Contrave is a prescription drug for weight loss. Many want to know what insurance pays for Contrave. This article breaks down coverage in clear, simple terms. It helps you understand costs and options.
Understanding Contrave
Contrave combines naltrexone and bupropion. It reduces appetite and cravings. Doctors prescribe it for adults with obesity or weight-related conditions. It’s used with diet and exercise.
The drug is taken as tablets. A typical dose is two tablets twice daily. Contrave is brand-name only, with no generic version. This affects its cost and coverage.
Why Insurance Coverage Is Important
Contrave can be expensive without insurance. A 30-day supply costs around $662. Insurance can lower this significantly. Knowing what insurance pays for Contrave saves money.
Coverage varies by plan. Some plans cover Contrave fully, others partially. Understanding your plan’s rules avoids unexpected costs.
How Insurance Covers Contrave
Many commercial insurance plans cover Contrave. Coverage often requires medical necessity. Insurers may need proof of obesity or conditions like diabetes. A BMI of 30 or higher is usually required.
Copays vary by plan. They typically range from $20 to $199. Some plans place Contrave in higher copay tiers.
Prior Authorization Needs
Most plans require prior authorization. Your doctor submits paperwork showing why Contrave is needed. This includes your weight history and health conditions. Without approval, you may pay full price.
The process takes days to weeks. Your doctor’s office handles most of it. Follow up to ensure timely approval.
Step Therapy and Limits
Some plans enforce step therapy. You may need to try other drugs first. For example, phentermine might be required before Contrave. If it fails, Contrave may be covered.
Plans may limit supply. A 30-day prescription is common. Some allow 90-day supplies for convenience.
Medicare and Medicaid Coverage
Medicare usually does not cover Contrave. Weight-loss drugs are seen as lifestyle treatments. Medicare Part D excludes them. Part B and Part A offer no coverage.
Medicaid coverage depends on the state. Some states cover Contrave with prior authorization. Others exclude weight-loss drugs. Contact your state’s Medicaid office for details.
Commercial Insurance Plans
Plans like Blue Cross Blue Shield or Cigna may cover Contrave. Coverage requires a diagnosis of obesity or related conditions. Prior authorization is often needed. Check your plan’s formulary for details.
With insurance, copays can be as low as $20. The Contrave Savings Coupon Card can further reduce costs. It’s available through the manufacturer.
Table: Typical Copays for Contrave with Commercial Insurance
| Insurance Provider | Copay Range | Prior Authorization? |
|---|---|---|
| Blue Cross Blue Shield | $20–$100 | Yes |
| Cigna | $30–$150 | Yes |
| United Healthcare | $50–$199 | Sometimes |
Note: Copays depend on your plan. Contact your insurer for exact costs.
Savings Programs and Discounts
Currax Pharmaceuticals offers the Contrave Savings Coupon Card. Insured patients may pay as little as $20. Uninsured patients pay no more than $199. Eligibility rules apply.
The CurAccess Program is another option. It costs $99 per month with free shipping. This is ideal for cash-paying patients.
GoodRx and Other Coupons
GoodRx coupons can lower costs. A 30-day supply may cost $610 with a coupon. Prices vary by pharmacy. Check GoodRx for the best deal.
SingleCare discounts are also available. They can reduce the price by about 25%. Always compare prices before filling.
Factors That Affect Coverage
Your diagnosis impacts coverage. Insurers require proof of obesity or conditions like hypertension. A BMI of 27 with comorbidities may qualify. Your plan’s formulary is also key.
Formularies list covered drugs. Contrave may be non-preferred, leading to higher copays. Check your formulary to confirm coverage.
Pharmacy and Plan Restrictions
Some plans restrict where you fill Contrave. In-network pharmacies offer better rates. Mail-order pharmacies like Ridgeway may be required. They offer free shipping.
Contrave requires a prescription. Only licensed pharmacies can dispense it. Verify your pharmacy’s status with your insurer.
Alternatives to Insurance Coverage
If insurance doesn’t cover Contrave, other options exist. Generic bupropion and naltrexone can be prescribed separately. These are often cheaper and covered by insurance. Doses may differ from Contrave.
Lifestyle changes are another route. Diet and exercise can aid weight loss. A nutritionist or trainer can provide guidance.
Manufacturer Assistance
Currax offers patient assistance programs. These provide Contrave at reduced or no cost. Eligibility depends on income and insurance status. Call 1-800-905-5576 for details.
Online pharmacies may offer discounts. Always use certified pharmacies. Uncertified ones risk selling unsafe drugs.
Tips for Securing Coverage
Start by talking to your doctor. They can submit prior authorization paperwork. Provide your weight history and health details. This strengthens your case.
Contact your insurer early. Ask about coverage, copays, and formulary status. Confirm prior authorization requirements. This prevents delays.
Working with Your Pharmacist
Pharmacists can suggest savings. They may recommend coupons or mail-order options. They can confirm if your pharmacy is in-network. Building a relationship helps.
Ask about 90-day supplies. These reduce costs and trips. Your insurer may need to approve this.
What to Do If Coverage Is Denied
Denials are common due to missing paperwork. Your doctor can resubmit with more details. Include medical records and prior weight-loss attempts. Appeals can overturn denials.
Submit appeals within your plan’s deadline. Your doctor’s letter should explain Contrave’s necessity. Follow up to track progress.
Exploring Other Medications
If Contrave isn’t covered, try other drugs. Phentermine is affordable but has risks. Saxenda or Wegovy may be options. Discuss alternatives with your doctor.
Bariatric surgery is another path. It’s covered by some plans with documentation. Surgery requires major lifestyle changes.
Summary
Understanding what insurance pays for Contrave helps manage costs. Commercial plans often cover it with prior authorization. Medicare typically doesn’t, and Medicaid varies.
Savings programs like the Contrave Savings Card and CurAccess reduce expenses. Check with your insurer and doctor to confirm coverage. With preparation, Contrave can be affordable.
FAQ
Does Medicare cover Contrave?
Medicare does not cover Contrave. Weight-loss drugs are excluded as lifestyle treatments. Patients must use savings programs or pay out-of-pocket.
How much is Contrave without insurance?
Contrave costs about $662 for a 30-day supply. GoodRx or the CurAccess Program can lower it to $99–$610. Prices vary by pharmacy.
What is prior authorization for Contrave?
Prior authorization requires your doctor to prove medical necessity. Insurers review this before approving coverage. It may delay treatment.
Can I use the Contrave Savings Card with insurance?
Yes, insured patients can use the Savings Card. Copays may drop to $20. Check eligibility at contrave.com.
What if my insurance denies Contrave?
Appeal with your doctor’s help. Provide medical records and weight-loss history. Consider generic bupropion and naltrexone as alternatives.