Does SummaCare Cover Benzphetamine (Didrex)

Explore SummaCare's benzphetamine coverage. Learn why claims may be denied, steps to gain approval, costs without insurance, and find answers to FAQs.
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SummaCare Coverage for Benzphetamine (Didrex)

 

  • SummaCare may provide coverage for Benzphetamine (Didrex) based on medical necessity guidelines. It is primarily prescribed for weight loss in patients with obesity-related conditions.
  •  

  • Eligibility for coverage often requires prior authorization. This means a healthcare provider must demonstrate that the patient meets specific criteria, such as a Body Mass Index (BMI) that classifies them as obese.
  •  

  • Documentation from a healthcare professional indicating previous unsuccessful weight loss attempts through diet and exercise alone may be necessary to justify the need for Benzphetamine.
  •  

  • It is essential to verify with SummaCare whether the specific pharmacy benefit plan includes Benzphetamine, as formularies and covered medications can vary.
  •  

  • Patients should contact SummaCare customer service or review their plan documents for detailed information on coverage criteria, copayments, and any potential step therapy requirements.

 

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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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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 Benzphetamine (Didrex) Coverage with SummaCare

 

Check Your Plan Details

 

  • Log in to your SummaCare member portal to review your current plan details. This will help determine if Benzphetamine (Didrex) is covered under your existing prescription drug plan.
  •  

  • Look for the formulary or drug list; it lists medications covered by the plan. Check if Benzphetamine is included and note any special instructions or requirements.

 

Contact Customer Service

 

  • If the drug isn’t listed in your plan's formulary, contact SummaCare customer service for clarification. Ask if there are any restrictions, pre-authorization requirements, or coverage alternatives.
  •  

  • Request information on the appeals process if initial coverage is denied.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Benzphetamine and any alternate treatments. Providing clinical justification can strengthen your coverage request.
  •  

  • If SummaCare requires pre-authorization, your healthcare provider may need to submit necessary medical records or documentation to support coverage.

 

Submit a Pre-Authorization Request

 

  • Work with your healthcare provider to submit a pre-authorization request to SummaCare. Ensure all necessary documentation and justification are included.
  •  

  • Keep copies of all submitted forms and correspondence for your records.

 

File an Appeal if Necessary

 

  • If coverage is initially denied, you have the option to file an appeal. Follow the instructions provided by SummaCare for submitting an appeal.
  •  

  • Include any additional information, such as letters from your healthcare provider, to support your need for Benzphetamine.

 

Review Plan Changes Annually

 

  • SummaCare may update its drug formulary annually. Regularly review any changes to your plan that could affect Benzphetamine coverage.
  •  

  • During the open enrollment period, consider changing your plan if it no longer meets your prescription needs.

 

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FAQs

Does SummaCare Cover Benzphetamine (Didrex)

Explore SummaCare's benzphetamine coverage. Learn why claims may be denied, steps to gain approval, costs without insurance, and find answers to FAQs.
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Is Benzphetamine (Didrex) Covered by SummaCare

 

SummaCare Coverage for Benzphetamine (Didrex)

 

  • SummaCare may provide coverage for Benzphetamine (Didrex) based on medical necessity guidelines. It is primarily prescribed for weight loss in patients with obesity-related conditions.
  •  

  • Eligibility for coverage often requires prior authorization. This means a healthcare provider must demonstrate that the patient meets specific criteria, such as a Body Mass Index (BMI) that classifies them as obese.
  •  

  • Documentation from a healthcare professional indicating previous unsuccessful weight loss attempts through diet and exercise alone may be necessary to justify the need for Benzphetamine.
  •  

  • It is essential to verify with SummaCare whether the specific pharmacy benefit plan includes Benzphetamine, as formularies and covered medications can vary.
  •  

  • Patients should contact SummaCare customer service or review their plan documents for detailed information on coverage criteria, copayments, and any potential step therapy requirements.

 

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SummaCare's Approved Criteria for Benzphetamine (Didrex) Coverage

 

SummaCare's Approved Criteria for Benzphetamine (Didrex) Coverage

 

  • Benzphetamine (Didrex) is covered for patients diagnosed with exogenous obesity, as indicated by a Body Mass Index (BMI) of at least 30 kg/m² or a BMI of 27 kg/m² with significant comorbidities, such as type 2 diabetes or hypertension.
  •  

  • The patient must be under the supervision of a healthcare provider with appropriate expertise in managing obesity-related conditions.
  •  

  • There must be documented evidence that the patient has engaged in a structured weight loss program, including a reduced-calorie diet and increased physical activity, for at least three months with insufficient weight loss.
  •  

  • Benzphetamine is intended for use as a short-term adjunct (a few weeks) in a regimen of weight reduction based on caloric restriction.
  •  

  • The healthcare provider must confirm that potential contraindications, such as hyperthyroidism, glaucoma, severe hypertension, or advanced arteriosclerosis, have been evaluated and ruled out.
  •  

  • Approval of coverage requires a review of the patient’s concurrent use of medications; benzphetamine should not be used concurrently with other CNS stimulants or monoamine oxidase inhibitors (MAOIs).
  •  

  • Continued coverage is dependent upon individual progress evaluations by the prescribing healthcare provider to reassess the patient’s overall health status and effectiveness of therapy, ensuring the positive outcome of weight reduction strategy.

 

Why SummaCare Might Deny Benzphetamine (Didrex) Coverage

 

Reasons for Denial of Coverage for Benzphetamine (Didrex) by SummaCare

 

  • Prescription for weight loss not medically necessary: Denied if the weight loss medication is not deemed medically necessary under the health plan's criteria.
  •  

  • Lack of documented obesity-related health conditions: Coverage may not be provided if there is no documentation of obesity-related health problems that warrant pharmaceutical intervention.
  •  

  • Failure to provide prior authorization: SummaCare may require prior authorization for Benzphetamine, and a failure to obtain it can result in denial of coverage.
  •  

  • Non-compliance with step therapy protocols: If the patient has not tried and failed or has been unable to tolerate lower-cost weight loss medications, coverage for Benzphetamine may be denied.
  •  

  • Exceeding prescription limits: Requests for coverage that exceed the FDA-approved dosage or duration limits of Benzphetamine can result in denial.
  •  

  • Age restrictions not met: Benzphetamine might not be covered for patients under a certain age if SummaCare has implemented age-related restrictions for this medication.
  •  

  • Off-label use: Coverage might be denied for uses of Benzphetamine that have not been approved by the FDA unless otherwise accepted by SummaCare policy.

 

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How Much Does Benzphetamine (Didrex) Cost without Insurance?

 

Understanding Benzphetamine (Didrex) Cost

 

  • Benzphetamine, commonly known by the brand name Didrex, is a prescription medication used as a short-term adjunct in weight reduction therapy.
  •  

  • The cost of Benzphetamine without insurance can vary significantly depending on the pharmacy and the dosage prescribed.
  •  

  • On average, the cost for a 30-day supply of Benzphetamine (50 mg tablets) can range from $40 to $70.
  •  

  • Prices may be higher or lower, depending on location, pharmacy pricing policies, and available discounts or coupons.
  •  

  • Pharmacy discount programs and generic versions of the drug may offer 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 Benzphetamine (Didrex) Coverage with SummaCare

 

Check Your Plan Details

 

  • Log in to your SummaCare member portal to review your current plan details. This will help determine if Benzphetamine (Didrex) is covered under your existing prescription drug plan.
  •  

  • Look for the formulary or drug list; it lists medications covered by the plan. Check if Benzphetamine is included and note any special instructions or requirements.

 

Contact Customer Service

 

  • If the drug isn’t listed in your plan's formulary, contact SummaCare customer service for clarification. Ask if there are any restrictions, pre-authorization requirements, or coverage alternatives.
  •  

  • Request information on the appeals process if initial coverage is denied.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Benzphetamine and any alternate treatments. Providing clinical justification can strengthen your coverage request.
  •  

  • If SummaCare requires pre-authorization, your healthcare provider may need to submit necessary medical records or documentation to support coverage.

 

Submit a Pre-Authorization Request

 

  • Work with your healthcare provider to submit a pre-authorization request to SummaCare. Ensure all necessary documentation and justification are included.
  •  

  • Keep copies of all submitted forms and correspondence for your records.

 

File an Appeal if Necessary

 

  • If coverage is initially denied, you have the option to file an appeal. Follow the instructions provided by SummaCare for submitting an appeal.
  •  

  • Include any additional information, such as letters from your healthcare provider, to support your need for Benzphetamine.

 

Review Plan Changes Annually

 

  • SummaCare may update its drug formulary annually. Regularly review any changes to your plan that could affect Benzphetamine coverage.
  •  

  • During the open enrollment period, consider changing your plan if it no longer meets your prescription needs.

 

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Benzphetamine (Didrex) FAQ

What are the side effects of Benzphetamine (Didrex)?

 

Common Side Effects

 

  • Insomnia
  • Nervousness
  • Dizziness
  • Dry Mouth
  • Headache
  • Constipation

 

Severe Side Effects

 

  • Increased Blood Pressure
  • Heart Palpitations
  • Seizures
  • Severe Mood Changes
  • Chest Pain
  • Breathing Difficulties

 

Important Considerations

 

  • If you experience severe side effects, seek medical attention immediately.
  • Use cautiously if you have a history of cardiovascular conditions.
  • Avoid usage in individuals with a history of drug abuse.
  • Always follow the prescribed dosage to minimize risks.
  • Inform your doctor of any existing health conditions or medications.

 

How does Benzphetamine help with weight loss?

 

Mechanism of Action

 

  • Benzphetamine is an appetite suppressant. It stimulates the central nervous system, which increases heart rate and blood pressure.
  •  
  • This leads to a reduced appetite and a feeling of fullness, helping individuals to control their caloric intake.

 

Usage Guidelines

 

  • It should be used as part of a comprehensive weight loss plan, including diet, exercise, and behavioral modification.
  •  
  • Typically prescribed for short-term use to jump-start weight loss efforts.

 

Precautions

 

  • Not suitable for individuals with a history of cardiovascular diseases, hyperthyroidism, or glaucoma.
  •  
  • It may cause side effects such as insomnia, dizziness, and dry mouth.

Is Benzphetamine similar to Phentermine?

 

Similarity between Benzphetamine and Phentermine

 

  • Benzphetamine (Didrex) and Phentermine are both stimulant medications primarily used to treat obesity.
  •  

  • They function as appetite suppressants by affecting the central nervous system.
  •  

  • Both are chemically related to amphetamines but are not classified as amphetamines themselves.

 

Differences

 

  • Benzphetamine is a prodrug and metabolizes into amphetamine and methamphetamine, while Phentermine does not convert into amphetamine derivatives.
  •  

  • Phentermine is generally preferred due to a more established safety profile and fewer side effects compared to Benzphetamine.
  •  

  • Phentermine is typically dosed once daily, whereas Benzphetamine might require multiple doses.

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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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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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