Does UnitedHealthcare Cover Phentermine (Adipex-P, Lomaira)

Find out if UnitedHealthcare covers Phentermine, why claims may be denied, costs without insurance, and tips to secure coverage.
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UnitedHealthcare Coverage for Phentermine

 

  • UnitedHealthcare may cover Phentermine (Adipex-P, Lomaira) if it is deemed medically necessary for weight loss programs.
  •  

  • Coverage usually requires the patient to meet certain criteria, such as having a body mass index (BMI) typically over 30, or over 27 with comorbidities like diabetes or hypertension.
  •  

    • Patients may need documented attempts of weight management with non-pharmaceutical methods.
    •  

    • A healthcare provider must prescribe the medication and demonstrate its necessity with supporting medical records.

     

  • Coverage policies can vary, and prior authorization is often required.
  •  

  • It's essential to consult your specific UnitedHealthcare plan documents or speak with a representative for detailed coverage information and process requirements.

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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 UnitedHealthcare

 

Check Your Plan's Coverage

 

  • Log in to your UnitedHealthcare online account or call their customer service to understand if Phentermine is covered under your plan.
  •  
  • Review your plan's formulary list, which is a catalog of medications covered under your policy. This can typically be found on the UnitedHealthcare website or within your plan documents.
  •  
  • Take note of any specific restrictions or prior authorization requirements for Phentermine.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Phentermine.
  •  
  • Ensure your doctor documents your medical necessity for Phentermine, such as for weight management in cases of obesity.
  •  
  • Ask your provider to write a prescription for Phentermine if deemed medically necessary.

 

Prepare for Prior Authorization

 

  • Contact UnitedHealthcare to verify if prior authorization is required for Phentermine.
  •  
  • Work with your healthcare provider to submit the necessary documentation to UnitedHealthcare for approval. This may include reasons for prescribing and any health evaluations.
  •  
  • Follow up with UnitedHealthcare periodically to check the status of your prior authorization request.

 

Fill Your Prescription

 

  • If UnitedHealthcare approves coverage, take your prescription to a network pharmacy to be filled.
  •  
  • Show your UnitedHealthcare insurance card at the pharmacy when filling your prescription to ensure coverage is applied.
  •  
  • Be aware of any co-pays or out-of-pocket costs associated with filling the prescription.

 

Appeal a Denied Request

 

  • If your request for Phentermine coverage is denied, review the denial letter from UnitedHealthcare for specific reasons.
  •  
  • Work with your healthcare provider to gather additional medical records or justification to support your case.
  •  
  • Submit an appeal to UnitedHealthcare, following their specified appeals process outlined in your denial letter or policy documents.
  •  
  • Stay in contact with UnitedHealthcare during the appeals process to track progress and any additional information needed.

 

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FAQs

Does UnitedHealthcare Cover Phentermine (Adipex-P, Lomaira)

Find out if UnitedHealthcare covers Phentermine, why claims may be denied, costs without insurance, and tips to secure coverage.
Curex allergy drops unboxing

Is Phentermine (Adipex-P, Lomaira) Covered by UnitedHealthcare

 

UnitedHealthcare Coverage for Phentermine

 

  • UnitedHealthcare may cover Phentermine (Adipex-P, Lomaira) if it is deemed medically necessary for weight loss programs.
  •  

  • Coverage usually requires the patient to meet certain criteria, such as having a body mass index (BMI) typically over 30, or over 27 with comorbidities like diabetes or hypertension.
  •  

    • Patients may need documented attempts of weight management with non-pharmaceutical methods.
    •  

    • A healthcare provider must prescribe the medication and demonstrate its necessity with supporting medical records.

     

  • Coverage policies can vary, and prior authorization is often required.
  •  

  • It's essential to consult your specific UnitedHealthcare plan documents or speak with a representative for detailed coverage information and process requirements.

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UnitedHealthcare's Approved Criteria for Phentermine (Adipex-P, Lomaira) Coverage

 

Eligibility Criteria for Phentermine Coverage by UnitedHealthcare

 

  • The individual must be 18 years or older.
  •  

  • The patient should have a body mass index (BMI) of 30 kg/m2 or greater, indicating they are obese.
  •  

  • If the patient has a BMI of 27 kg/m2 or greater, there must be an associated weight-related comorbidity. Qualifying comorbidities include conditions like hypertension, type 2 diabetes, or dyslipidemia.

 

Documentation Requirements

 

  • A recent clinical evaluation, documenting the patient's weight history and demonstrating a need for pharmacological intervention in managing obesity, must be provided.
  •  

  • The prescribing physician should provide a treatment plan that includes lifestyle modifications such as diet and exercise in conjunction with medication therapy.
  •  

  • Records should indicate that the patient has been counseled regarding the potential risks and benefits of phentermine use.

 

Trial and Failure of Previous Weight Loss Interventions

 

  • Documentation should confirm that the patient has previously attempted to lose weight through supervised diet and exercise programs without achieving a clinically meaningful weight loss.
  •  

  • There is a need for a trial and failure of other weight loss medications, if applicable, unless contraindicated or not tolerated by the patient.

 

Ongoing Monitoring and Reassessment

 

  • The patient must agree to regular follow-up appointments with the prescribing healthcare provider to monitor the effectiveness and safety of the therapy.
  •  

  • Weight loss progress and any adverse effects should be documented during follow-up visits, typically every 3 months.

 

Insurance Approval and Reauthorization

 

  • Initial coverage typically starts with a limited authorization period, requiring evidence of effectiveness and adherence to the prescribed weight loss program for continued coverage.
  •  

  • Reauthorization will require updated documentation demonstrating successful weight loss or notable health improvements attributed to phentermine use.

 

Why UnitedHealthcare Might Deny Phentermine (Adipex-P, Lomaira) Coverage

 

Reasons UnitedHealthcare Might Deny Phentermine Coverage

 

  • The medication is not on the formulary or approved drug list provided by UnitedHealthcare.
  •  

  • Phentermine is being prescribed for a non-FDA-approved indication or for an off-label use not covered by the plan.
  •  

  • The patient does not meet the specific clinical criteria established by UnitedHealthcare for weight-loss medications, such as a certain Body Mass Index (BMI) threshold.
  •  

  • Lack of documentation supporting necessary lifestyle changes or previous attempts at weight loss through diet and exercise, as required by the insurer.
  •  

  • Concurrent use of other weight loss medications might prohibit coverage of Phentermine.
  •  

  • The medication is considered a cosmetic or lifestyle drug, which is often excluded from coverage by health insurance plans.
  •  

  • The healthcare provider is not within the UnitedHealthcare network, and out-of-network prescriptions might not be covered.
  •  

  • Missing prior authorization or pre-certification from UnitedHealthcare, which is required to establish necessity before coverage is approved.
  •  

  • Coverage is denied due to policy exclusions for specific age groups such as individuals under 18 or over a particular age.

 

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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 UnitedHealthcare

 

Check Your Plan's Coverage

 

  • Log in to your UnitedHealthcare online account or call their customer service to understand if Phentermine is covered under your plan.
  •  
  • Review your plan's formulary list, which is a catalog of medications covered under your policy. This can typically be found on the UnitedHealthcare website or within your plan documents.
  •  
  • Take note of any specific restrictions or prior authorization requirements for Phentermine.

 

Consult Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the need for Phentermine.
  •  
  • Ensure your doctor documents your medical necessity for Phentermine, such as for weight management in cases of obesity.
  •  
  • Ask your provider to write a prescription for Phentermine if deemed medically necessary.

 

Prepare for Prior Authorization

 

  • Contact UnitedHealthcare to verify if prior authorization is required for Phentermine.
  •  
  • Work with your healthcare provider to submit the necessary documentation to UnitedHealthcare for approval. This may include reasons for prescribing and any health evaluations.
  •  
  • Follow up with UnitedHealthcare periodically to check the status of your prior authorization request.

 

Fill Your Prescription

 

  • If UnitedHealthcare approves coverage, take your prescription to a network pharmacy to be filled.
  •  
  • Show your UnitedHealthcare insurance card at the pharmacy when filling your prescription to ensure coverage is applied.
  •  
  • Be aware of any co-pays or out-of-pocket costs associated with filling the prescription.

 

Appeal a Denied Request

 

  • If your request for Phentermine coverage is denied, review the denial letter from UnitedHealthcare for specific reasons.
  •  
  • Work with your healthcare provider to gather additional medical records or justification to support your case.
  •  
  • Submit an appeal to UnitedHealthcare, following their specified appeals process outlined in your denial letter or policy documents.
  •  
  • Stay in contact with UnitedHealthcare during the appeals process to track progress and any additional information needed.

 

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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.

 

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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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