Does SelectHealth Cover Saxenda

Explore SelectHealth coverage for Saxenda, learn denial reasons, steps to secure coverage, costs without insurance, and FAQs in this comprehensive guide.
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Does SelectHealth Cover Saxenda?

 

  • Coverage for Saxenda by SelectHealth can depend on your specific plan. Generally, it is covered when deemed medically necessary for weight-related issues such as obesity.
  •  

  • The patient usually needs to meet certain criteria including a BMI of 30 or higher, or 27 with obesity-related conditions like type 2 diabetes or hypertension.
  •  

  • Documentation from a healthcare provider that Saxenda is part of a comprehensive weight management program may be required.
  •  

  • Preauthorization may be necessary, requiring the healthcare provider to justify the need for Saxenda as a treatment option.
  •  

  • Always check with SelectHealth directly or consult your policy documents for the most accurate information and specific plan details.

 

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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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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 Saxenda Coverage with SelectHealth

 

Understand Your Saxenda Needs

 

  • Consult with your healthcare provider to determine if Saxenda is the appropriate medication for your weight management plan.
  •  

  • Gather necessary medical documentation that supports the need for Saxenda, such as medical history and BMI details.

 

Verify Your SelectHealth Plan

 

  • Log into your SelectHealth member account on their website to review your plan details.
  •  

  • Check if your specific plan covers prescription medications for weight management and Saxenda in particular.
  •  

  • Contact SelectHealth customer service to confirm details and gain clarity about your coverage options for Saxenda.

 

Obtain a Prescription

 

  • Request a formal prescription for Saxenda from your healthcare provider.
  •  

  • Ensure that the prescription includes all necessary information, such as dosage and frequency, to facilitate the authorization process.

 

Request Pre-authorization from SelectHealth

 

  • Contact SelectHealth's customer service to understand the process for obtaining pre-authorization for Saxenda.
  •  

  • Gather the required documents for pre-authorization, including your prescription, medical documentation, and any forms provided by SelectHealth.
  •  

  • Submit all necessary documentation for pre-authorization, either through your healthcare provider or directly to SelectHealth, following their specified procedure.

 

Follow Up on Pre-authorization Status

 

  • Contact SelectHealth regularly to check on the status of your pre-authorization request.
  •  

  • Work with your healthcare provider to provide any additional information requested by SelectHealth during the review process.

 

Addressing Denials or Appeals

 

  • If your pre-authorization request is denied, review the reasons provided by SelectHealth.
  •  

  • Consult with your healthcare provider to gather additional documentation or alternate solutions that may support your case.
  •  

  • Submit an appeal to SelectHealth, following their appeals process and using any forms or formats they require.

 

Once Approved, Fill Your Prescription

 

  • If approval is granted, go to a participating pharmacy to fill your Saxenda prescription.
  •  

  • Show your SelectHealth insurance card to ensure that the medication is covered under your plan as discussed during the verification stage.
  • Discuss potential out-of-pocket expenses, co-pays, or different options with your pharmacist.

 

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FAQs

Does SelectHealth Cover Saxenda

Explore SelectHealth coverage for Saxenda, learn denial reasons, steps to secure coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Saxenda Covered by SelectHealth

 

Does SelectHealth Cover Saxenda?

 

  • Coverage for Saxenda by SelectHealth can depend on your specific plan. Generally, it is covered when deemed medically necessary for weight-related issues such as obesity.
  •  

  • The patient usually needs to meet certain criteria including a BMI of 30 or higher, or 27 with obesity-related conditions like type 2 diabetes or hypertension.
  •  

  • Documentation from a healthcare provider that Saxenda is part of a comprehensive weight management program may be required.
  •  

  • Preauthorization may be necessary, requiring the healthcare provider to justify the need for Saxenda as a treatment option.
  •  

  • Always check with SelectHealth directly or consult your policy documents for the most accurate information and specific plan details.

 

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SelectHealth's Approved Criteria for Saxenda Coverage

 

SelectHealth Approved Criteria for Saxenda Coverage

 

  • The member must have a Body Mass Index (BMI) equal to or greater than 30 kg/m², indicating they meet the clinical definition of obesity.
  •  

  • If the BMI is between 27 kg/m² and 29.9 kg/m², the member must present at least one weight-related comorbidity such as type 2 diabetes, hypertension, or dyslipidemia.
  •  

  • There must be documented evidence that the member has been unable to achieve or maintain weight loss through traditional weight-loss methods like diet and exercise, despite appropriate attempts for at least six months.
  •  

  • The member must be participating in a comprehensive, medically managed weight loss program that includes dietary modification and physical activity components.
  •  

  • Saxenda must be prescribed by a healthcare provider experienced in the treatment of obesity and related metabolic disorders.
  •  

  • The initial approval for Saxenda will cover a period of three months. Continued use beyond this period requires documentation of meaningful weight loss defined as at least a 4% reduction in baseline weight.
  •  

  • The member requires adequate monitoring by the healthcare provider to assess the efficacy and safety of the therapy, along with progress towards weight loss goals.

 

Why SelectHealth Might Deny Saxenda Coverage

 

Reasons SelectHealth Might Deny Saxenda Coverage

 

  • The patient does not meet the required BMI criteria as defined by SelectHealth’s policy for Saxenda coverage.
  •  

  • The patient does not have a documented diagnosis of weight-related conditions such as type 2 diabetes, hypertension, or dyslipidemia when such conditions are stipulated as necessary for coverage.
  •  

  • The patient has not undergone a structured weight management program prior to Saxenda prescription, if a prerequisite participation is mandated by SelectHealth.
  •  

  • There is insufficient medical documentation to demonstrate the necessity of Saxenda as part of the patient's weight management strategy.
  •  

  • The prescription for Saxenda is not part of a comprehensive treatment plan or lacks supporting evidence from other failed weight-loss medications.
  •  

  • The patient is currently using another weight-loss medication that is contraindicated for concurrent use with Saxenda under SelectHealth’s policy.
  •  

  • The patient has a history of medication misuse or non-compliance with previously prescribed treatment plans, relevant to Saxenda use.
  •  

  • Saxenda is prescribed outside of the approved indications and age range as per SelectHealth’s pharmaceutical policy.
  •  

  • The prescribing physician is not a participating provider within the SelectHealth network, if this is a stipulated requirement for drug approval.
  •  

 

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How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with SelectHealth

 

Understand Your Saxenda Needs

 

  • Consult with your healthcare provider to determine if Saxenda is the appropriate medication for your weight management plan.
  •  

  • Gather necessary medical documentation that supports the need for Saxenda, such as medical history and BMI details.

 

Verify Your SelectHealth Plan

 

  • Log into your SelectHealth member account on their website to review your plan details.
  •  

  • Check if your specific plan covers prescription medications for weight management and Saxenda in particular.
  •  

  • Contact SelectHealth customer service to confirm details and gain clarity about your coverage options for Saxenda.

 

Obtain a Prescription

 

  • Request a formal prescription for Saxenda from your healthcare provider.
  •  

  • Ensure that the prescription includes all necessary information, such as dosage and frequency, to facilitate the authorization process.

 

Request Pre-authorization from SelectHealth

 

  • Contact SelectHealth's customer service to understand the process for obtaining pre-authorization for Saxenda.
  •  

  • Gather the required documents for pre-authorization, including your prescription, medical documentation, and any forms provided by SelectHealth.
  •  

  • Submit all necessary documentation for pre-authorization, either through your healthcare provider or directly to SelectHealth, following their specified procedure.

 

Follow Up on Pre-authorization Status

 

  • Contact SelectHealth regularly to check on the status of your pre-authorization request.
  •  

  • Work with your healthcare provider to provide any additional information requested by SelectHealth during the review process.

 

Addressing Denials or Appeals

 

  • If your pre-authorization request is denied, review the reasons provided by SelectHealth.
  •  

  • Consult with your healthcare provider to gather additional documentation or alternate solutions that may support your case.
  •  

  • Submit an appeal to SelectHealth, following their appeals process and using any forms or formats they require.

 

Once Approved, Fill Your Prescription

 

  • If approval is granted, go to a participating pharmacy to fill your Saxenda prescription.
  •  

  • Show your SelectHealth insurance card to ensure that the medication is covered under your plan as discussed during the verification stage.
  • Discuss potential out-of-pocket expenses, co-pays, or different options with your pharmacist.

 

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Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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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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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.

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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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