Does SummaCare Cover Contrave

Explore SummaCare's coverage for Contrave, reasons for denial, tips for securing coverage, costs without insurance, and common questions answered.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Contrave

 

  • SummaCare may cover Contrave, a weight loss medication, subject to specific plan benefits and conditions. It's crucial to check your individual plan details as coverage can vary.
  •  

 

Situations for Coverage

 

  • Contrave is generally covered when prescribed for weight management in adults with a BMI of 30 or higher, or 27 with related health issues like hypertension, diabetes, or high cholesterol.
  •  

 

Criteria for Approval

 

  • Pre-authorization is typically required, meaning your healthcare provider must provide justification for the prescription to SummaCare.
  •  

  • Documentation of previous weight loss attempts under a physician's supervision might be necessary.
  •  

  • You might be required to enroll in a weight management program as part of the coverage requirements.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 SummaCare

 

Check Your Coverage

 

  • Log into your SummaCare member portal to review your prescription benefits. This will help you determine if Contrave is included in your current plan.
  •  

  • Contact SummaCare customer service to confirm if Contrave is covered and inquire about any specific requirements or restrictions.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight management goals and the potential benefits of using Contrave.
  •  

  • Ask your provider about prescribing Contrave and ensure they note any necessary details for insurance approval.

 

Secure a Pre-Authorization

 

  • Request pre-authorization from SummaCare if required. This step is crucial as many insurance providers require this for weight management medications.
  •  

  • Your healthcare provider may need to submit documentation or a letter of medical necessity to justify the use of Contrave.

 

Explore Step Therapy Requirements

 

  • Inquire with SummaCare if there are any step therapy protocols you must follow. Step therapy typically requires trying less costly alternatives before moving to Contrave.
  •  

  • If applicable, work with your provider to document outcomes or issues with initial therapies to strengthen your case for moving to Contrave.

 

Fill the Prescription

 

  • Once approved, obtain the prescription from your healthcare provider and have it filled at a pharmacy that accepts SummaCare insurance.
  •  

  • Check with the pharmacy to ensure they process your insurance coverage correctly and apply any benefits, discounts, or copays as necessary.

 

Use Manufacturer Savings Programs

 

  • Visit the official Contrave website or contact the manufacturer for any available savings programs or coupons, which can reduce out-of-pocket costs.
  •  

  • Present any savings coupons to your pharmacy along with your insurance information when filling your prescription.

 

Review and Appeal Denials

 

  • If coverage is denied, carefully review the denial letter from SummaCare for specific reasons.
  •  

  • Work with your healthcare provider to gather additional documentation that may support an appeal for the insurance decision.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

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

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does SummaCare Cover Contrave

Explore SummaCare's coverage for Contrave, reasons for denial, tips for securing coverage, costs without insurance, and common questions answered.
Curex allergy drops unboxing

Is Contrave Covered by SummaCare

 

Coverage for Contrave

 

  • SummaCare may cover Contrave, a weight loss medication, subject to specific plan benefits and conditions. It's crucial to check your individual plan details as coverage can vary.
  •  

 

Situations for Coverage

 

  • Contrave is generally covered when prescribed for weight management in adults with a BMI of 30 or higher, or 27 with related health issues like hypertension, diabetes, or high cholesterol.
  •  

 

Criteria for Approval

 

  • Pre-authorization is typically required, meaning your healthcare provider must provide justification for the prescription to SummaCare.
  •  

  • Documentation of previous weight loss attempts under a physician's supervision might be necessary.
  •  

  • You might be required to enroll in a weight management program as part of the coverage requirements.

 

A weight management program tailored to you

Start with Curex

SummaCare's Approved Criteria for Contrave Coverage

 

SummaCare's Criteria for Contrave Coverage

 

  • Members must have a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Documented evidence of unsuccessful weight loss through diet, exercise, and lifestyle modification for at least six months prior to request for medication.
  •  

  • Medication request must be initiated and managed by a licensed healthcare provider with expertise in obesity management.
  •  

  • Completion of a comprehensive assessment by the healthcare provider to rule out contraindications and assess the potential benefits and risks of Contrave use.
  •  

  • Member must consent to engage in an ongoing weight management program while taking Contrave, including regular follow-up visits to monitor progress and address any side effects.
  •  

  • Documented review of the member's current medication profile to avoid potential drug interactions with Contrave.
  •  

  • Prior authorization is required, including submission of relevant clinical documentation supporting the need for this medication.
  •  

  • Members should meet age specifications as indicated by the FDA, with appropriate adjusting for any gender-related dosing considerations.
  •  

Why SummaCare Might Deny Contrave Coverage

 

Reasons for Denial of Contrave Coverage by SummaCare

 

  • Contrave may not be covered if it is prescribed for a medical condition that is not explicitly covered under SummaCare's current plan benefits.
  •  

  • If the prescribed use of Contrave is considered "off-label" and not within the approved uses according to the FDA, coverage might be denied.
  •  

  • Lack of sufficient medical necessity documentation by the prescribing physician can result in denial of coverage for Contrave.
  •  

  • If the patient has not met specific criteria such as a documented trial and failure of other weight management strategies, SummaCare might deny coverage.
  •  

  • Eligibility conditions such as age restrictions, body mass index (BMI) requirements, or previous health history criteria may lead to denial if they are not satisfied.
  •  

  • Prescriptions not filled by network pharmacies or those not following SummaCare's preferred drug list might be excluded from coverage.
  •  

  • Non-compliance with SummaCare’s pre-authorization process, if required for Contrave, can lead to denial of coverage.

 

Together with our partners we have changed the lives of over 300,000 patients.

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.

 

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 SummaCare

 

Check Your Coverage

 

  • Log into your SummaCare member portal to review your prescription benefits. This will help you determine if Contrave is included in your current plan.
  •  

  • Contact SummaCare customer service to confirm if Contrave is covered and inquire about any specific requirements or restrictions.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight management goals and the potential benefits of using Contrave.
  •  

  • Ask your provider about prescribing Contrave and ensure they note any necessary details for insurance approval.

 

Secure a Pre-Authorization

 

  • Request pre-authorization from SummaCare if required. This step is crucial as many insurance providers require this for weight management medications.
  •  

  • Your healthcare provider may need to submit documentation or a letter of medical necessity to justify the use of Contrave.

 

Explore Step Therapy Requirements

 

  • Inquire with SummaCare if there are any step therapy protocols you must follow. Step therapy typically requires trying less costly alternatives before moving to Contrave.
  •  

  • If applicable, work with your provider to document outcomes or issues with initial therapies to strengthen your case for moving to Contrave.

 

Fill the Prescription

 

  • Once approved, obtain the prescription from your healthcare provider and have it filled at a pharmacy that accepts SummaCare insurance.
  •  

  • Check with the pharmacy to ensure they process your insurance coverage correctly and apply any benefits, discounts, or copays as necessary.

 

Use Manufacturer Savings Programs

 

  • Visit the official Contrave website or contact the manufacturer for any available savings programs or coupons, which can reduce out-of-pocket costs.
  •  

  • Present any savings coupons to your pharmacy along with your insurance information when filling your prescription.

 

Review and Appeal Denials

 

  • If coverage is denied, carefully review the denial letter from SummaCare for specific reasons.
  •  

  • Work with your healthcare provider to gather additional documentation that may support an appeal for the insurance decision.

 

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.

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?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

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.

Made in Webflow