Does Tufts Health Plan Cover Phendimetrazine

Explore Phendimetrazine coverage under Tufts Health Plan, potential denials, costs without insurance, and FAQs to navigate your health coverage options.
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Coverage of Phendimetrazine by Tufts Health Plan

 

  • Phendimetrazine may be covered under Tufts Health Plan if prescribed as part of a weight management program.
  •  

  • For coverage, the prescription must be for short-term use in conjunction with diet and exercise.
  •  

  • The patient must meet specific clinical criteria, generally verified by the healthcare provider.
  •  

  • Prior authorization is usually required, and the prescriber must provide evidence of medical necessity.
  •  

  • Coverage may vary based on the specific plan type, so members are advised to check their plan documents or contact customer service for precise details.

 

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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 Phendimetrazine Coverage with Tufts Health Plan

 

Check Your Plan Details

 

  • Review your specific insurance plan's details with Tufts Health Plan to understand what medications are covered. Visit their official website or refer to the plan documents you may have received.
  •  

  • Check the formulary list provided by Tufts Health Plan to see if Phendimetrazine is listed as a covered medication for your specific plan.

 

Consult with Your Healthcare Provider

 

  • Contact your healthcare provider to discuss your need for Phendimetrazine. They can provide a prescription and may help in understanding whether it is medically necessary for you.
  •  

  • Inquire if your healthcare provider has experience working with Tufts Health Plan and can provide necessary documentation to facilitate coverage.

 

Request Prior Authorization

 

  • If Phendimetrazine requires prior authorization under your plan, ask your healthcare provider to submit a prior authorization request on your behalf. This often includes providing medical justification for why Phendimetrazine is necessary.
  •  

  • Ensure that all forms and documentation are properly filled out and submitted to Tufts Health Plan. Follow up with your provider to confirm submission.

 

Contact Tufts Health Plan Member Services

 

  • Reach out to Tufts Health Plan Member Services to verify if all necessary steps have been completed for coverage. They can provide clarity on any additional requirements.
  •  

  • Discuss alternative coverage options if Phendimetrazine is not included in your specific plan. The representatives may help you find a suitable pathway.

 

Appeal a Denial

 

  • If your initial request for Phendimetrazine coverage is denied, consult the denial letter sent by Tufts Health Plan for specifics on why the request was not approved.
  •  

  • Prepare to file an appeal, working closely with your healthcare provider to gather supplemental information or documentation supporting your case. Clearly outline the medical necessity of Phendimetrazine in your appeal.

 

Seek Alternative Coverage Options

 

  • If these steps do not lead to coverage, consider discussing alternative medications with your healthcare provider that may be covered by your Tufts Health Plan.
  •  

  • Investigate any available discount programs or manufacturer coupons that might reduce the cost of Phendimetrazine if it remains uncovered.

 

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FAQs

Does Tufts Health Plan Cover Phendimetrazine

Explore Phendimetrazine coverage under Tufts Health Plan, potential denials, costs without insurance, and FAQs to navigate your health coverage options.
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Is Phendimetrazine Covered by Tufts Health Plan

 

Coverage of Phendimetrazine by Tufts Health Plan

 

  • Phendimetrazine may be covered under Tufts Health Plan if prescribed as part of a weight management program.
  •  

  • For coverage, the prescription must be for short-term use in conjunction with diet and exercise.
  •  

  • The patient must meet specific clinical criteria, generally verified by the healthcare provider.
  •  

  • Prior authorization is usually required, and the prescriber must provide evidence of medical necessity.
  •  

  • Coverage may vary based on the specific plan type, so members are advised to check their plan documents or contact customer service for precise details.

 

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Tufts Health Plan's Approved Criteria for Phendimetrazine Coverage

 

Eligibility Requirements for Coverage

 

  • The patient must be at least 18 years of age and have a Body Mass Index (BMI) of 30 kg/m² or higher, unless there is a clinical condition such as diabetes or hypertension, in which case a BMI of 27 kg/m² or higher is acceptable.
  •  

  • Documentation must demonstrate that the patient has attempted to lose weight through conventional methods such as diet and exercise for at least 6 months without significant success.

 

Required Medical Documentation

 

  • A comprehensive medical history and examination report from the healthcare provider describing the obesity-related health conditions and previous weight loss attempts.
  •  

  • Relevant lab results and any diagnostic evaluations that support the necessity of pharmacotherapy for weight management.

 

Prescriber Requirements

 

  • The prescription must be written by a healthcare provider who is board-certified in endocrinology, internal medicine, or related specialties, and experienced in managing obesity and weight-related disorders.
  •  

  • There must be a documented plan for ongoing medical supervision of the patient's weight loss regimen.

 

Duration and Quantity Limits

 

  • The initial prescription coverage is limited to a maximum of 12 weeks, with an evaluation to assess efficacy and tolerability before reauthorization for further therapy.
  •  

  • Quantity limits are typically set at the standard dosing as per FDA guidelines, unless the prescriber provides justification for dose adjustment based on clinical necessity.

 

Continued Use Evaluation

 

  • Evidence of weight loss or improvement in obesity-related conditions must be submitted for review to continue coverage beyond the initial authorization period.
  •  

  • The patient must be participating in a comprehensive weight management program that includes nutritional guidance, lifestyle modification, and exercise.

 

Why Tufts Health Plan Might Deny Phendimetrazine Coverage

 

Exclusions for Phendimetrazine Coverage

 

  • Coverage may be denied if the prescription for Phendimetrazine does not align with specified labeling and FDA-approved indications for weight management or obesity treatment.
  •  

  • Tufts Health Plan may deny coverage for Phendimetrazine if the member does not meet the specific BMI (Body Mass Index) criteria outlined in their policy for weight loss medications.
  •  

  • If the prescribed dosage of Phendimetrazine exceeds the plan’s established daily limit or recommended treatment duration without a prior authorization, the coverage might be denied.
  •  

  • The health plan may withhold coverage if the member has pre-existing conditions or comorbidities that are contraindicated with the use of Phendimetrazine, such as severe heart disease, uncontrolled high blood pressure, or hyperthyroidism.
  •  

  • Phendimetrazine might not be covered if the member has a history of substance misuse or drug abuse, as defined by the plan’s guidelines for controlled substances.
  •  

  • Coverage might not be provided if the prescription does not include documentation of previous unsuccessful attempts with weight management programs and lifestyle changes.
  •  

  • Tufts Health Plan may deny coverage in cases where Phendimetrazine is used in combination with other weight loss medications, going against the plan’s coverage limits and guidelines.

 

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How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

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 Phendimetrazine Coverage with Tufts Health Plan

 

Check Your Plan Details

 

  • Review your specific insurance plan's details with Tufts Health Plan to understand what medications are covered. Visit their official website or refer to the plan documents you may have received.
  •  

  • Check the formulary list provided by Tufts Health Plan to see if Phendimetrazine is listed as a covered medication for your specific plan.

 

Consult with Your Healthcare Provider

 

  • Contact your healthcare provider to discuss your need for Phendimetrazine. They can provide a prescription and may help in understanding whether it is medically necessary for you.
  •  

  • Inquire if your healthcare provider has experience working with Tufts Health Plan and can provide necessary documentation to facilitate coverage.

 

Request Prior Authorization

 

  • If Phendimetrazine requires prior authorization under your plan, ask your healthcare provider to submit a prior authorization request on your behalf. This often includes providing medical justification for why Phendimetrazine is necessary.
  •  

  • Ensure that all forms and documentation are properly filled out and submitted to Tufts Health Plan. Follow up with your provider to confirm submission.

 

Contact Tufts Health Plan Member Services

 

  • Reach out to Tufts Health Plan Member Services to verify if all necessary steps have been completed for coverage. They can provide clarity on any additional requirements.
  •  

  • Discuss alternative coverage options if Phendimetrazine is not included in your specific plan. The representatives may help you find a suitable pathway.

 

Appeal a Denial

 

  • If your initial request for Phendimetrazine coverage is denied, consult the denial letter sent by Tufts Health Plan for specifics on why the request was not approved.
  •  

  • Prepare to file an appeal, working closely with your healthcare provider to gather supplemental information or documentation supporting your case. Clearly outline the medical necessity of Phendimetrazine in your appeal.

 

Seek Alternative Coverage Options

 

  • If these steps do not lead to coverage, consider discussing alternative medications with your healthcare provider that may be covered by your Tufts Health Plan.
  •  

  • Investigate any available discount programs or manufacturer coupons that might reduce the cost of Phendimetrazine if it remains uncovered.

 

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Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

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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.

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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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