Does UnitedHealthcare Cover Saxenda

Explore Saxenda coverage with UnitedHealthcare, reasons for denial, tips for approval, out-of-pocket costs, and FAQs in this insightful guide.
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Does UnitedHealthcare Cover Saxenda?

 

  • UnitedHealthcare may cover Saxenda for weight loss if it is deemed medically necessary. Coverage often requires prior authorization.
  •  

  • To qualify for coverage, patients may need to meet specific criteria, such as a BMI over a certain threshold or having weight-related health conditions like type 2 diabetes.
  •  

  • Physicians often need to provide documentation supporting the necessity of Saxenda as part of a comprehensive weight management program.
  •  

  • Patients should verify with UnitedHealthcare directly or consult their specific health plan details for exact coverage rules and possible co-payments or deductibles.

 

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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 Saxenda Coverage with UnitedHealthcare

 

Verify Your Coverage Eligibility

 

  • Check your specific UnitedHealthcare plan details to determine if Saxenda is covered. Coverage may vary depending on your plan type and location.
  •  

  • Locate your insurance ID card and member number, as this information will be needed to verify your benefits.
  •  

  • Log into your UnitedHealthcare online account or contact customer service for guidance on your plan's coverage concerning Saxenda.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight management needs and the appropriateness of Saxenda for you.
  •  

  • Ensure your healthcare provider is informed about your insurance plan and is ready to assist with any required documentation for prior authorization.

 

Acquire Prior Authorization

 

  • Understand that Saxenda may require prior authorization from UnitedHealthcare. This means your healthcare provider must submit a request proving the need and suitability for this treatment.
  •  

  • Coordinate with your healthcare provider to initiate the prior authorization process, ensuring all necessary forms and medical documentation are completed accurately.

 

Submit Documentation and Appeals if Necessary

 

  • If the initial request for prior authorization is denied, review the denial letter from UnitedHealthcare for specific reasons and required steps for appeal.
  •  

  • Work with your healthcare provider to gather additional documentation or clarification needed for the appeal process.

 

Pharmacy Coordination

 

  • Once approval is obtained, coordinate with your pharmacy to ensure Saxenda is available and confirm your co-pay amount, as this could differ based on your plan.
  •  

  • Set up any necessary delivery or pick-up arrangements with your pharmacy to receive your medication without delay.

 

Review and Monitor Coverage

 

  • Continuously review your UnitedHealthcare plan for any changes in coverage terms or renewal requirements for Saxenda.
  •  

  • Stay engaged with both your healthcare provider and UnitedHealthcare to address any future issues or updated guidelines regarding Saxenda coverage.

 

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FAQs

Does UnitedHealthcare Cover Saxenda

Explore Saxenda coverage with UnitedHealthcare, reasons for denial, tips for approval, out-of-pocket costs, and FAQs in this insightful guide.
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Is Saxenda Covered by UnitedHealthcare

 

Does UnitedHealthcare Cover Saxenda?

 

  • UnitedHealthcare may cover Saxenda for weight loss if it is deemed medically necessary. Coverage often requires prior authorization.
  •  

  • To qualify for coverage, patients may need to meet specific criteria, such as a BMI over a certain threshold or having weight-related health conditions like type 2 diabetes.
  •  

  • Physicians often need to provide documentation supporting the necessity of Saxenda as part of a comprehensive weight management program.
  •  

  • Patients should verify with UnitedHealthcare directly or consult their specific health plan details for exact coverage rules and possible co-payments or deductibles.

 

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UnitedHealthcare's Approved Criteria for Saxenda Coverage

 

Eligibility Criteria for Saxenda Coverage

 

  • **Body Mass Index (BMI) Requirement:** Saxenda is approved for adults with a BMI of 30 kg/m² or greater, indicating obesity, or those with a BMI of 27 kg/m² or greater who have at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • **Previous Weight Management Efforts:** Candidates must have demonstrated an unsatisfactory weight loss result from previous weight management efforts which may include lifestyle changes, diet, and exercise.
  •  

  • **Medical Documentation:** Comprehensive medical records are required to demonstrate the medical necessity for Saxenda. This may include documentation of obesity-related risk factors or comorbidities, previous treatments attempted, and ongoing management plans.
  •  

  • **Physician Supervision:** The prescription and continuous management of Saxenda must be under the guidance and supervision of a licensed healthcare provider. Regular follow-up appointments are necessary to assess efficacy and safety.
  •  

  • **Lifestyle Modification Program Enrollment:** Coverage approval may require evidence of active participation in a comprehensive weight management program. This could be a formal weight loss program that includes dietary, physical activity, and behavioral strategies.
  •  

  • **Age Requirement:** Saxenda is covered for use in adult patients typically 18 years of age or older when medically indicated.
  •  

  • **Continuous Coverage Evaluation:** Ongoing coverage might require evidence of a clinically significant weight loss or health improvement achieved with Saxenda over a defined evaluation period, often established in UnitedHealthcare policies.

 

Why UnitedHealthcare Might Deny Saxenda Coverage

 

Reasons UnitedHealthcare Might Deny Saxenda Coverage

 

  • Saxenda is prescribed for a condition not listed in the approved indications under the UnitedHealthcare plan.
  •  

  • The patient does not meet the specific body mass index (BMI) requirements outlined by UnitedHealthcare for Saxenda coverage.
  •  

  • Failure to demonstrate previous unsuccessful attempts with other weight loss interventions or lifestyle modifications as required by UnitedHealthcare.
  •  

  • Absence of documented or diagnosed obesity-related comorbidities, which UnitedHealthcare may require for coverage.
  •  

  • Lack of prior authorization if such a process is mandated by UnitedHealthcare for Saxenda prescriptions.
  •  

  • Continued usage without evidence of significant weight loss as per UnitedHealthcare's evaluation timelines can lead to denial.
  •  

  • Exceeding the approved dosage or duration of therapy as stated in UnitedHealthcare's coverage guidelines.

 

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

How Much Does Saxenda Cost without Insurance?

 

Approximate Cost of Saxenda Without Insurance

 

  • Saxenda is a prescription medication used to aid in weight loss and management for patients who are overweight or have obesity-related medical problems.
  •  

  • Without insurance, the cost of Saxenda can be substantial. Prices typically range from $1,200 to $1,500 for a 30-day supply, which consists of 3 pens.
  •  

  • The exact cost can vary based on the pharmacy you visit and potential discounts or coupons you may be able to use.
  •  

  • It's important to consider the long-term cost if Saxenda is prescribed for an extended period, as the monthly expense can add up significantly over time.
  •  

  • Some pharmacies may offer loyalty programs or discounts that can slightly reduce the cost, so it's advisable to shop around or inquire about savings programs.
  •  

  • Additionally, pharmaceutical assistance programs or patient assistance programs might be available for eligible patients to help minimize out-of-pocket costs.

 

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 Saxenda Coverage with UnitedHealthcare

 

Verify Your Coverage Eligibility

 

  • Check your specific UnitedHealthcare plan details to determine if Saxenda is covered. Coverage may vary depending on your plan type and location.
  •  

  • Locate your insurance ID card and member number, as this information will be needed to verify your benefits.
  •  

  • Log into your UnitedHealthcare online account or contact customer service for guidance on your plan's coverage concerning Saxenda.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your weight management needs and the appropriateness of Saxenda for you.
  •  

  • Ensure your healthcare provider is informed about your insurance plan and is ready to assist with any required documentation for prior authorization.

 

Acquire Prior Authorization

 

  • Understand that Saxenda may require prior authorization from UnitedHealthcare. This means your healthcare provider must submit a request proving the need and suitability for this treatment.
  •  

  • Coordinate with your healthcare provider to initiate the prior authorization process, ensuring all necessary forms and medical documentation are completed accurately.

 

Submit Documentation and Appeals if Necessary

 

  • If the initial request for prior authorization is denied, review the denial letter from UnitedHealthcare for specific reasons and required steps for appeal.
  •  

  • Work with your healthcare provider to gather additional documentation or clarification needed for the appeal process.

 

Pharmacy Coordination

 

  • Once approval is obtained, coordinate with your pharmacy to ensure Saxenda is available and confirm your co-pay amount, as this could differ based on your plan.
  •  

  • Set up any necessary delivery or pick-up arrangements with your pharmacy to receive your medication without delay.

 

Review and Monitor Coverage

 

  • Continuously review your UnitedHealthcare plan for any changes in coverage terms or renewal requirements for Saxenda.
  •  

  • Stay engaged with both your healthcare provider and UnitedHealthcare to address any future issues or updated guidelines regarding Saxenda coverage.

 

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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.

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.

Saxenda FAQ

1. How much weight can you lose with Saxenda?

 

Expected Weight Loss with Saxenda

 

  • According to clinical studies, Saxenda helps achieve significant weight loss; patients can expect to lose around 5% to 10% of their initial body weight.
  •  

  • The average weight loss in clinical trials was approximately 8%, but individual results can vary based on several factors including diet and exercise.
  •  

  • For some, weight loss may exceed 10%, while others may experience less than 5% reduction.
  •  

  • Adopt lifestyle changes alongside Saxenda, like improved diet and increased physical activity, to maximize weight loss.
  •  

 

2. What are the common side effects of Saxenda?

 

Common Side Effects of Saxenda

 

  • Nausea: This is the most frequently reported side effect, often decreasing over time as the body adjusts.
  •  

  • Diarrhea: Changes in bowel habits, including diarrhea, are possible but usually manageable.
  •  

  • Constipation: Some patients experience constipation, a common gastrointestinal effect.
  •  

  • Vomiting: Vomiting can occur, especially in the initial stages of treatment.
  •  

  • Headache: Many patients report headaches, though these often lessen as treatment progresses.
  •  

  • Dizziness: Feeling lightheaded or dizzy can accompany Saxenda use.
  •  

  • Fatigue: Tiredness or fatigue is commonly noted but tends to be temporary.
  •  

  • Injection Site Reactions: Redness or irritation at the injection site may occur.

 

3. How long does it take for Saxenda to start working?

 

How Saxenda Works

 

  • Saxenda is a GLP-1 receptor agonist, which works by decreasing appetite and caloric intake.
  •  

  • The onset of its effects can vary among individuals.

 

Timeframe for Effects

 

  • Patients may start experiencing decreased appetite within the first week of treatment.
  •  

  • Noticeable weight loss usually begins after 4-8 weeks, especially when combined with a reduced-calorie diet and increased physical activity.

 

Monitoring Progress

 

  • Regular follow-ups with your healthcare provider are essential to assess progress and adjust the dosage if necessary.
  •  

  • Adherence to lifestyle changes significantly enhances results with Saxenda.

 

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Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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