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Does Sharp Health Plan Cover Contrave

Explore Contrave coverage by Sharp Health Plan, reasons for denial, tips to secure coverage, and cost without insurance in our detailed guide.
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Coverage for Contrave with Sharp Health Plan

 

  • Sharp Health Plan may cover Contrave for weight management when deemed medically necessary. Specific coverage details depend on your plan type and benefits.

    •  

  • To determine eligibility, a prescription from your healthcare provider is required, and the necessity of Contrave must meet Sharp Health Plan's medical guidelines.

    •  

  • Prior authorization might be necessary, where your provider submits a request justifying the medical need for Contrave, including current weight management efforts and any related conditions.

    •  

  • Considerations often include the policyholder's Body Mass Index (BMI) and any comorbid conditions.

    •  

  • Some plans may have specific pharmacy networks or preferred locations where you can fill the Contrave prescription at a reduced cost.

 

Next Steps

 

  • Contact Sharp Health Plan directly or check your specific plan details in your member portal to confirm if Contrave is covered and understand any out-of-pocket costs or requirements you may need to fulfill.

    •  

  • Speak with your healthcare provider about your weight management goals and whether Contrave is a suitable option for you.

 

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Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Contrave Coverage with Sharp Health Plan

 

Understand Sharp Health Plan Coverage

 

  • Review the specific benefits provided by Sharp Health Plan to understand their prescription drug coverage policies, particularly regarding weight management medications like Contrave.

    •  

  • Consult the Sharp Health Plan's formulary list to verify if Contrave is listed as a covered prescription drug.

 

Consult with Your Healthcare Provider

 

  • Discuss with your primary care physician or healthcare provider about the necessity of Contrave for your condition and any alternative treatments that might be covered.

    •  

  • Request your healthcare provider to document the medical necessity for Contrave, which can be essential for insurance approval.

 

Connect with Sharp Health Plan Member Services

 

  • Contact Sharp Health Plan member services for detailed information on the coverage criteria for Contrave. Request clarification on any potential out-of-pocket costs or requirements for prior authorization.

    •  

  • Ensure you understand the process and any documentation needed from your healthcare provider to facilitate coverage.

 

Complete Prior Authorization if Necessary

 

  • Inquire if Sharp Health Plan requires prior authorization for Contrave. If so, collaborate with your healthcare provider to submit the necessary forms and medical records.

    •  

  • Track the status of your prior authorization request, and be prepared to provide additional information if requested by Sharp Health Plan.

 

Review Alternative Options

 

  • Ask Sharp Health Plan about any preferred alternatives to Contrave that may be covered if Contrave itself is not a covered option.

    •  

  • Consider discussing these alternatives with your healthcare provider to determine their suitability for your treatment plan.

 

Appeal Denied Coverage

 

  • If your request for Contrave coverage is denied, review the denial notice for specific reasons and guidance on how to file an appeal.

    •  

  • With your healthcare provider's assistance, prepare and submit an appeal to Sharp Health Plan, including any supporting medical documentation and a detailed explanation of the need for Contrave.

 

Stay Informed and Persistent

 

  • Keep in regular contact with Sharp Health Plan representatives to ensure all necessary steps are completed promptly.

    •  

  • Maintain records of all communications and submissions related to your request for Contrave coverage to aid in any follow-up actions.

 

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Sharp Health Plan Cover Contrave

Explore Contrave coverage by Sharp Health Plan, reasons for denial, tips to secure coverage, and cost without insurance in our detailed guide.
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Is Contrave Covered by Sharp Health Plan

 

Coverage for Contrave with Sharp Health Plan

 

  • Sharp Health Plan may cover Contrave for weight management when deemed medically necessary. Specific coverage details depend on your plan type and benefits.

    •  

  • To determine eligibility, a prescription from your healthcare provider is required, and the necessity of Contrave must meet Sharp Health Plan's medical guidelines.

    •  

  • Prior authorization might be necessary, where your provider submits a request justifying the medical need for Contrave, including current weight management efforts and any related conditions.

    •  

  • Considerations often include the policyholder's Body Mass Index (BMI) and any comorbid conditions.

    •  

  • Some plans may have specific pharmacy networks or preferred locations where you can fill the Contrave prescription at a reduced cost.

 

Next Steps

 

  • Contact Sharp Health Plan directly or check your specific plan details in your member portal to confirm if Contrave is covered and understand any out-of-pocket costs or requirements you may need to fulfill.

    •  

  • Speak with your healthcare provider about your weight management goals and whether Contrave is a suitable option for you.

 

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Sharp Health Plan's Approved Criteria for Contrave Coverage

 

Eligibility Criteria for Contrave Coverage

 

  • Members must be aged 18 years or older with a body mass index (BMI) of 30 kg/m2 or greater.

    •  

  • Alternatively, coverage is available for members with a BMI of 27 kg/m2 or greater who have at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.

    •  

  • The patient must have demonstrated unsuccessful weight management through diet and exercise alone.

    •  

  • An individual assessment and approval by a healthcare provider, outlining the necessity of Contrave for weight management, are required.

 

Prescribing Requirements

 

  • Contrave must be prescribed by or in consultation with a healthcare provider experienced in weight management treatments.

    •  

  • The healthcare provider must provide documentation indicating that the member will participate in a formal weight loss program alongside Contrave treatment.

    •  

  • Frequent follow-ups with the healthcare provider to monitor progress and any potential side effects are necessary during the treatment period.

 

Weight Loss Requirements

 

  • Members must achieve at least a 5% weight loss from baseline at 12 weeks of using Contrave to continue coverage.

    •  

  • Continued use beyond this period will require evidence that the member is maintaining or further reducing their weight under the medication's use.

 

Renewal Criteria

 

  • Prior authorization for the continued use of Contrave is contingent upon demonstrated ongoing weight loss achievements and positive health outcomes related to comorbid conditions.

    •  

  • The renewal request must include updated health and weight metrics reviewed by the healthcare provider.

 

Why Sharp Health Plan Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage by Sharp Health Plan

 

  • Prescription does not comply with Sharp Health Plan's required pre-approval process or lacks prior authorization.

    •  

  • Contrave is prescribed for a condition or situation classified as experimental or investigational according to Sharp Health Plan's policy guidelines.

    •  

  • The patient does not meet the specific health criteria defined by Sharp Health Plan, such as BMI requirements or documented weight-related health issues.

    •  

  • Coverage is denied due to the medication being intended for off-label use not supported by Sharp Health Plan's formulary guidelines.

    •  

  • The patient has exceeded the quantity limits set by Sharp Health Plan for Contrave without the necessary authorization for an exception.

    •  

  • Alternative treatments are available and covered under Sharp Health Plan's policy but have not been sufficiently tried or documented as ineffective.

    •  

  • Current membership or plan coverage does not include prescription drug benefits that cover medications like Contrave.

    •  

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How Much Does Contrave Cost without Insurance?

 

Cost of Contrave Without Insurance

 

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

 

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Contrave Coverage with Sharp Health Plan

 

Understand Sharp Health Plan Coverage

 

  • Review the specific benefits provided by Sharp Health Plan to understand their prescription drug coverage policies, particularly regarding weight management medications like Contrave.

    •  

  • Consult the Sharp Health Plan's formulary list to verify if Contrave is listed as a covered prescription drug.

 

Consult with Your Healthcare Provider

 

  • Discuss with your primary care physician or healthcare provider about the necessity of Contrave for your condition and any alternative treatments that might be covered.

    •  

  • Request your healthcare provider to document the medical necessity for Contrave, which can be essential for insurance approval.

 

Connect with Sharp Health Plan Member Services

 

  • Contact Sharp Health Plan member services for detailed information on the coverage criteria for Contrave. Request clarification on any potential out-of-pocket costs or requirements for prior authorization.

    •  

  • Ensure you understand the process and any documentation needed from your healthcare provider to facilitate coverage.

 

Complete Prior Authorization if Necessary

 

  • Inquire if Sharp Health Plan requires prior authorization for Contrave. If so, collaborate with your healthcare provider to submit the necessary forms and medical records.

    •  

  • Track the status of your prior authorization request, and be prepared to provide additional information if requested by Sharp Health Plan.

 

Review Alternative Options

 

  • Ask Sharp Health Plan about any preferred alternatives to Contrave that may be covered if Contrave itself is not a covered option.

    •  

  • Consider discussing these alternatives with your healthcare provider to determine their suitability for your treatment plan.

 

Appeal Denied Coverage

 

  • If your request for Contrave coverage is denied, review the denial notice for specific reasons and guidance on how to file an appeal.

    •  

  • With your healthcare provider's assistance, prepare and submit an appeal to Sharp Health Plan, including any supporting medical documentation and a detailed explanation of the need for Contrave.

 

Stay Informed and Persistent

 

  • Keep in regular contact with Sharp Health Plan representatives to ensure all necessary steps are completed promptly.

    •  

  • Maintain records of all communications and submissions related to your request for Contrave coverage to aid in any follow-up actions.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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

Contrave FAQ

What are the side effects of Contrave?

 

Common Side Effects

 

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

 

Less Common Side Effects

 

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

 

Serious Side Effects

 

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

 

How much weight can you lose with Contrave?

 

Potential Weight Loss with Contrave

 

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

    •  

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

 

Factors Affecting Weight Loss

 

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

    •  

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

    •  

  • Medical conditions and medications might influence effectiveness.

 

Consult a Professional

 

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

 

Can you drink alcohol while taking Contrave?

 

Alcohol and Contrave Interaction

 

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

    •  

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

 

Recommendations

 

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

    •  

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

    •  

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

 

Have questions left?

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A weight management program tailored to you

Initial Dosage

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

Titration

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

Additional Treatments

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

Got questions? We have answers.

Do your plans include prescriptions and medications?

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

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

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

What medications do your providers prescribe?

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

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

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

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

Will I be prescribed semaglutide if I sign up?

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

What is compounded medication?

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

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

Is compounded medication the same as generic medication?

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

Is insurance required?

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

Can I pay with an FSA or HSA card?

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

How much does treatment cost?

Semaglutide Injections:

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

Tirzepatide Injections:

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

Semaglutide Tablets:

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

Tirzepatide Tablets:

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

‍

Can you prescribe Ozempic®* or Wegovy®*?

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

Are video visits with a provider required?

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

What states do you serve?

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

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

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

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

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