Does WellCare Cover Phentermine (Adipex-P, Lomaira)

Explore WellCare coverage for Phentermine, learn why it might be denied, how to secure it, cost without insurance, and get answers to common questions.
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Coverage for Phentermine

 

  • WellCare may cover Phentermine (Adipex-P, Lomaira) for weight loss if deemed medically necessary.
  •  

  • It is often prescribed as part of a comprehensive weight management plan, including diet and exercise.

 

Eligibility Criteria

 

  • Patients typically need a BMI of 30 or higher, or 27 with weight-related conditions such as diabetes or hypertension.
  •  

  • Prior authorization might be required to ensure the appropriateness of treatment.

 

Steps to Ensure Coverage

 

  • Consult with your healthcare provider to discuss the need for Phentermine based on your health profile.
  •  

  • Your physician must provide necessary documentation to WellCare for approval, detailing your health status and prior attempts to lose weight through lifestyle changes.

 

Important Considerations

 

  • Check with WellCare directly or through your plan's formulary details to verify specific terms and coverage for Phentermine.
  •  

  • Be aware that coverage may vary based on location and specific policy 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 Phentermine (Adipex-P, Lomaira) Coverage with WellCare

 

Verify Coverage and Plan Details

 

  • Contact WellCare customer service to verify if Phentermine (Adipex-P, Lomaira) is covered under your current plan. Use the contact information on your insurance card or their official website.
  •  

  • Review your policy documentation, either in hard copy or online through your WellCare member portal, to understand the specifics of your plan regarding prescription drugs.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Phentermine. Ensure they are aware of your medical history, including any prescriptions you currently take.
  •  

  • If your healthcare provider agrees that Phentermine is appropriate for you, ask them to provide necessary documentation, such as a Letter of Medical Necessity or detailed medical records, which may help in securing insurance approval.

 

Get a Prescription

 

  • Once your healthcare provider prescribes Phentermine, ensure the prescription is written correctly and includes all necessary details such as dosage and quantity.
  •  

  • Check if WellCare requires your provider to follow a specific prescription submission process, like electronic submission through an approved system.

 

Initiate a Prior Authorization Request

 

  • If necessary, work with your healthcare provider to submit a prior authorization request. This process involves providing WellCare with justification for prescribing Phentermine, detailing why alternative medications may not be suitable for you.
  •  

  • Prepare for this process by gathering any required documents WellCare might need, such as past medical records or previous treatments tried.

 

Submit a Coverage Appeal if Required

 

  • If your initial request for Phentermine coverage is denied, refer to the denial letter for reasons and WellCare’s appeal process. An appeal allows you to provide additional information or clarification regarding your need for the medication.
  •  

  • Consider seeking assistance from your healthcare provider to strengthen your appeal with further medical evidence supporting your case.

 

Fill the Prescription

 

  • Upon approval from WellCare, visit a network pharmacy to fill your prescription to ensure coverage. Confirm any co-pays or cost-sharing as per your plan.
  •  

  • If the prescription is partially covered or denied, consult WellCare customer service for clarification and next steps.

 

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FAQs

Does WellCare Cover Phentermine (Adipex-P, Lomaira)

Explore WellCare coverage for Phentermine, learn why it might be denied, how to secure it, cost without insurance, and get answers to common questions.
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Is Phentermine (Adipex-P, Lomaira) Covered by WellCare

 

Coverage for Phentermine

 

  • WellCare may cover Phentermine (Adipex-P, Lomaira) for weight loss if deemed medically necessary.
  •  

  • It is often prescribed as part of a comprehensive weight management plan, including diet and exercise.

 

Eligibility Criteria

 

  • Patients typically need a BMI of 30 or higher, or 27 with weight-related conditions such as diabetes or hypertension.
  •  

  • Prior authorization might be required to ensure the appropriateness of treatment.

 

Steps to Ensure Coverage

 

  • Consult with your healthcare provider to discuss the need for Phentermine based on your health profile.
  •  

  • Your physician must provide necessary documentation to WellCare for approval, detailing your health status and prior attempts to lose weight through lifestyle changes.

 

Important Considerations

 

  • Check with WellCare directly or through your plan's formulary details to verify specific terms and coverage for Phentermine.
  •  

  • Be aware that coverage may vary based on location and specific policy details.

 

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

 

WellCare's Approved Criteria for Phentermine Coverage

 

  • The patient is diagnosed with obesity, indicated by a Body Mass Index (BMI) of 30 kg/m² or higher, or 27 kg/m² with accompanying weight-related co-morbidities such as hypertension, type 2 diabetes, or dyslipidemia.
  •  

  • The patient is at least 18 years old, ensuring the safety and effectiveness of the medication within the adult population.
  •  

  • There is documentation of previous significant weight management efforts, including lifestyle modifications such as diet and exercise, which have not resulted in adequate weight loss success.
  •  

  • Phentermine is prescribed as part of a comprehensive weight management program, which also includes behavioral modification and lifestyle changes.
  •  

  • The patient does not have a history of cardiovascular disease, including coronary artery disease, stroke, arrhythmias, or heart failure, as these may pose a risk when using appetite suppressants.
  •  

  • The prescribing healthcare professional is adequately qualified, typically an endocrinologist, or an obesity management specialist, who has assessed the patient’s health status and approved the use of Phentermine based on a thorough evaluation.
  •  

  • The patient does not have a history of substance abuse, ensuring proper use and minimizing potential misuse or dependency on the medication.
  •  

  • There is a documented plan for monitoring the patient’s progress, with regular follow-up appointments to assess efficacy and any potential adverse effects, ensuring ongoing safety and effectiveness of treatment.

 

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

 

Reasons WellCare Might Deny Phentermine Coverage

 

  • Phentermine is prescribed for purposes not covered under WellCare's policy, such as non-medical or lifestyle weight loss programs.
  •  

  • The patient does not meet the medical necessity criteria established by WellCare. This may include not having a documented body mass index (BMI) that falls within the specified range required for coverage.
  •  

  • Treatment duration exceeds the maximum allowed by WellCare. Phentermine is typically approved for short-term use, and any requests beyond that period may be denied.
  •  

  • Required prior authorization has not been obtained, which is necessary to ensure the prescription aligns with WellCare's clinical guidelines.
  •  

  • The patient has a history of drug abuse, which may lead WellCare to deny coverage due to the potential for misuse of Phentermine.
  •  

  • Concomitant use with other medications contraindicated by WellCare's pharmaceutical policy, such as monoamine oxidase inhibitors, which may lead to an automatic denial.

 

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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 WellCare

 

Verify Coverage and Plan Details

 

  • Contact WellCare customer service to verify if Phentermine (Adipex-P, Lomaira) is covered under your current plan. Use the contact information on your insurance card or their official website.
  •  

  • Review your policy documentation, either in hard copy or online through your WellCare member portal, to understand the specifics of your plan regarding prescription drugs.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your interest in Phentermine. Ensure they are aware of your medical history, including any prescriptions you currently take.
  •  

  • If your healthcare provider agrees that Phentermine is appropriate for you, ask them to provide necessary documentation, such as a Letter of Medical Necessity or detailed medical records, which may help in securing insurance approval.

 

Get a Prescription

 

  • Once your healthcare provider prescribes Phentermine, ensure the prescription is written correctly and includes all necessary details such as dosage and quantity.
  •  

  • Check if WellCare requires your provider to follow a specific prescription submission process, like electronic submission through an approved system.

 

Initiate a Prior Authorization Request

 

  • If necessary, work with your healthcare provider to submit a prior authorization request. This process involves providing WellCare with justification for prescribing Phentermine, detailing why alternative medications may not be suitable for you.
  •  

  • Prepare for this process by gathering any required documents WellCare might need, such as past medical records or previous treatments tried.

 

Submit a Coverage Appeal if Required

 

  • If your initial request for Phentermine coverage is denied, refer to the denial letter for reasons and WellCare’s appeal process. An appeal allows you to provide additional information or clarification regarding your need for the medication.
  •  

  • Consider seeking assistance from your healthcare provider to strengthen your appeal with further medical evidence supporting your case.

 

Fill the Prescription

 

  • Upon approval from WellCare, visit a network pharmacy to fill your prescription to ensure coverage. Confirm any co-pays or cost-sharing as per your plan.
  •  

  • If the prescription is partially covered or denied, consult WellCare customer service for clarification and next steps.

 

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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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Titration

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

Additional Treatments

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

Got questions? We have answers.

Do your plans include prescriptions and medications?

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

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

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

What medications do your providers prescribe?

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

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

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

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

Will I be prescribed semaglutide if I sign up?

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

What is compounded medication?

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

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

Is compounded medication the same as generic medication?

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

Is insurance required?

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

Can I pay with an FSA or HSA card?

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

How much does treatment cost?

Semaglutide Injections:

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

Tirzepatide Injections:

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

Semaglutide Tablets:

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

Tirzepatide Tablets:

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

Can you prescribe Ozempic®* or Wegovy®*?

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

Are video visits with a provider required?

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

What states do you serve?

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

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