Does Tufts Health Plan Cover Contrave

Explore if Tufts Health Plan covers Contrave, reasons for denial, how to secure coverage, costs without insurance, and get vital FAQs.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Contrave

 

  • Tufts Health Plan may cover Contrave for weight management if deemed medically necessary.
  •  

  • Prescription must be obtained through an in-network provider.

 

Criteria for Coverage

 

  • Patient typically needs to meet specific criteria, such as a body mass index (BMI) of 30 or higher, or 27 with a related comorbidity (e.g., hypertension, type 2 diabetes).
  •  

  • Pre-authorization might be required to ensure eligibility.

 

Additional Considerations

 

  • Coverage can vary based on the specific plan and policy terms. Members should review their benefits or contact customer service for detailed info.
  •  

  • There may be limits on the duration for which Contrave is covered; follow-up evaluations might be necessary.

 

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 Tufts Health Plan

 

Check Your Plan Details

 

  • Log in to your Tufts Health Plan online member portal to review your specific health plan benefits. Look for information on prescription drug coverage, including tiers and formulary lists.
  •  

  • Ensure that your plan includes coverage for weight management medications, as Contrave is specifically used for weight loss.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the use of Contrave for your weight management goals.
  •  

  • Ask your doctor if Contrave is appropriate for you and ensure they are aware that Tufts Health Plan is your insurer.
  •  

  • Your healthcare provider should provide the necessary documentation supporting the medical necessity of Contrave for your condition.

 

Call Tufts Health Plan Customer Service

 

  • Contact Tufts Health Plan customer service using the number found on your insurance card to confirm that Contrave is covered under your current plan.
  •  

  • Inquire about any specific requirements such as prior authorization, step therapy, or quantity limits on Contrave.

 

Submit a Prior Authorization Request

 

  • If needed, your healthcare provider may need to submit a prior authorization request on your behalf to get Contrave covered.
  •  

  • Your provider will need to complete the necessary forms and provide supporting documentation of medical necessity as required by Tufts Health Plan.

 

Wait for Approval

 

  • Once the prior authorization request is submitted, wait for a response from Tufts Health Plan regarding the approval or denial of coverage.
  •  

  • If approved, you will receive information on how to proceed with obtaining Contrave through your pharmacy.

 

Appeal a Denial, if Necessary

 

  • If your request is denied, review the denial letter carefully to understand the reasons provided by Tufts Health Plan.
  •  

  • Work with your doctor to gather additional evidence or information to support an appeal.
  •  

  • Submit an appeal to Tufts Health Plan, following the instructions provided in the denial letter.

 

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 Tufts Health Plan Cover Contrave

Explore if Tufts Health Plan covers Contrave, reasons for denial, how to secure coverage, costs without insurance, and get vital FAQs.
Curex allergy drops unboxing

Is Contrave Covered by Tufts Health Plan

 

Coverage for Contrave

 

  • Tufts Health Plan may cover Contrave for weight management if deemed medically necessary.
  •  

  • Prescription must be obtained through an in-network provider.

 

Criteria for Coverage

 

  • Patient typically needs to meet specific criteria, such as a body mass index (BMI) of 30 or higher, or 27 with a related comorbidity (e.g., hypertension, type 2 diabetes).
  •  

  • Pre-authorization might be required to ensure eligibility.

 

Additional Considerations

 

  • Coverage can vary based on the specific plan and policy terms. Members should review their benefits or contact customer service for detailed info.
  •  

  • There may be limits on the duration for which Contrave is covered; follow-up evaluations might be necessary.

 

A weight management program tailored to you

Start with Curex

Tufts Health Plan's Approved Criteria for Contrave Coverage

 

Criteria for Contrave Coverage

 

  • Patients must be 18 years of age or older.
  •  

  • The patient has a Body Mass Index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related co-morbid condition such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • There must be documentation that the patient has attempted weight loss through diet and exercise alone for at least six months without success.
  •  

  • Contrave must be prescribed by a healthcare provider who specializes in obesity treatment or has experience in weight management.
  •  

  • Continued coverage requires documented improvement in weight loss, defined as at least 5% of baseline body weight within 16 weeks of starting treatment.
  •  

  • Patients must not have any contraindications to Contrave, including uncontrolled hypertension or seizure disorders.
  •  

  • Documentation of adherence to the treatment plan and regular follow-up consultations must be maintained and provided as required.
  •  

 

Why Tufts Health Plan Might Deny Contrave Coverage

 

Circumstances When Contrave Coverage May Be Denied by Tufts Health Plan

 

  • Non-Approval of Prior Authorization: If the necessary prior authorization is not obtained or approved, coverage for Contrave may be denied.
  •  

  • Failure to Meet Medical Necessity Criteria: Coverage may be denied if the use of Contrave does not meet the medical necessity criteria established by Tufts Health Plan.
  •  

  • Non-Formulary Medication: If Contrave is not listed on Tufts Health Plan’s drug formulary, this may result in denial of coverage.
  •  

  • Lack of Documented Weight Loss Attempts: If there is insufficient documentation of previous weight loss attempts as required by the plan, coverage could be denied.
  •  

  • Exceeding Quantity Limits: If the prescribed dosage exceeds the quantity limits set by the plan, access to coverage might be denied.
  •  

  • Exclusion Based on Policy: Certain health plans might specifically exclude coverage for weight-loss medications like Contrave, leading to denial.

 

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 Tufts Health Plan

 

Check Your Plan Details

 

  • Log in to your Tufts Health Plan online member portal to review your specific health plan benefits. Look for information on prescription drug coverage, including tiers and formulary lists.
  •  

  • Ensure that your plan includes coverage for weight management medications, as Contrave is specifically used for weight loss.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the use of Contrave for your weight management goals.
  •  

  • Ask your doctor if Contrave is appropriate for you and ensure they are aware that Tufts Health Plan is your insurer.
  •  

  • Your healthcare provider should provide the necessary documentation supporting the medical necessity of Contrave for your condition.

 

Call Tufts Health Plan Customer Service

 

  • Contact Tufts Health Plan customer service using the number found on your insurance card to confirm that Contrave is covered under your current plan.
  •  

  • Inquire about any specific requirements such as prior authorization, step therapy, or quantity limits on Contrave.

 

Submit a Prior Authorization Request

 

  • If needed, your healthcare provider may need to submit a prior authorization request on your behalf to get Contrave covered.
  •  

  • Your provider will need to complete the necessary forms and provide supporting documentation of medical necessity as required by Tufts Health Plan.

 

Wait for Approval

 

  • Once the prior authorization request is submitted, wait for a response from Tufts Health Plan regarding the approval or denial of coverage.
  •  

  • If approved, you will receive information on how to proceed with obtaining Contrave through your pharmacy.

 

Appeal a Denial, if Necessary

 

  • If your request is denied, review the denial letter carefully to understand the reasons provided by Tufts Health Plan.
  •  

  • Work with your doctor to gather additional evidence or information to support an appeal.
  •  

  • Submit an appeal to Tufts Health Plan, following the instructions provided in the denial letter.

 

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