Does SelectHealth Cover Phendimetrazine

Explore SelectHealth coverage for Phendimetrazine. Learn denial reasons, approval tips, costs without insurance, and FAQs in this comprehensive guide.
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Does SelectHealth Cover Phendimetrazine?

 

  • Coverage: SelectHealth may cover Phendimetrazine under specific conditions related to obesity management or weight reduction, subject to medical necessity.
  •  

  • Authorization: Coverage often requires prior authorization. Your healthcare provider needs to demonstrate medical necessity, indicating that other weight loss methods have not been effective.
  •  

  • Eligibility: Patients typically need a documented Body Mass Index (BMI) that meets the criteria for obesity treatment as determined by SelectHealth policies.
  •  

  • Prescription: A valid physician’s prescription is required, specifying Phendimetrazine as part of a comprehensive weight loss plan.
  •  

  • Plan Variability: Benefits and coverage specifics can vary based on the plan type (e.g., commercial, Medicaid). It’s crucial to review the member’s plan details or contact SelectHealth for precise coverage information.

 

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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.

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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 Phendimetrazine Coverage with SelectHealth

 

Verify Coverage for Phendimetrazine

 

  • Start by reviewing your specific SelectHealth plan documents to understand what medications are covered under your prescription drug plan.
  •  

  • Access SelectHealth's official website and login to your member account to check the drug formulary list for Phendimetrazine.
  •  

  • Contact SelectHealth customer service for clarification on Phendimetrazine coverage if you cannot find relevant information in your online account or plan documents.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Phendimetrazine for your condition and ensure they are aware of any coverage requirements from SelectHealth.
  •  

  • Your doctor might need to provide medical documentation or complete a specific form to justify the prescription of Phendimetrazine.

 

Follow Prior Authorization Procedures

 

  • If required, your doctor should initiate the prior authorization process with SelectHealth. This often involves submitting a request form provided by the insurance company.
  •  

  • Ensure your healthcare provider includes all necessary patient history and medical documentation to support the use of Phendimetrazine.

 

Stay Informed About Step Therapy or Quantity Limits

 

  • Check if SelectHealth has any step therapy requirements. You may need to try other medications before Phendimetrazine is approved.
  •  

  • Verify potential quantity limits imposed by SelectHealth, which could dictate how much Phendimetrazine you can receive over a certain period.

 

Appeal if Necessary

 

  • If SelectHealth denies the coverage request, review the denial letter for specific reasons and instructions on appealing the decision.
  •  

  • Work with your healthcare provider to gather additional information or documentation that could support your appeal.

 

Stay Updated with Plan Changes

 

  • Regularly review updates from SelectHealth regarding any changes to your prescription drug coverage to ensure Phendimetrazine remains covered.
  •  

  • Contact SelectHealth during their open enrollment period to discuss any updates or changes in your medication needs.

 

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FAQs

Does SelectHealth Cover Phendimetrazine

Explore SelectHealth coverage for Phendimetrazine. Learn denial reasons, approval tips, costs without insurance, and FAQs in this comprehensive guide.
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Is Phendimetrazine Covered by SelectHealth

 

Does SelectHealth Cover Phendimetrazine?

 

  • Coverage: SelectHealth may cover Phendimetrazine under specific conditions related to obesity management or weight reduction, subject to medical necessity.
  •  

  • Authorization: Coverage often requires prior authorization. Your healthcare provider needs to demonstrate medical necessity, indicating that other weight loss methods have not been effective.
  •  

  • Eligibility: Patients typically need a documented Body Mass Index (BMI) that meets the criteria for obesity treatment as determined by SelectHealth policies.
  •  

  • Prescription: A valid physician’s prescription is required, specifying Phendimetrazine as part of a comprehensive weight loss plan.
  •  

  • Plan Variability: Benefits and coverage specifics can vary based on the plan type (e.g., commercial, Medicaid). It’s crucial to review the member’s plan details or contact SelectHealth for precise coverage information.

 

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SelectHealth's Approved Criteria for Phendimetrazine Coverage

 

SelectHealth's Approved Criteria for Phendimetrazine Coverage

 

  • Patient has a Body Mass Index (BMI) of 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • In cases where the patient does not have a weight-related comorbidity, a BMI of 30 kg/m² or greater is required.
  •  

  • Documentation must be provided showing that the patient has attempted weight loss through dietary adjustments and physical activity for six months prior to requesting coverage for Phendimetrazine.
  •  

  • Patient must be 18 years of age or older.
  •  

  • There is a requirement for regular follow-up and monitoring by the prescribing healthcare provider to assess the effectiveness of the medication and any side effects.
  •  

  • Healthcare provider must issue the prescription for Phendimetrazine, confirming its necessity after evaluating other weight-loss alternatives that have not been effective for the patient.
  •  

  • SelectHealth necessitates that coverage for Phendimetrazine be aligned with current FDA-prescribed labeling and indications.

 

Why SelectHealth Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage by SelectHealth

 

  • Phendimetrazine is not covered if it's prescribed for off-label uses that are not FDA approved.
  •  

  • SelectHealth may deny coverage if the patient does not meet the body mass index (BMI) or other health criteria specified in their policy.
  •  

  • The medication might not be covered if used as a first-line treatment without trying preferred or mandatory alternatives first.
  •  

  • Coverage denial can occur if the prescribing physician is not within the SelectHealth network or if the prescription is from an unapproved provider.
  •  

  • SelectHealth may not cover Phendimetrazine if the patient has a history of certain contraindications or conditions outlined in their policy.
  •  

  • The medication may not be covered if prior authorization is not obtained when required.
  •  

  • Phendimetrazine is not covered if the prescription exceeds the quantity limits set by SelectHealth.
  •  

  • Coverage might be denied if the patient has not followed the steps required by SelectHealth, such as enrollment in a weight management program.
  •  

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

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

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

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

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

 

Factors Affecting Price

 

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

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

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

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

 

Conclusion

 

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

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

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Phendimetrazine Coverage with SelectHealth

 

Verify Coverage for Phendimetrazine

 

  • Start by reviewing your specific SelectHealth plan documents to understand what medications are covered under your prescription drug plan.
  •  

  • Access SelectHealth's official website and login to your member account to check the drug formulary list for Phendimetrazine.
  •  

  • Contact SelectHealth customer service for clarification on Phendimetrazine coverage if you cannot find relevant information in your online account or plan documents.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Phendimetrazine for your condition and ensure they are aware of any coverage requirements from SelectHealth.
  •  

  • Your doctor might need to provide medical documentation or complete a specific form to justify the prescription of Phendimetrazine.

 

Follow Prior Authorization Procedures

 

  • If required, your doctor should initiate the prior authorization process with SelectHealth. This often involves submitting a request form provided by the insurance company.
  •  

  • Ensure your healthcare provider includes all necessary patient history and medical documentation to support the use of Phendimetrazine.

 

Stay Informed About Step Therapy or Quantity Limits

 

  • Check if SelectHealth has any step therapy requirements. You may need to try other medications before Phendimetrazine is approved.
  •  

  • Verify potential quantity limits imposed by SelectHealth, which could dictate how much Phendimetrazine you can receive over a certain period.

 

Appeal if Necessary

 

  • If SelectHealth denies the coverage request, review the denial letter for specific reasons and instructions on appealing the decision.
  •  

  • Work with your healthcare provider to gather additional information or documentation that could support your appeal.

 

Stay Updated with Plan Changes

 

  • Regularly review updates from SelectHealth regarding any changes to your prescription drug coverage to ensure Phendimetrazine remains covered.
  •  

  • Contact SelectHealth during their open enrollment period to discuss any updates or changes in your medication needs.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

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

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

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

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

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

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

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

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

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

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

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

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

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

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

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

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

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

 

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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.

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Do your plans include prescriptions and medications?

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

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

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

What medications do your providers prescribe?

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

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

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

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

Will I be prescribed semaglutide if I sign up?

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

What is compounded medication?

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

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

Is compounded medication the same as generic medication?

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

Is insurance required?

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

Can I pay with an FSA or HSA card?

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

How much does treatment cost?

Semaglutide Injections:

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

Tirzepatide Injections:

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

Semaglutide Tablets:

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

Tirzepatide Tablets:

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

Can you prescribe Ozempic®* or Wegovy®*?

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

Are video visits with a provider required?

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

What states do you serve?

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

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