status of your coverage request by contacting Security Health Plan.
  •  

  • Review any feedback or requests for additional information from the insurance provider in a timely manner.
  •  

  • Engage with your healthcare provider to expedite any additional documentation or clarifications requested by Security Health Plan.

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.

 

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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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