Does SummaCare Cover Saxenda

Discover if SummaCare covers Saxenda, learn steps to secure coverage, understand costs without insurance, and explore Saxenda FAQs in this detailed guide.
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Coverage of Saxenda by SummaCare

 

  • SummaCare may cover Saxenda for patients with a body mass index (BMI) of 30 or higher, or a BMI of 27 with weight-related conditions such as hypertension or type 2 diabetes.
  •  

  • Eligibility often requires the patient to have attempted weight loss through diet and exercise without achieving significant results.
  •  

  • Preauthorization is typically needed, involving documentation from a healthcare provider to support medical necessity.

 

Basic Rules and Criteria

 

  • Coverage can depend on specific policy terms, so it is important for members to consult their plan documents or contact SummaCare directly.
  •  

  • Patients may need to adhere to a monitored treatment plan, potentially involving regular medical reviews.
  •  

  • Patients should ensure that their prescribing physician is within the SummaCare network to maximize coverage benefits.

 

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Dr. Neeta Ogden, MD

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

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

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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 SummaCare

 

Research SummaCare's Policy on Saxenda

 

  • Visit the official SummaCare website and navigate to the Pharmacy or Prescription Benefits section to find information on covered medications.
  •  

  • Check the formulary to see if Saxenda is listed. Formularies are usually available as downloadable PDFs.
  •  

  • Contact SummaCare's customer service to confirm coverage details, if necessary. You can find contact information on their website.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Saxenda and if it's the right medication for your treatment plan.
  •  

  • Ensure that your healthcare provider is aware of SummaCare's requirements for prior authorizations or documentation to prescribe Saxenda.

 

Obtain a Prescription

 

  • Ask your healthcare provider to write a prescription for Saxenda. Make sure the prescription includes the correct dosage and administration instructions.
  •  

  • Request any additional documentation that might be required by SummaCare for prior authorization, such as medical necessity forms or treatment plans.

 

Handle Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to SummaCare. This involves completing specific forms that justify the need for Saxenda.
  •  

  • Follow up with SummaCare to ensure the prior authorization request is being processed and provide any additional information if requested.

 

Choose a Pharmacy

 

  • Select a pharmacy that is within SummaCare's network. You can find this information on SummaCare's website or by contacting their customer service.
  •  

  • Verify with the pharmacy that they can process the prescription for Saxenda with your SummaCare plan.

 

Review Coverage and Costs

 

  • Confirm with SummaCare and your pharmacy regarding any copayments, coinsurance, or out-of-pocket expenses for Saxenda.
  •  

  • Review your SummaCare policy documents to understand the amount covered under your plan and any limitations.

 

Fill Your Prescription

 

  • Submit your prescription to the chosen pharmacy and remind them of any prior approvals provided by SummaCare.
  •  

  • Ensure you get the correct supply as prescribed. Coordinate with the pharmacy for any refills as needed.

 

Follow Up Regularly

 

  • Stay in touch with your healthcare provider regarding the effectiveness of Saxenda, adjusting the treatment plan as necessary.
  •  

  • Keep track of any changes in your SummaCare policy that might affect your coverage.

 

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FAQs

Does SummaCare Cover Saxenda

Discover if SummaCare covers Saxenda, learn steps to secure coverage, understand costs without insurance, and explore Saxenda FAQs in this detailed guide.
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Is Saxenda Covered by SummaCare

 

Coverage of Saxenda by SummaCare

 

  • SummaCare may cover Saxenda for patients with a body mass index (BMI) of 30 or higher, or a BMI of 27 with weight-related conditions such as hypertension or type 2 diabetes.
  •  

  • Eligibility often requires the patient to have attempted weight loss through diet and exercise without achieving significant results.
  •  

  • Preauthorization is typically needed, involving documentation from a healthcare provider to support medical necessity.

 

Basic Rules and Criteria

 

  • Coverage can depend on specific policy terms, so it is important for members to consult their plan documents or contact SummaCare directly.
  •  

  • Patients may need to adhere to a monitored treatment plan, potentially involving regular medical reviews.
  •  

  • Patients should ensure that their prescribing physician is within the SummaCare network to maximize coverage benefits.

 

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SummaCare's Approved Criteria for Saxenda Coverage

 

SummaCare's Approved Criteria for Saxenda Coverage

 

  • Saxenda is covered for individuals diagnosed with a Body Mass Index (BMI) of 30 kg/m² or higher (obesity).
  •  

  • Individuals with a BMI of 27 kg/m² or higher (overweight), with at least one weight-related comorbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia, are eligible for coverage.
  •  

  • Authorization of coverage requires documentation of previous failure, intolerance, or contraindication to at least one weight management program or medication.
  •  

  • Continued coverage requires evidence of a state-approved weight loss program or ongoing dietary consultation.
  •  

  • Initial approval is typically granted for a period of 3 months, during which the patient must demonstrate adherence to prescribed dosage and weight management strategies.
  •  

  • Reevaluation for continued coverage involves a reassessment of weight loss progress, typically showing a minimum of 4% weight reduction from baseline.
  •  

  • Saxenda coverage applies when used as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management.
  •  

  • Documentation of comprehensive metabolic panel results within a time frame specified by the provider may be required to monitor safety and effectiveness.

Why SummaCare Might Deny Saxenda Coverage

 

Situations Where SummaCare Might Deny Saxenda Coverage

 

  • If a patient does not meet the clinical criteria necessary for Saxenda therapy, such as specific BMI thresholds or health conditions, SummaCare may deny coverage.
  •  

  • Requests for Saxenda that are not accompanied by sufficient medical documentation or justification of medical necessity might be denied.
  •  

  • If Saxenda is being requested for an off-label use that is not approved by SummaCare's coverage policy, it may not be covered.
  •  

  • Coverage might be denied if the prescribed dosage and frequency of Saxenda exceed what is allowed under SummaCare's plan guidelines.
  •  

  • SummaCare may refuse coverage if a patient has not attempted or demonstrated inadequate response to alternative weight management therapies before requesting Saxenda.
  •  

  • If a patient's health plan excludes weight-management medications as a category, Saxenda will not be covered under that plan.

 

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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 SummaCare

 

Research SummaCare's Policy on Saxenda

 

  • Visit the official SummaCare website and navigate to the Pharmacy or Prescription Benefits section to find information on covered medications.
  •  

  • Check the formulary to see if Saxenda is listed. Formularies are usually available as downloadable PDFs.
  •  

  • Contact SummaCare's customer service to confirm coverage details, if necessary. You can find contact information on their website.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Saxenda and if it's the right medication for your treatment plan.
  •  

  • Ensure that your healthcare provider is aware of SummaCare's requirements for prior authorizations or documentation to prescribe Saxenda.

 

Obtain a Prescription

 

  • Ask your healthcare provider to write a prescription for Saxenda. Make sure the prescription includes the correct dosage and administration instructions.
  •  

  • Request any additional documentation that might be required by SummaCare for prior authorization, such as medical necessity forms or treatment plans.

 

Handle Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to SummaCare. This involves completing specific forms that justify the need for Saxenda.
  •  

  • Follow up with SummaCare to ensure the prior authorization request is being processed and provide any additional information if requested.

 

Choose a Pharmacy

 

  • Select a pharmacy that is within SummaCare's network. You can find this information on SummaCare's website or by contacting their customer service.
  •  

  • Verify with the pharmacy that they can process the prescription for Saxenda with your SummaCare plan.

 

Review Coverage and Costs

 

  • Confirm with SummaCare and your pharmacy regarding any copayments, coinsurance, or out-of-pocket expenses for Saxenda.
  •  

  • Review your SummaCare policy documents to understand the amount covered under your plan and any limitations.

 

Fill Your Prescription

 

  • Submit your prescription to the chosen pharmacy and remind them of any prior approvals provided by SummaCare.
  •  

  • Ensure you get the correct supply as prescribed. Coordinate with the pharmacy for any refills as needed.

 

Follow Up Regularly

 

  • Stay in touch with your healthcare provider regarding the effectiveness of Saxenda, adjusting the treatment plan as necessary.
  •  

  • Keep track of any changes in your SummaCare policy that might affect your coverage.

 

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

Additional Treatments

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

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Do your plans include prescriptions and medications?

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

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

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

What medications do your providers prescribe?

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

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

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

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

Will I be prescribed semaglutide if I sign up?

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

What is compounded medication?

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

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

Is compounded medication the same as generic medication?

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

Is insurance required?

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

Can I pay with an FSA or HSA card?

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

How much does treatment cost?

Semaglutide Injections:

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

Tirzepatide Injections:

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

Semaglutide Tablets:

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

Tirzepatide Tablets:

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

Can you prescribe Ozempic®* or Wegovy®*?

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

Are video visits with a provider required?

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

What states do you serve?

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

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