Is Qsymia Covered By Medicaid


Which Drugs Are Covered By Our Iowa Medicaid Plan

The Preferred Drug List is the list of drugs covered by Iowa Total Care. Iowa Total Care works with providers and pharmacists to ensure that medications used to treat a variety of conditions and diseases are covered. The PDL applies to drugs you receive at retail or mail order pharmacies. Iowa Total Care’s PDL, which is the same as the state’s PDL, is continually evaluated by the Pharmacy and Therapeutics Committee to promote the appropriate and cost-effective use of medications.

To view the Preferred Drug List, .

You can request a copy of the PDL by calling Member Services at 1-833-404-1061.

How Does Qsymia Help People Lose Weight

Qsymia is an oral medication, and the recommended dose of Qsymia is just once per day. It should be stored at room temperature. Made up of phentermine and topiramate in an extended-release form, Qsymia helps people control their hunger and resist food cravings for 24 hours. Phentermine is a fast acting drug that begins to work immediately to reduce your appetite, helping to control hunger. Topiramate is an extended-release drug that provides a feeling of fullness throughout the day and can alter the taste of some foods, which makes eating less enjoyable. As a result, patients are more likely to lose weight when taking Qsymia combined with diet and exercise. The medication is intended only for use in adults with a BMI of 30 kg/m2 or greater, putting them in the obese category, or in adults with a BMI of 27 kg/m2 or greater when combined with at least one medical condition resulting from being overweight, such as high cholesterol, high blood pressure, or type 2 diabetes. Qsymia must be used in conjunction with a doctor-approved program that includes exercise, behavioral changes, and a reduced-calorie diet.

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How Much Does Qsymia Cost

Qsymia is still manufactured under the original patent issued to the manufacturer, which means that no generic version of the drug is currently available. The manufacturer offers a flat 98 dollar purchase price across all doses when Qsymia is purchased from their website through a program called Qsymia Engage with a prescription. However, it is possible to save even more on the cost of the medication by using a pharmacy discount card. Pharmacy discount cards offer savings on all FDA-approved medications, including both brand name and generic prescriptions. When purchased using a pharmacy discount card, Qsymia can be purchased for less than 70 dollars per month, saving patients nearly 30 dollars per month. Qsymia is not covered by most commercial insurance programs, and it is not covered by Medicare and Medicaid plans. The two primary ways of saving on the drug include purchasing through the manufacturers website and using a pharmacy discount card at local pharmacies that carry the medication. Because of the risk of serious birth defects, only doctors and pharmacies trained in Qsymias distribution program, Qsymia REMS, should prescribe or dispense the medication.

View General Prescription Drug Lists

FREE 12+ Sample Letter of Medical Necessity Forms in PDF

View the lists below to find general pharmacy benefits information for UnitedHealthcare plans, including certain PDLs. Remember, this is only general information. Sign in on or call the number on your health plan ID card to see your PDL and get specific information about your pharmacy benefits.

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While Belviq Is Slated To Launch In Early 2013 Qsymia Launched This Past September And Monthly Costs For Qsymia Range From $120 To $184 Depending On The Dose

The monthly savings offer card requires an activated program id prior to use. Without insurance, the price of wegovy would be out of reach for many. The patient has a body mass index 30 kg/m2 Unfortunately, coverage for obesity care and weight loss medications can be hit or miss. While belviq is slated to launch in early 2013, qsymia launched this past september , and monthly costs for qsymia range from $120 to $184, depending on the dose. Ask your patients to check their plans for details.

If you become pregnant while taking qsymia, stop taking qsymia immediately, and tell your healthcare provider right away. A valid prescription for qsymia is required at the time of redemption. Without insurance, the price of wegovy would be out of reach for many. Even without insurance, the cost for either is well under 100 dollars per month. Choose qsymia for your patients covered by these plans.

Individual and family medical and dental insurance plans are insured by cigna health and life insurance company , cigna healthcare of arizona, inc., cigna healthcare of illinois, inc., and cigna healthcare of north carolina, inc. Compare, research and select an online doctor. Generics for phentermine and topiramate exist. Caps the monthly cost of qsymia at $98, regardless of dose. Qsymia is now covered on the majority of commercial healthcare plans!

List Of Drugs Change Notice

Drugs may be added or removed from our list of drugs during the year. Generally, we will tell you before the following changes are made to the list of drugs.

  • Remove a drug from the list
  • Change drug requirements
  • Move a drug to a higher cost sharing tier

If the Food and Drug Administration or the drugs maker says a drug is not safe, it will be removed from our list of drugs right away. To view the changes, open the PDF list below.

If you have questions about our list of drugs, or want the most recent version, . We are here to help.

Our list of drugs shows the drugs we cover. The list includes:

  • Medicare Part D drugs
  • Some Medicaid covered prescription and over-the-counter drugs and items

In general, we cover drugs if they are medically necessary. Drugs on the list of drugs are covered when you use our network pharmacies or mail order program for maintenance drugs. Maintenance drugs are drugs you take for a chronic or long-term condition. Some drugs we cover have limits or other rules.

The Pharmacy and Therapeutics Committee, our team of independent healthcare experts, reviews and approves the list of drugs. We dont include all drugs. Some drugs may not be covered or are excluded. Other drugs are not on the list because of clinical and cost reasons.

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Is Qsymia Covered By Insurance Idea

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Is Qsymia Covered By Insurance. Even though weight loss is important to holistic health, it is considered a lifestyle concern under medicare insurance regulations, and therefore, weight loss medications like qsymia are generally not covered. Qsymia is now covered on the majority of commercial healthcare plans! Group health insurance and health benefit plans are insured or administered by chlic, connecticut general life insurance company , or. Choose qsymia for your patients covered by these plans.

Weight Loss Drug Qsymia Side Effects BMI Formula From

What Conditions Is Qsymia Used To Treat

Qsymia is a weight loss drug by Vivus, Inc. that is designed to help obese adults and some overweight adults lose weight and keep it off. The majority of patients who use Qsymia are classified as obese, meaning they have a body mass index of 30 kg/m2 or greater. However, the medication can also be used in adults whose BMI classifies them as overweight if they have a coexisting medical condition that is related to their weight. Weight-related medical conditions include high blood pressure, dyslipidemia, high cholesterol, and type 2 diabetes. Qsymia is not a weight loss product intended for patients who only have a small amount of weight to lose, as it has the potential to be addictive and should only be used when the benefits outweigh the risks.

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Who Should Not Take Qsymia

Qsymia can be a helpful weight loss tool for some people, but it is not right for everyone. People who should not take Qsymia include:

  • Women who are pregnant, planning to become pregnant, or who become pregnant while taking Qsymia
  • People with glaucoma
  • People with thyroid problems, including hyperthyroidism
  • People taking medications called monoamine oxidase inhibitors or people who have taken MAOIs in the past 14 days
  • People who are allergic to topiramate, sympathomimetic amines like phentermine, or any of Qsymias ingredients

There are also potential drug interactions, and you should seek prescribing information and medical advice if you take zonisamide, valproic acid and other antiepileptic drugs, or if you take any type of amphetamine.


How To Get Qsymia Prescribed

If you are interested in exploring potential pharmaceutical weight loss options, schedule an appointment with your primary care doctor. If he or she does not prescribe Qsymia, consider speaking with a weight loss clinic or specialist .

Qsymia is a schedule IV-controlled substance, so it is NOT available without a prescription

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How Do I Search For A Drug In The List Of Drugs

You can search for a drug by using either the drug search tool by clicking the link below or by opening the List of Drugs PDF document below. Each option gives you a complete list of covered drugs and any restrictions or limits. The search tool also shows you covered drug alternatives.

The PDF document lists drugs by medical condition and alphabetically within the index. To search for your drug in the PDF, hold down the Control and F keys. When the search box appears, type the name of your drug. Press the Enter key. You also have the option to print the PDF drug list. The drug list is updated monthly.

How To Request A Medicine Not On The Pdl

FREE 12+ Sample Letter of Medical Necessity Forms in PDF

You can ask for a medicine that is not on our preferred drug list. This is called asking for an exception. To ask for an exception, please fill out an exception request form and submit it. Select your state from the list above and click the GO button to get the link to this form. When you are done, click Submit Request. Our Pharmacy department will look at your request and give you an answer within 72 hours

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Does Medicare Cover Qsymia

Maintaining a healthy weight is one of the cornerstones of achieving overall health. Obesity can lead to serious problems within the cardiovascular system, including high cholesterol, coronary artery disease, heart attack or stroke. Additionally, extra weight may lead to the development of diseases like cancer, and the stress that added body weight puts on bones and joints can lead to the breakdown of connective tissue over time.

Unfortunately, as people age, losing weight often becomes more difficult, and this can be compounded due to aching joints, increased fragility and decreased mobility with age. While you should always consult with your physician prior to adding to or changing an exercise routine or dietary regimen, you may also consider discussing weight loss medications like Qsymia to lose weight by changing the way the body and brain process hunger signals.

What is Qsymia?Qsymia is a prescription drug developed by Vivus. It provides additional assistance to individuals who have found it difficult to lose weight or maintain a healthy weight by reducing appetite and diminishing cravings through the alteration of taste bud function.

Finally, you may receive a discount on Qsymia through a Medicare Advantage plan via discounted premiums, deductibles or reimbursement for certain medication expenses that are not covered directly. Check with your plan directly for more information about costs and coverage.

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What Is Iowa Medicaid Specialty Pharmacy Coverage

A specialty drug is a prescription drug that requires special handling, administration, or monitoring. These are usually only ordered through a specialty pharmacy.

If you are unsure whether your current medication is a specialty drug, please review our Specialty Pharmacy Program. It has a list of specialty drugs, plus more information about them.

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What Risks Are Associated With Qsymia

There are numerous risks associated with Qsymia, but two of the most significant are the risk of serious birth defects and the risk of dependence or abuse when taking the medication. Qsymia should never be taken by women who are pregnant or planning to become pregnant, as the medication greatly increases the risk of birth defects even when taken very early in a pregnancy, such as before a woman knows she is pregnant. The most common birth defects associated with Qsymia use during pregnancy include cleft lip and cleft palate. Women who are capable of becoming pregnant should receive a negative pregnancy test result prior to taking Qsymia and should test monthly while taking the medication to ensure that they have not become pregnant. They also must use effective birth control consistently while taking Qsymia. If a woman becomes pregnant while taking Qsymia, she should stop taking the medication immediately and notify her healthcare provider.

  • Sudden decrease in vision with or without eye pain
  • Redness or blockage of fluid in the eye causing increased pressure in the eye

Idaho Medicaid Pharmacy Program

The goal of the Idaho Medicaid Pharmacy Program is to provide quality care to Medicaid participants with the most effective drug at the right price. Magellan Medicaid Administration, Inc. is the Idaho Medicaid Pharmacy Benefit Management contractor.

Idaho Medicaid Pharmacy call centerCall: 208-364-1829 OR toll free 866-827-9967 Fax: 800-327-5541

  • For prior authorization status inquiries, call Magellan Medicaid Administration Pharmacy Support Center at 800-922-3987

Prior authorization faxMagellan Medicaid Administration Pharmacy Support CenterProvider line: 800-922-3987 Participant line: 888-773-9466

  • Drug coverage and payment information
  • Eligibility issues or inquiries

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Qsymia: What Is It And How Much Does It Cost

The Centers for Disease Prevention and Control, or CDC, estimates that approximately 42.2 percent of the United States adult population is obese as of 2017-2018, representing an increase of nearly 12 percent since 1999-2000. The obesity epidemic, as the situation is often described, costs an estimated 147 billion dollars a year in annual medical costs, with people who are obese paying approximately 1,429 dollars per year in medical costs compared to people who are at a normal body weight. Unfortunately, being obese or even overweight is associated with a wide range of different weight related comorbidities including heart disease, heart attacks, and general heart problems, type 2 diabetes mellitus, chronic back pain, stroke, high blood pressure, high cholesterol, and even some types of cancer. More and more Americans need to get their weight under control before they experience significant health issues, but many people have tried to lose weight for years with little to no success. Qsymia is a prescription medication that can help people who are obese or who are overweight and have a weight-related medical condition lose weight when used in conjunction with a reduced-calorie diet, exercise plan, and behavioral changes. Many people would benefit from a medication like Qsymia, but how much does it cost?

Where To Fill Your Prescription

Qsymia is available from most major pharmacies in the United States, including certified mail-order pharmacies.

Due to its drug schedule, these capsules are not available from all online pharmacies. At this time, Qsymia prescriptions can only be filled in-person or through the following certified mail-order pharmacies: Walgreens, Walmart and Kaiser Permanente (

15mg / 96mg $206-$220

NOTE: These prices are only estimates and do not represent any type of guarantee or coupon. Updated March 2019 .

When compared to the cost of other phentermine pills, Qsymia is an expensive option. More, weight loss medications are NOT covered under most insurance plans, including Medicaid in most states .

Thankfully, VIVUS, Inc. offers a generous manufacturers discount. The Qsymia Advantage program entitles you to two weeks free of the starter dose , caps the monthly cost of Qsymia at $98 for any dose and provides an at-home delivery service.

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Where Can I Get My Prescription Filled

To find a pharmacy that is in the Iowa Total Care network, you can use the Find a Doctor tool.

Type in your city or zip code into the Find a Doctor search bar. Then click Update.

Choose Other and type the name of your pharmacy.

You can also select the pharmacy type in the Select Specialty area. Only those pharmacies in the Iowa Total Care network are listed.

Explore The Benefits Offered By Iowa Total Care

FREE 12+ Sample Letter of Medical Necessity Forms in PDF

Iowa Total Care covers most prescription medications for our Iowa Medicaid members. Some prescriptions require prior authorization and may have limitations based on age or the amount of medicine prescribed. Iowa Total Care also covers certain over-the-counter medications with a prescription from an Iowa Total Care provider.

If you have questions about which drugs or prescriptions are covered by your Medicaid plan, we lay out your Iowa Medicaid prescription drug coverage below and how to find a pharmacy within the Iowa Medicaid network.

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