Does Tufts Health Plan Cover Phentermine (Adipex-P, Lomaira)

Discover if Tufts Health Plan covers Phentermine, reasons for denial, ways to secure coverage, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage Overview

 

  • Tufts Health Plan may cover Phentermine (Adipex-P, Lomaira) if it is deemed medically necessary.
  • Coverage often targets those with significant obesity-related health issues who have not achieved weight loss through diet and exercise alone.

 

Criteria for Coverage

 

  • Doctors typically need to provide documentation showing the medical necessity for Phentermine.
  • Patients may be required to have a BMI over a specific threshold, often above 27 with associated comorbidities or over 30 without.

 

Pre-Authorization Process

 

  • A pre-authorization from a healthcare provider is usually required before obtaining Phentermine coverage.
  • Providing a comprehensive health evaluation can improve approval chances.

 

Exclusions and Limits

 

  • Coverage might exclude those with a history of heart disease, uncontrolled hypertension, or certain other health conditions.
  • Some plans may limit the duration of Phentermine use due to safety concerns.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Tufts Health Plan

 

Determine Eligibility for Coverage

 

  • Review your plan's benefits summary document to understand if weight loss medications, like Phentermine, are covered. You can access this document through your Tufts Health Plan member portal.
  •  

  • Consult the Tufts Health Plan Drug Coverage List, which is regularly updated and provides information on covered prescription drugs.
  •  

  • Contact Tufts Health Plan customer service to confirm the terms of your specific plan regarding weight management medications. Be ready to provide your member ID for more accurate support.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor whether Phentermine is suitable for your weight management goals. They can evaluate your health and determine if the medication is medically necessary.
  •  

  • Ensure that your healthcare provider is in the Tufts Health Plan network, as this may affect coverage and out-of-pocket costs.

 

Obtain a Prescription

 

  • If Phentermine is deemed appropriate, request a prescription from your healthcare provider. Ensure all necessary medical information and justification for the prescription are documented.
  •  

  • Check if your provider needs to submit a prior authorization form to Tufts Health Plan, as some medications require approval before being covered.

 

Submit Prior Authorization (if necessary)

 

  • If required, work closely with your healthcare provider to submit a prior authorization request. This form will include the medical justification for the prescription.
  •  

  • Ensure all relevant medical records and documentation are attached, supporting the need for Phentermine as part of your treatment.

 

Fill Your Prescription at a Network Pharmacy

 

  • Once approved, take your prescription to a pharmacy within the Tufts Health Plan network to ensure coverage.
  •  

  • Provide your insurance information and ensure the pharmacist processes the prescription through your health plan to receive the appropriate coverage benefits.
  •  

  • If you encounter any issues during this process, contact Tufts Health Plan customer service for assistance.

 

Review Your Costs and Adherence to Plan Guidelines

 

  • Be aware of any copayments, coinsurance, or deductibles associated with your plan when filling your prescription.
  •  

  • Ensure adherence to any guidelines or limitations set by Tufts Health Plan regarding the duration and dosage of Phentermine.

 

Regular Follow-Up with Your Healthcare Provider

 

  • Schedule follow-up appointments with your doctor to monitor progress and make any necessary adjustments to your treatment plan.
  •  

  • Report any side effects or concerns to your doctor immediately to ensure your safety and the continued appropriateness of Phentermine.

 

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 Phentermine (Adipex-P, Lomaira)

Discover if Tufts Health Plan covers Phentermine, reasons for denial, ways to secure coverage, costs without insurance, and FAQs in this comprehensive guide.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by Tufts Health Plan

 

Coverage Overview

 

  • Tufts Health Plan may cover Phentermine (Adipex-P, Lomaira) if it is deemed medically necessary.
  • Coverage often targets those with significant obesity-related health issues who have not achieved weight loss through diet and exercise alone.

 

Criteria for Coverage

 

  • Doctors typically need to provide documentation showing the medical necessity for Phentermine.
  • Patients may be required to have a BMI over a specific threshold, often above 27 with associated comorbidities or over 30 without.

 

Pre-Authorization Process

 

  • A pre-authorization from a healthcare provider is usually required before obtaining Phentermine coverage.
  • Providing a comprehensive health evaluation can improve approval chances.

 

Exclusions and Limits

 

  • Coverage might exclude those with a history of heart disease, uncontrolled hypertension, or certain other health conditions.
  • Some plans may limit the duration of Phentermine use due to safety concerns.

 

A weight management program tailored to you

Start with Curex

Tufts Health Plan's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Criteria for Phentermine Coverage (Adipex-P, Lomaira)

 

  • Patient must have a documented diagnosis of obesity, indicated by a Body Mass Index (BMI) of 30 kg/m² or more.
  •  

  • Alternatively, coverage may be provided for patients with a documented BMI of 27 kg/m² or more if there are additional risk factors such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • Evidence of inability to achieve adequate weight loss over a considerable period through diet and exercise alone must be provided by a healthcare professional.
  •  

  • There must be a comprehensive weight management plan in place, supervised by a healthcare provider, which includes lifestyle modifications such as diet, exercise, and behavioral interventions.
  •  

  • Phentermine should be prescribed as a part of a short-term (a few weeks) regimen for weight reduction, complementing the broader weight management program.
  •  

  • Renewal of coverage may require documentation of significant weight loss or health improvement milestones as assessed by the supervising healthcare provider.
  •  

  • Patients should not have a history of cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, or other conditions that contraindicate the use of phentermine.

 

Why Tufts Health Plan Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons for Denial of Phentermine Coverage by Tufts Health Plan

 

  • Medical necessity criteria not met: Tufts Health Plan might deny coverage if the use of Phentermine does not meet their specific medical necessity guidelines, which generally require substantiated medical justification for its use in treating obesity or other related conditions.
  •  

  • Non-approved indications: Coverage may be denied if Phentermine is prescribed for conditions or purposes not approved by Tufts Health Plan, as the intended use must align with their coverage policies.
  •  

  • Exceeding recommended dosage or duration: If the prescription for Phentermine involves dosages or treatment durations beyond the approved or recommended guidelines, it can lead to a denial of coverage.
  •  

  • Lack of prior authorization: Tufts Health Plan may require prior authorization for Phentermine coverage. If this step is not completed or authorization is denied, coverage might be refused.
  •  

  • Age restrictions: There may be age limitations on who can receive coverage for Phentermine; if the patient does not meet these requirements, the coverage could be denied.
  •  

  • Duplicate therapy: If Phentermine is part of a therapy regimen that duplicates other treatments the patient is undergoing, the coverage may be denied to avoid redundancy in therapy.
  •  

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Phentermine (Adipex-P, Lomaira) Cost without Insurance?

 

Cost of Phentermine (Adipex-P, Lomaira) Without Insurance

 

  • The price of Phentermine can vary based on the pharmacy location and dosage strength. Typically, the cost for Adipex-P (the tablet form) without insurance is approximately $30 to $100 for a 30-day supply, at the standard dose of 37.5 mg per tablet.
  •  

  • Lomaira, which is a lower-dosage version of Phentermine, might be priced differently. The average cost without insurance for Lomaira is around $50 to $90 for a 30-day supply, depending on the pharmacy and location.
  •  

  • It's worth noting that these costs reflect retail prices, and there might be cheaper generic options available. Additionally, some pharmacies offer discount programs or coupons which can significantly lower the price.
  •  

  • Shopping around at different pharmacies or using online resources may help in obtaining the best available price without insurance.

 

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 Phentermine (Adipex-P, Lomaira) Coverage with Tufts Health Plan

 

Determine Eligibility for Coverage

 

  • Review your plan's benefits summary document to understand if weight loss medications, like Phentermine, are covered. You can access this document through your Tufts Health Plan member portal.
  •  

  • Consult the Tufts Health Plan Drug Coverage List, which is regularly updated and provides information on covered prescription drugs.
  •  

  • Contact Tufts Health Plan customer service to confirm the terms of your specific plan regarding weight management medications. Be ready to provide your member ID for more accurate support.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor whether Phentermine is suitable for your weight management goals. They can evaluate your health and determine if the medication is medically necessary.
  •  

  • Ensure that your healthcare provider is in the Tufts Health Plan network, as this may affect coverage and out-of-pocket costs.

 

Obtain a Prescription

 

  • If Phentermine is deemed appropriate, request a prescription from your healthcare provider. Ensure all necessary medical information and justification for the prescription are documented.
  •  

  • Check if your provider needs to submit a prior authorization form to Tufts Health Plan, as some medications require approval before being covered.

 

Submit Prior Authorization (if necessary)

 

  • If required, work closely with your healthcare provider to submit a prior authorization request. This form will include the medical justification for the prescription.
  •  

  • Ensure all relevant medical records and documentation are attached, supporting the need for Phentermine as part of your treatment.

 

Fill Your Prescription at a Network Pharmacy

 

  • Once approved, take your prescription to a pharmacy within the Tufts Health Plan network to ensure coverage.
  •  

  • Provide your insurance information and ensure the pharmacist processes the prescription through your health plan to receive the appropriate coverage benefits.
  •  

  • If you encounter any issues during this process, contact Tufts Health Plan customer service for assistance.

 

Review Your Costs and Adherence to Plan Guidelines

 

  • Be aware of any copayments, coinsurance, or deductibles associated with your plan when filling your prescription.
  •  

  • Ensure adherence to any guidelines or limitations set by Tufts Health Plan regarding the duration and dosage of Phentermine.

 

Regular Follow-Up with Your Healthcare Provider

 

  • Schedule follow-up appointments with your doctor to monitor progress and make any necessary adjustments to your treatment plan.
  •  

  • Report any side effects or concerns to your doctor immediately to ensure your safety and the continued appropriateness of Phentermine.

 

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.

Phentermine (Adipex-P, Lomaira) FAQ

What are the side effects of phentermine?

 

Common Side Effects

 

  • Increased heart rate
  • Insomnia
  • Anxiety
  • Dry mouth

 

Less Common Side Effects

 

  • Dizziness
  • Constipation
  • Chest discomfort

 

Severe Side Effects

 

  • Shortness of breath
  • Severe headache
  • Heart palpitations

 

Recommendations

 

  • Avoid combining with other stimulants.
  • Limit alcohol consumption.
  • Consult a physician if side effects are severe or persist.

 

Important Note

 

  • Use only as prescribed by your doctor.
  • Avoid taking it late in the day to prevent insomnia.

 

How does phentermine help with weight loss?

 

How Phentermine Aids Weight Loss

 

  • Phentermine suppresses appetite by releasing neurotransmitters like norepinephrine in the brain, which helps reduce hunger.
  •  

  • It is similar to an amphetamine and works by stimulating the central nervous system, increasing heart rate and blood pressure, which can decrease appetite.
  •  

  • The medication should be combined with a reduced-calorie diet, increased physical activity, and behavior therapy for optimal results.
  •  

  • Often used for short-term management of obesity, typically up to 12 weeks, as part of a broader weight-loss program.

 

Is phentermine safe to use long-term?

 

Phentermine Safety

 

  • Phentermine is mainly prescribed for short-term use, generally up to 12 weeks, due to the lack of long-term efficacy and safety studies.
  •  

  • While it can be effective for weight loss over a short period, the potential for dependency and cardiovascular issues makes prolonged use risky.
  •  

  • Long-term use may lead to side effects like elevated blood pressure, palpitations, insomnia, and mood changes.
  •  

  • Consult your healthcare provider regularly to evaluate its ongoing necessity and monitor any adverse effects.
  •  

  • Alternative weight management strategies, such as lifestyle changes, should be prioritized for sustainable results.

 

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