Contrave is a prescription drug used for weight management in adults with obesity or weight-related health issues. Knowing what insurance companies cover Contrave can help you manage costs.
Coverage varies widely, and some plans may not include it. This article explains which insurers might cover Contrave, how to check, and ways to save.
Understanding Contrave and Its Use
Contrave combines naltrexone and bupropion to reduce appetite and cravings. It’s FDA-approved for adults with a BMI of 30 or higher, or 27 with conditions like diabetes.
Taken twice daily with a low-fat meal, it works best with diet and exercise. There’s no generic version, making it pricey without coverage.
The drug’s cost can be $600-$830 for a 30-day supply without insurance. Insurance coverage can lower this significantly, but weight-loss drugs are often excluded. Understanding your plan’s rules is key to accessing Contrave affordably.
How Insurance Covers Prescription Drugs
Most insurance plans, including private and Medicare, use a formulary—a list of covered drugs. Drugs are grouped into tiers, with higher tiers having higher copays.
Weight-loss drugs like Contrave are often not covered or placed on high tiers. Coverage depends on the insurer, plan, and medical necessity.
Some plans require prior authorization, where your doctor must prove Contrave is needed. Others may cover it only for specific conditions, like obesity with comorbidities. Checking your plan’s formulary is the first step to finding coverage.
Private Insurance Companies and Contrave
What insurance companies cover Contrave? Coverage varies among private insurers like Blue Cross Blue Shield (BCBS), Aetna, Cigna, and UnitedHealthcare.
BCBS may cover Contrave in some states if deemed medically necessary, but it often requires prior authorization. Aetna’s Standard Control Plan typically excludes Contrave, though exceptions can be requested.
Cigna and UnitedHealthcare may cover Contrave under certain plans, especially if your BMI meets criteria and prior weight-loss attempts are documented.
Always check your specific plan’s formulary, as coverage differs by employer or policy. Contacting your insurer directly clarifies what’s included.
Medicare and Contrave Coverage
Medicare Part D, which covers prescription drugs, rarely covers weight-loss medications like Contrave. Federal guidelines classify these drugs as non-essential for medical treatment.
Some Medicare Advantage plans (Part C) or Medigap plans might offer limited coverage, but this is uncommon.
If Contrave is covered, it’s likely on a high tier, leading to costly copays. Medicare beneficiaries can explore savings programs, as payments through these don’t count toward out-of-pocket expenses. Review your plan’s drug list or call your provider to confirm.
TRICARE and Other Federal Programs
TRICARE, the insurance for military members and families, may cover Contrave in specific cases. Coverage often depends on medical necessity and prior authorization.
Contact your TRICARE provider or pharmacy to verify if Contrave is included. Other federal programs, like Medicaid, rarely cover weight-loss drugs.
If covered, TRICARE may require documentation of failed weight-loss attempts or a high BMI. Your healthcare provider can assist with the necessary paperwork. Savings programs are also available for TRICARE beneficiaries.
Why Some Insurers Don’t Cover Contrave
Weight-loss drugs are often excluded because insurers view them as lifestyle-related rather than medically essential.
Contrave may be denied if prescribed for off-label uses, like depression, or if BMI criteria aren’t met. Lack of prior authorization or undocumented weight-loss attempts can also lead to denials.
Some insurers prioritize cheaper alternatives, like phentermine, before approving Contrave. Appealing a denial with a Letter of Medical Necessity from your doctor can sometimes secure coverage. Understanding denial reasons helps you navigate the process.
Checking Your Insurance Coverage
To find out what insurance companies cover Contrave, start with your plan’s formulary. Access it online through your insurer’s portal or request a copy. Look for Contrave (naltrexone/bupropion) and note its tier, copay, or restrictions. If it’s not listed, it’s likely not covered.
Call your insurer’s customer service for clarification. Ask about prior authorization, BMI requirements, or appeal processes. Your pharmacist or doctor can also check coverage when prescribing Contrave.
Appealing for Coverage
If Contrave isn’t covered, you can appeal the decision. Your doctor can submit a Letter of Medical Necessity, explaining why Contrave is essential. Include your medical history, BMI, and prior weight-loss efforts. Insurers may approve coverage if the appeal meets their criteria.
Follow your plan’s appeal process, which is outlined in your denial letter or on the insurer’s website. Submit all required documents promptly. Your doctor’s support is crucial for a successful appeal.
Savings Programs for Contrave
If insurance doesn’t cover Contrave, savings programs can help. The CurAccess Program, offered by Currax Pharmaceuticals, provides Contrave for $99/month with free shipping. Medicare Part D and TRICARE patients are eligible, but prescriptions are processed as cash payments. This means costs won’t count toward your insurance out-of-pocket limits.
The Contrave Savings Coupon Card lowers copays to $20-$199, depending on insurance status. Uninsured or cash-paying patients pay no more than $199. Visit contrave.com or call 800-905-5576 to enroll.
Cost-Saving Options for Contrave
- CurAccess Program: $99/month with free shipping, available to Medicare and TRICARE patients.
- Contrave Savings Coupon Card: Pay $20-$199 based on insurance, with a maximum savings of $444.96.
- SingleCare Coupons: Save up to 25%, reducing costs to $610-$700.
- 90-Day Supply: Fill larger prescriptions to cut pharmacy visits and costs.
These programs make Contrave more affordable, even without insurance coverage.
Comparing Contrave Costs
The cost of Contrave varies based on insurance and savings programs. The table below shows estimated costs for a 30-day supply (120 tablets) under different scenarios.
| Scenario | Estimated Cost | Notes |
|---|---|---|
| Retail Price (No Insurance) | $600-$830 | Varies by pharmacy |
| CurAccess Program | $99 | Free shipping, cash payment required |
| Contrave Savings Coupon Card | $20-$199 | Depends on insurance status |
| With Insurance (If Covered) | $20-$200 | Varies by plan tier and copay |
This table helps you compare options and plan for expenses.
Alternatives to Contrave
If Contrave isn’t covered, consider alternatives. Generic phentermine is cheaper but meant for short-term use. Bupropion and naltrexone, Contrave’s ingredients, can be prescribed separately and may be covered by insurance. However, dosing differs, so consult your doctor.
Lifestyle changes, like a reduced-calorie diet and exercise, are cost-free and effective. Some insurers cover nutrition counseling or wellness programs. Discuss all options with your healthcare provider to find affordable solutions.
Working With Your Doctor
Your doctor can help navigate insurance challenges. They can request prior authorization or appeal denials with a Letter of Medical Necessity. Provide them with your insurance details to streamline the process. They can also recommend pharmacies or savings programs.
Regular follow-ups ensure Contrave is effective and affordable. If coverage is denied, your doctor may suggest alternative medications or treatments. Open communication is essential for managing costs.
Lifestyle Changes to Support Weight Loss
Contrave works best with healthy habits. Eating more fruits, vegetables, and lean proteins supports weight loss without extra costs. Walking, cycling, or home workouts are free ways to stay active. These changes reduce reliance on medications.
Stress management and quality sleep also aid weight loss. Some insurance plans cover dietitians or wellness programs, which can complement Contrave. Combining lifestyle changes with medication maximizes results.
Summary
What insurance companies cover Contrave? Private insurers like Blue Cross Blue Shield, Cigna, and UnitedHealthcare may cover it, but coverage varies by plan and often requires prior authorization.
Medicare Part D typically excludes Contrave, though some Advantage plans might include it. TRICARE may cover it with medical justification. Without coverage, Contrave costs $600-$830 monthly, but programs like CurAccess ($99/month) or the Contrave Savings Coupon Card ($20-$199) can help.
Appealing denials, exploring alternatives like phentermine, or adopting lifestyle changes can also reduce costs. Check your formulary and work with your doctor to find the best option.
FAQ
What insurance companies cover Contrave?
Blue Cross Blue Shield, Cigna, and UnitedHealthcare may cover Contrave, depending on the plan. Coverage often requires prior authorization and proof of medical necessity. Check your plan’s formulary for details.
Does Medicare cover Contrave?
Standard Medicare Part D plans rarely cover Contrave, as weight-loss drugs are often excluded. Some Medicare Advantage plans may offer coverage. Contact your plan administrator to confirm.
How can I lower Contrave’s cost if insurance doesn’t cover it?
Use the CurAccess Program for $99/month with free shipping or the Contrave Savings Coupon Card for $20-$199. SingleCare coupons can also reduce costs. Ask your pharmacist about discounts.
Can I get Contrave’s ingredients separately?
Yes, bupropion and naltrexone can be prescribed separately and may be covered by insurance. Dosing differs from Contrave, so consult your doctor. This option can be more affordable.