Does Tufts Health Plan Cover Liraglutide (Saxenda)

Find out if Tufts Health Plan covers Liraglutide (Saxenda), navigate coverage challenges, learn costs, and get answers in our comprehensive guide.
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Tufts Health Plan Coverage for Liraglutide (Saxenda)

 

  • Tufts Health Plan may offer coverage for Liraglutide (Saxenda) under certain conditions. It's typically covered when prescribed for weight management in adults with a BMI of 30 or greater, or for those with a BMI of 27 or greater who also have weight-related conditions such as hypertension or type 2 diabetes.
  •  

  • Pre-authorization is usually required. Patients must demonstrate that other weight loss methods, such as diet and exercise, have failed.
  •  

  • The plan may require documentation from the healthcare provider detailing the patient's medical history, current health status, and previous weight loss attempts.
  •  

  • Continuous monitoring and periodic reassessment may be needed to maintain coverage, ensuring the medication remains necessary and effective.

 

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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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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 Liraglutide (Saxenda) Coverage with Tufts Health Plan

 

Verify Coverage Eligibility

 

  • Check if your specific Tufts Health Plan includes coverage for weight loss medications. This can usually be found by reviewing your plan's benefits documentation or contacting their customer service.
  •  

  • Ensure you meet the plan’s criteria for BMI and other health conditions that might be necessary for coverage of Liraglutide (Saxenda).

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the possibility of using Liraglutide (Saxenda) for your weight loss goals.
  •  

  • Your healthcare provider can evaluate your condition and determine if Liraglutide is a suitable option for you based on your medical history and weight loss objectives.

 

Prescription Requirement

 

  • Obtain a prescription for Liraglutide (Saxenda) if your healthcare provider deems it appropriate for your treatment.
  •  

  • Ensure the prescription includes all necessary details such as dosage, frequency, and any specific instructions from your doctor.

 

Submit Prior Authorization

 

  • Understand that many insurance plans, including Tufts Health Plan, require prior authorization for medications like Liraglutide (Saxenda).
  •  

  • Have your healthcare provider or pharmacy submit a prior authorization request to Tufts Health Plan. This typically involves providing clinical information and justifications for the medication’s necessity.

 

Follow Up with Tufts Health Plan

 

  • Contact Tufts Health Plan to check the status of your prior authorization request. This can usually be done via their member portal, customer service number, or through your healthcare provider’s office assistance.
  •  

  • Inquire if they need any additional information or if there are alternative steps required to ensure approval.

 

Appeals Process

 

  • If your request for Liraglutide coverage is denied, ask for details on the appeals process. Tufts Health Plan should provide instructions on how to submit an appeal.
  •  

  • Work with your healthcare provider to gather any additional information or documentation that supports the necessity of Liraglutide (Saxenda) for your treatment.

 

Explore Additional Assistance

 

  • Consider reaching out to Novo Nordisk, the manufacturer of Liraglutide, as they may offer patient assistance programs or resources to help with costs not covered by insurance.
  •  

  • Discuss alternative payment plans or discounts with your pharmacy if the cost remains prohibitive.

 

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FAQs

Does Tufts Health Plan Cover Liraglutide (Saxenda)

Find out if Tufts Health Plan covers Liraglutide (Saxenda), navigate coverage challenges, learn costs, and get answers in our comprehensive guide.
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Is Liraglutide (Saxenda) Covered by Tufts Health Plan

 

Tufts Health Plan Coverage for Liraglutide (Saxenda)

 

  • Tufts Health Plan may offer coverage for Liraglutide (Saxenda) under certain conditions. It's typically covered when prescribed for weight management in adults with a BMI of 30 or greater, or for those with a BMI of 27 or greater who also have weight-related conditions such as hypertension or type 2 diabetes.
  •  

  • Pre-authorization is usually required. Patients must demonstrate that other weight loss methods, such as diet and exercise, have failed.
  •  

  • The plan may require documentation from the healthcare provider detailing the patient's medical history, current health status, and previous weight loss attempts.
  •  

  • Continuous monitoring and periodic reassessment may be needed to maintain coverage, ensuring the medication remains necessary and effective.

 

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Tufts Health Plan's Approved Criteria for Liraglutide (Saxenda) Coverage

 

Tufts Health Plan Coverage for Liraglutide (Saxenda)

 

  • A documented diagnosis of obesity, defined as a BMI (body mass index) of 30 kg/m2 or greater, is required.
  •  

  • In cases where the BMI is 27 kg/m2 or greater, but less than 30 kg/m2, there must be at least one weight-related comorbidity such as hypertension, type 2 diabetes mellitus, or dyslipidemia.
  •  

  • The patient must be an adult 18 years of age or older at the time of the request for coverage.
  •  

  • Documentation should show that the patient has attempted to reduce weight through a structured weight loss program, which includes lifestyle changes such as an established diet and exercise regimen.
  •  

  • The prescribing physician is required to provide evidence of monitoring and follow-up. This includes recording weight loss targets and ensuring the patient is adhering to an appropriate weight management plan.
  •  

  • Evidence should be provided to confirm that other weight loss therapies have been considered, and why Saxenda is the preferred option for the patient.
  •  

  • Evidence of adherence to the Saxenda treatment plan and monitoring for side effects should be part of the follow-up documentation.

 

Why Tufts Health Plan Might Deny Liraglutide (Saxenda) Coverage

 

Tufts Health Plan Non-Coverage Situations for Liraglutide (Saxenda)

 

  • Liraglutide (Saxenda) is not covered when used for weight management in patients who do not meet the FDA-approved indication criteria for obesity treatment. Tufts Health Plan may require a documented diagnosis of obesity, specifically a BMI of 30 kg/m² or greater, or 27 kg/m² with a weight-related comorbidity.
  •  

  • Coverage is not provided for off-label uses or conditions that are not FDA-approved for Liraglutide (Saxenda). This means any uses other than for weight management in adults who meet the specified BMI criteria.
  •  

  • Tufts Health Plan will not cover Liraglutide (Saxenda) if there is a lack of medical necessity as determined by health plan guidelines. This includes situations where alternative, potentially covered medications or therapies have not been trialed and documented as ineffective or inappropriate for the patient.
  •  

  • Prescription for Liraglutide (Saxenda) may not be covered if the prescribing healthcare provider does not submit the necessary prior authorization forms or documentation demonstrating the medical necessity as per Tufts Health Plan’s coverage policy.
  •  

  • If the prescription exceeds the dosage and duration limits set by the plan’s policy, Liraglutide (Saxenda) will not be covered unless an exception is documented and approved.
  •  

  • Coverage for Liraglutide (Saxenda) will be denied if it is deemed non-compliant with specific pharmacy benefit management guidelines imposed by Tufts Health Plan, especially if these involve step therapy or failing to meet prerequisites for coverage.

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How Much Does Liraglutide (Saxenda) Cost without Insurance?

 

Liraglutide (Saxenda) Cost without Insurance

 

  • The cost of Liraglutide, commonly marketed under the brand name Saxenda, can vary based on location and pharmacy, but it typically ranges between $1,300 and $1,500 for a 30-day supply, which includes five injectable pens.
  •  

  • Prices can fluctuate due to factors like pharmacy pricing policies, manufacturer offers, and location. It is advisable to compare prices from various pharmacies or online sources.
  •  

  • Pharmacies may offer discount programs or coupons that could reduce the out-of-pocket cost. It's a good idea to inquire about available savings options.
  •  

  • Some online pharmacy platforms may provide competitive pricing and discounts, so checking these can be beneficial for finding better deals.
  •  

  • Prescription assistance programs, sometimes offered by the manufacturer, can provide help for individuals who meet certain income or insurance criteria. Exploring these options might also lead to cost savings.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Liraglutide (Saxenda) Coverage with Tufts Health Plan

 

Verify Coverage Eligibility

 

  • Check if your specific Tufts Health Plan includes coverage for weight loss medications. This can usually be found by reviewing your plan's benefits documentation or contacting their customer service.
  •  

  • Ensure you meet the plan’s criteria for BMI and other health conditions that might be necessary for coverage of Liraglutide (Saxenda).

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the possibility of using Liraglutide (Saxenda) for your weight loss goals.
  •  

  • Your healthcare provider can evaluate your condition and determine if Liraglutide is a suitable option for you based on your medical history and weight loss objectives.

 

Prescription Requirement

 

  • Obtain a prescription for Liraglutide (Saxenda) if your healthcare provider deems it appropriate for your treatment.
  •  

  • Ensure the prescription includes all necessary details such as dosage, frequency, and any specific instructions from your doctor.

 

Submit Prior Authorization

 

  • Understand that many insurance plans, including Tufts Health Plan, require prior authorization for medications like Liraglutide (Saxenda).
  •  

  • Have your healthcare provider or pharmacy submit a prior authorization request to Tufts Health Plan. This typically involves providing clinical information and justifications for the medication’s necessity.

 

Follow Up with Tufts Health Plan

 

  • Contact Tufts Health Plan to check the status of your prior authorization request. This can usually be done via their member portal, customer service number, or through your healthcare provider’s office assistance.
  •  

  • Inquire if they need any additional information or if there are alternative steps required to ensure approval.

 

Appeals Process

 

  • If your request for Liraglutide coverage is denied, ask for details on the appeals process. Tufts Health Plan should provide instructions on how to submit an appeal.
  •  

  • Work with your healthcare provider to gather any additional information or documentation that supports the necessity of Liraglutide (Saxenda) for your treatment.

 

Explore Additional Assistance

 

  • Consider reaching out to Novo Nordisk, the manufacturer of Liraglutide, as they may offer patient assistance programs or resources to help with costs not covered by insurance.
  •  

  • Discuss alternative payment plans or discounts with your pharmacy if the cost remains prohibitive.

 

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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.

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Liraglutide (Saxenda) FAQ

How much weight can you lose with Saxenda?

 

Weight Loss with Saxenda

 

  • Clinical trials show Saxenda users can lose an average of 5-10% of their initial body weight over 56 weeks.
  •  

  • Weight loss can vary depending on factors such as initial weight, diet, and physical activity.
  •  

  • Combining Saxenda with a reduced-calorie diet and increased physical activity enhances results.
  •  

  • It's important to monitor progress and consult with a healthcare provider to tailor the plan to individual needs.
  •  

  • Results are not guaranteed, and lifestyle changes significantly influence effectiveness.

What are the side effects of Liraglutide?

 

Common Side Effects

 

  • Nausea, particularly when starting treatment.
  • Vomiting or diarrhea, which can lead to dehydration.
  • Reduced appetite, a desired effect for weight management.
  • Headaches and dizziness, usually mild to moderate.

 

Serious Side Effects

 

  • Severe abdominal pain, signaling possible pancreatitis.
  • Symptoms of thyroid tumors, such as neck swelling or difficulty swallowing.
  • Serious allergic reactions, including hives or breath difficulty.
  • Elevated heart rate or palpitations.

 

Recommendations

 

  • Alert healthcare providers about any side effects.
  • Hydrate well to minimize dehydration from gastrointestinal effects.
  • Monitor blood sugar if diabetic, as levels may change.

 

How does Saxenda work for weight loss?

 

Mechanism of Action

 

  • Saxenda (liraglutide) is a GLP-1 receptor agonist. It mimics the action of the glucagon-like peptide-1, a hormone involved in appetite regulation.
  •  

  • It enhances insulin secretion and delays gastric emptying, promoting a feeling of fullness.

 

Appetite Suppression

 

  • Saxenda targets areas of the brain that control hunger, reducing appetite and calorie intake.
  •  

  • This helps in forming healthier eating habits and better portion control.

 

Additional Benefits

 

  • Besides weight loss, it assists in improving glycemic control for type 2 diabetes patients.
  •  

  • May lead to reductions in waist circumference and improvements in cardiovascular measures.

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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.

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