Does Tufts Health Plan Cover Diethylpropion (Tenuate)

Explore coverage details for Diethylpropion with Tufts, costs without insurance, denial reasons, ways to secure coverage, and FAQs in this comprehensive guide.
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Coverage for Diethylpropion (Tenuate)

 

  • Tufts Health Plan may cover Diethylpropion (Tenuate) in certain situations, primarily for clinically diagnosed obesity or weight management when lifestyle changes alone have not been sufficient.
  •  

  • Eligibility often depends on medical necessity as documented by a healthcare provider, with consideration of the patient's BMI and their response to previous weight-loss interventions.

 

Basic Rules and Criteria

 

  • Physician documentation is required to justify the prescription, including evidence of a comprehensive weight-loss program and potential benefits outweighing the risks.
  •  

  • Prior authorization may be needed. Doctors must submit a request which Tufts will review to ensure the medication is appropriate for the condition.
  •  

  • Regular follow-up appointments are recommended to monitor effectiveness and side effects to ensure the prescription remains justified over time.

 

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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 Diethylpropion (Tenuate) Coverage with Tufts Health Plan

 

Understand Your Prescription Benefits

 

  • Review your Tufts Health Plan benefits to determine your coverage for prescription medications. You can find this information in your health plan documents or by logging into your member account on the Tufts Health Plan website.
  •  

  • Check if Diethylpropion (Tenuate) is listed in your plan's formulary, which is a list of covered drugs. If it's not listed, you may need to explore other options for coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Diethylpropion (Tenuate) and whether it's an appropriate medication for your condition.
  •  

  • Your healthcare provider may need to provide documentation or complete a prior authorization form to justify the medical necessity of the prescription.

 

Contact Tufts Health Plan Member Services

 

  • Call the Tufts Health Plan member services number found on your insurance card to inquire about coverage for Diethylpropion (Tenuate).
  •  

  • Ask the representative for information on any specific steps required to obtain coverage for this medication, including prior authorization or exceptions.

 

Submit a Prior Authorization Request

 

  • If a prior authorization is required, work with your healthcare provider to complete the necessary forms and submit them to Tufts Health Plan for review.
  •  

  • Ensure all required information and documentation are provided, as incomplete requests can delay processing.

 

Review Coverage Determination

 

  • Once submitted, Tufts Health Plan will review the prior authorization request and make a determination.
  •  

  • You will receive notification of the decision, which will explain whether coverage is approved or denied and any relevant details.

 

Explore Alternative Options

 

  • If coverage for Diethylpropion (Tenuate) is denied, discuss alternative medications or treatments with your healthcare provider that may be covered under your plan.
  •  

  • You may also consider filing an appeal with Tufts Health Plan if you believe there is a strong case for coverage.

 

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FAQs

Does Tufts Health Plan Cover Diethylpropion (Tenuate)

Explore coverage details for Diethylpropion with Tufts, costs without insurance, denial reasons, ways to secure coverage, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Diethylpropion (Tenuate) Covered by Tufts Health Plan

 

Coverage for Diethylpropion (Tenuate)

 

  • Tufts Health Plan may cover Diethylpropion (Tenuate) in certain situations, primarily for clinically diagnosed obesity or weight management when lifestyle changes alone have not been sufficient.
  •  

  • Eligibility often depends on medical necessity as documented by a healthcare provider, with consideration of the patient's BMI and their response to previous weight-loss interventions.

 

Basic Rules and Criteria

 

  • Physician documentation is required to justify the prescription, including evidence of a comprehensive weight-loss program and potential benefits outweighing the risks.
  •  

  • Prior authorization may be needed. Doctors must submit a request which Tufts will review to ensure the medication is appropriate for the condition.
  •  

  • Regular follow-up appointments are recommended to monitor effectiveness and side effects to ensure the prescription remains justified over time.

 

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Tufts Health Plan's Approved Criteria for Diethylpropion (Tenuate) Coverage

 

Eligibility Criteria for Diethylpropion (Tenuate) Coverage

 

  • Patient must have a documented diagnosis of obesity, characterized by a body mass index (BMI) of 30 kg/m² or higher.
  •  

  • If BMI is between 27 kg/m² and 29.9 kg/m², the patient must have at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • There must be documented evidence of previous unsuccessful weight loss attempts through lifestyle modification, including diet and exercise.
  •  

  • Patient must be 16 years of age or older to qualify for coverage.
  •  

  • Diethylpropion (Tenuate) must be prescribed by a licensed healthcare professional specializing in weight management.
  •  

  • Patient should not have a history of cardiovascular disease or uncontrolled hypertension, as determined by the prescribing physician.

 

Why Tufts Health Plan Might Deny Diethylpropion (Tenuate) Coverage

 

Reasons for Denial of Diethylpropion (Tenuate) Coverage

 

  • Diethylpropion (Tenuate) may be denied if the prescribed usage does not comply with the plan's approved indications for use, particularly if it is not prescribed for weight management in patients with a body mass index (BMI) meeting certain clinical guidelines.
  •  

  • Coverage might be denied if there is insufficient documentation of prior attempts at weight loss with standard lifestyle interventions, such as diet and exercise, as required by the plan's criteria for approving weight loss medications.
  •  

  • Requests for Diethylpropion may be denied if there is missing or inadequate information regarding the potential risks or contraindications for the patient based on their medical history, particularly with regard to heart disease or uncontrolled hypertension.
  •  

  • Tufts Health Plan may not cover Diethylpropion if it is sought for a duration of treatment that exceeds what is considered clinically appropriate or safe according to their policy guidelines.
  •  

  • Coverage for Diethylpropion could be denied if the request lacks appropriate authorization or fails to comply with any step therapy or prior authorization requirements stipulated by the Tufts Health Plan.
  •  

  • The plan may reject coverage if there is evidence of concurrent use of other medications or substances that pose a known interaction risk with Diethylpropion unless specifically overridden by clinical review.

 

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How Much Does Diethylpropion (Tenuate) Cost without Insurance?

 

Approximate Cost of Diethylpropion (Tenuate) Without Insurance

 

  • The cost of Diethylpropion (Tenuate), a prescription medication used for weight loss, can vary widely depending on the pharmacy location and any available discounts or generic alternatives.
  •  

  • On average, the price for a supply of 30, 75 mg controlled-release tablets can range from $50 to $100 without insurance.
  •  

  • For the immediate-release version, the cost for a supply of 30, 25 mg tablets is typically around $30 to $70 without insurance.
  •  

  • Prices can fluctuate due to factors such as location, manufacturer pricing, and availability of alternative generic options.
  •  

  • It's often beneficial to check with different pharmacies for any potential coupons or discounts that may further reduce the cost.

 

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 Diethylpropion (Tenuate) Coverage with Tufts Health Plan

 

Understand Your Prescription Benefits

 

  • Review your Tufts Health Plan benefits to determine your coverage for prescription medications. You can find this information in your health plan documents or by logging into your member account on the Tufts Health Plan website.
  •  

  • Check if Diethylpropion (Tenuate) is listed in your plan's formulary, which is a list of covered drugs. If it's not listed, you may need to explore other options for coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Diethylpropion (Tenuate) and whether it's an appropriate medication for your condition.
  •  

  • Your healthcare provider may need to provide documentation or complete a prior authorization form to justify the medical necessity of the prescription.

 

Contact Tufts Health Plan Member Services

 

  • Call the Tufts Health Plan member services number found on your insurance card to inquire about coverage for Diethylpropion (Tenuate).
  •  

  • Ask the representative for information on any specific steps required to obtain coverage for this medication, including prior authorization or exceptions.

 

Submit a Prior Authorization Request

 

  • If a prior authorization is required, work with your healthcare provider to complete the necessary forms and submit them to Tufts Health Plan for review.
  •  

  • Ensure all required information and documentation are provided, as incomplete requests can delay processing.

 

Review Coverage Determination

 

  • Once submitted, Tufts Health Plan will review the prior authorization request and make a determination.
  •  

  • You will receive notification of the decision, which will explain whether coverage is approved or denied and any relevant details.

 

Explore Alternative Options

 

  • If coverage for Diethylpropion (Tenuate) is denied, discuss alternative medications or treatments with your healthcare provider that may be covered under your plan.
  •  

  • You may also consider filing an appeal with Tufts Health Plan if you believe there is a strong case for coverage.

 

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Diethylpropion (Tenuate) FAQ

What are the common side effects of Diethylpropion?

 

Common Side Effects of Diethylpropion

 

  • Diethylpropion may cause dizziness and drowsiness; avoid driving or operating heavy machinery if affected.
  •  

  • Patients often report headaches and insomnia. Adjust usage to early daytime to help mitigate insomnia.
  •  

  • It can lead to digestive issues like nausea, dry mouth, and constipation; drinking ample water and maintaining a balanced diet may assist.
  •  

  • Commonly, users experience increased heart rate or palpitations; seek medical advice if severe or persistent.
  •  

  • Nervousness and restlessness are possible; managing stress and limiting caffeine can be beneficial.

 

How effective is Diethylpropion for weight loss?

 

Effectiveness of Diethylpropion for Weight Loss

 

  • Diethylpropion is an appetite suppressant, aiding in short-term obesity management.
  •  

  • Primarily effective when combined with a structured diet and exercise plan.
  •  

  • Clinical studies show a modest weight reduction on average, typically around 3-4% body weight over 12 weeks.
  •  

  • Most beneficial in the initial phase of a weight loss program, stimulating early weight loss which can motivate further progress.
  •  

  • Advantages can diminish over time as appetite levels adjust, necessitating lifestyle modifications for sustained loss.
  •  

 

Considerations

 

  • Prescribed for short periods due to potential side effects and risk of dependency.
  •  

  • Not suitable for individuals with specific health conditions, such as cardiovascular disease or uncontrolled hypertension.

 

Is Diethylpropion similar to phentermine?

 

Overview of Diethylpropion and Phentermine

 

  • Both Diethylpropion and Phentermine are prescription medications classified as appetite suppressants and sympathomimetic amines.
  •  

  • They are primarily used to assist weight loss in individuals who are obese and have related risk factors such as diabetes or high blood pressure.

 

Mechanism of Action

 

  • Diethylpropion and Phentermine stimulate the central nervous system, increasing heart rate and blood pressure while decreasing appetite by affecting hypothalamic neurotransmitters.
  •  

  • Though they function similarly, Phentermine typically has a stronger effect and longer duration than Diethylpropion.

 

Potential Side Effects

 

  • Common side effects of both drugs include increased heart rate, dry mouth, insomnia, dizziness, and constipation.
  •  

  • Due to their stimulant properties, they pose a risk of dependency or abuse.

 

Usage Considerations

 

  • Both medications are intended for short-term use and should be accompanied by lifestyle changes like diet and exercise.
  •  

  • It's crucial to evaluate each individual's health status and history for a safe and effective treatment plan.

 

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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.

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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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