Does SelectHealth Cover Liraglutide (Saxenda)

Explore coverage of Liraglutide (Saxenda) by SelectHealth, with insights on potential denials, coverage tips, costs without insurance, and FAQs.
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Does SelectHealth Cover Liraglutide (Saxenda)

 

  • SelectHealth may cover Liraglutide (Saxenda) for patients meeting specific criteria, primarily tied to medical necessity and existing health conditions.
  •  

  • Coverage is often linked to BMI requirements: typically, a BMI over 30, or a BMI over 27 with weight-related comorbidities such as diabetes or hypertension.
  •  

  • Prior authorization is usually necessary, requiring documentation from your healthcare provider to justify the need for Liraglutide.
  •  

  • Patients may be required to demonstrate previous attempts at weight management or lifestyle interventions before qualifying for coverage.
  •  

  • Coverage details can vary based on the specific SelectHealth plan, so reviewing your individual plan benefits and contacting SelectHealth directly is advised.

 

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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.

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 Liraglutide (Saxenda) Coverage with SelectHealth

 

Verify Your Eligibility

 

  • Check your specific SelectHealth plan details to see if Liraglutide (Saxenda) is covered. You can find this information in the policy documents or by contacting Customer Service.
  •  

  • Understand your plan's requirements for prescription coverage, including any necessary prerequisites or criteria related to weight loss medications.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Liraglutide (Saxenda) for weight management.
  •  

  • Ensure your provider is aware of your SelectHealth insurance plan, as they may need to submit prior authorization or provide documentation to support the necessity of this medication for your treatment plan.

 

Obtain Prior Authorization

 

  • Have your healthcare provider submit a prior authorization request to SelectHealth, if necessary.
  •  

  • The documentation should include clinical evidence supporting the need for Liraglutide (Saxenda) as well as any previous weight loss attempts and relevant medical history.

 

Work with a SelectHealth Representative

 

  • Contact a SelectHealth representative for guidance on their process and ensure all required paperwork is correctly submitted.
  •  

  • Inquire about turnaround times on prior authorization requests and address any discrepancies or questions regarding the paperwork promptly.

 

Review Coverage Details

 

  • Once prior authorization is approved, review the coverage details including copayments, specific pharmacies for medication fulfillment, and any applicable limits.
  •  

  • Clarify any conditions of coverage, such as step therapy requirements or provider recommendations.

 

Fill Your Prescription

 

  • Fill the prescription at a pharmacy that is within SelectHealth's network to ensure the medication is covered correctly.
  •  

  • Present your SelectHealth insurance card at the pharmacy to receive your plan’s benefits and be aware of any out-of-pocket costs.

 

Follow Up Regularly

 

  • Maintain regular follow-up appointments with your healthcare provider to monitor the effectiveness of the medication and address any side effects or concerns.
  •  

  • Report any issues with coverage or prescription refills to SelectHealth or your healthcare provider promptly.

 

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FAQs

Does SelectHealth Cover Liraglutide (Saxenda)

Explore coverage of Liraglutide (Saxenda) by SelectHealth, with insights on potential denials, coverage tips, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Liraglutide (Saxenda) Covered by SelectHealth

 

Does SelectHealth Cover Liraglutide (Saxenda)

 

  • SelectHealth may cover Liraglutide (Saxenda) for patients meeting specific criteria, primarily tied to medical necessity and existing health conditions.
  •  

  • Coverage is often linked to BMI requirements: typically, a BMI over 30, or a BMI over 27 with weight-related comorbidities such as diabetes or hypertension.
  •  

  • Prior authorization is usually necessary, requiring documentation from your healthcare provider to justify the need for Liraglutide.
  •  

  • Patients may be required to demonstrate previous attempts at weight management or lifestyle interventions before qualifying for coverage.
  •  

  • Coverage details can vary based on the specific SelectHealth plan, so reviewing your individual plan benefits and contacting SelectHealth directly is advised.

 

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SelectHealth's Approved Criteria for Liraglutide (Saxenda) Coverage

 

SelectHealth's Approved Criteria for Liraglutide (Saxenda) Coverage

 

  • **Patient Age Criteria:** SelectHealth covers the use of Liraglutide (Saxenda) for patients 18 years or older. Coverage is primarily for adult individuals needing assistance with weight management.
  •  

  • **BMI Requirements:** To be eligible, patients must have a body mass index (BMI) of 30 kg/m² or greater, which classifies them as obese. Alternatively, individuals with a BMI of 27 kg/m² or above who have at least one weight-related comorbidity, such as hypertension, type 2 diabetes mellitus, or dyslipidemia, may qualify.
  •  

  • **Weight Loss Program Participation:** Patients should be actively participating in a SelectHealth-approved weight management program. This participation should include consistent lifestyle modifications such as diet and exercise, monitored and guided by healthcare professionals.
  •  

  • **Previous Weight Loss Efforts:** Documentation of previous weight loss attempts, including at least a 6-month history of weight management efforts, is required. This can include supervised diet plans, exercise programs, or other attempts to lose weight without pharmaceutical aids.
  •  

  • **Medical Evaluation and Documentation:** Patients must undergo a thorough medical evaluation to establish the presence of obesity-related health issues. The evaluation should include a detailed medical history, physical examination, and any necessary diagnostic tests to rule out other underlying causes of excess weight.
  •  

  • **Prescription and Monitoring by Healthcare Provider:** A healthcare provider must prescribe Saxenda, and continuous monitoring is needed. Progress should be regularly reviewed, ensuring treatment effectiveness and safety.
  •  

  • **Initial Trial Period Compliance:** Approval may include a requirement for an initial trial period during which the patient demonstrates compliance and effectiveness. Continuation of coverage can depend on achieving specific weight loss targets as outlined in the treatment plan.

 

Why SelectHealth Might Deny Liraglutide (Saxenda) Coverage

 

Reasons for Denial of Liraglutide (Saxenda) by SelectHealth

 

  • Liraglutide (Saxenda) may not be covered if the patient has not met certain BMI criteria established by SelectHealth for the medication's use.
  •  

  • If the patient has not documented a history of failed weight loss attempts through standard diet and exercise, SelectHealth might deny coverage.
  •  

  • Coverage may be denied if Saxenda is prescribed for a purpose other than weight management, as defined by SelectHealth's guidelines.
  •  

  • SelectHealth might not cover Saxenda if there is no evidence of significant risk factors associated with obesity, such as hypertension or type 2 diabetes.
  •  

  • If the prescription does not adhere to the specific dosages outlined in SelectHealth's coverage policy, it could result in denial.
  •  

  • Patients who have not completed a comprehensive weight management program prior to prescription may experience denial of coverage.
  •  

  • Coverage could be denied if the patient is concurrently using another weight management medication without approval from SelectHealth.
  •  

  • If the prescriber or pharmacy involved is out-of-network, SelectHealth might not cover the medication.
  •  

 

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

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 Liraglutide (Saxenda) Coverage with SelectHealth

 

Verify Your Eligibility

 

  • Check your specific SelectHealth plan details to see if Liraglutide (Saxenda) is covered. You can find this information in the policy documents or by contacting Customer Service.
  •  

  • Understand your plan's requirements for prescription coverage, including any necessary prerequisites or criteria related to weight loss medications.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Liraglutide (Saxenda) for weight management.
  •  

  • Ensure your provider is aware of your SelectHealth insurance plan, as they may need to submit prior authorization or provide documentation to support the necessity of this medication for your treatment plan.

 

Obtain Prior Authorization

 

  • Have your healthcare provider submit a prior authorization request to SelectHealth, if necessary.
  •  

  • The documentation should include clinical evidence supporting the need for Liraglutide (Saxenda) as well as any previous weight loss attempts and relevant medical history.

 

Work with a SelectHealth Representative

 

  • Contact a SelectHealth representative for guidance on their process and ensure all required paperwork is correctly submitted.
  •  

  • Inquire about turnaround times on prior authorization requests and address any discrepancies or questions regarding the paperwork promptly.

 

Review Coverage Details

 

  • Once prior authorization is approved, review the coverage details including copayments, specific pharmacies for medication fulfillment, and any applicable limits.
  •  

  • Clarify any conditions of coverage, such as step therapy requirements or provider recommendations.

 

Fill Your Prescription

 

  • Fill the prescription at a pharmacy that is within SelectHealth's network to ensure the medication is covered correctly.
  •  

  • Present your SelectHealth insurance card at the pharmacy to receive your plan’s benefits and be aware of any out-of-pocket costs.

 

Follow Up Regularly

 

  • Maintain regular follow-up appointments with your healthcare provider to monitor the effectiveness of the medication and address any side effects or concerns.
  •  

  • Report any issues with coverage or prescription refills to SelectHealth or your healthcare provider promptly.

 

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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.

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Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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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