Does Insurance Cover Phentermine for Weight Loss

Many people struggle with weight loss, and phentermine can be a helpful tool. Some insurance plans may cover the cost of phentermine, but it depends on the specific plan and the individual's circumstances.

Typically, insurance companies require a doctor's prescription for phentermine, and the doctor will need to justify its use for weight loss. This is often done through a process called prior authorization, which involves the doctor submitting a request to the insurance company for approval.

Insurance coverage for phentermine varies widely depending on the plan and the individual's insurance provider. Some plans may cover phentermine for a limited time, while others may not cover it at all.

Phentermine is a type of medication that's classified as an appetite suppressant. It's used to help people lose weight by reducing hunger and increasing feelings of fullness.

Phentermine works by affecting certain chemicals in the brain that control hunger and satiety. It's available in both prescription and over-the-counter forms, although the prescription version is more commonly used for weight loss.

Phentermine was first approved by the FDA in 1959 and has been used for decades to help people manage their weight.

Insurance coverage for phentermine varies by program. Medicaid coverage differs by state and is largely dependent upon meeting certain income requirements.

Phentermine is generally not covered by TRICARE or VA benefits because it's primarily used for weight loss, which is often considered a non-essential medication by these plans.

Medicare typically does not cover phentermine because it is classified as a weight loss medication. Coverage policies can vary by plan, and a bill in Congress may change this policy in the near future.

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Medicaid coverage for phentermine is a bit of a mixed bag. It varies by state, and only a handful of state programs cover weight loss medications.

To find out if phentermine is covered by your state's Medicaid policy, you'll need to contact your state's Medicaid agency. They'll be able to tell you if your state covers phentermine and what the requirements are.

Phentermine is covered by Medicaid in only a few states, such as Michigan. If you're eligible for Medicaid, you may be able to get phentermine for free or at a very low cost.

Medicaid will also cover other aspects of treatment, including healthcare provider visits and tests. However, be sure to examine the policies carefully, as only a few states allow Medicaid to pay for weight loss medications.

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Medicare typically doesn't cover phentermine because it's classified as a weight loss medication. This is due to a law that bars Medicare from covering weight loss medication because of past safety concerns.

In 2003, Medicare Part D was launched, but it's still prohibited from covering weight loss medication due to the risks outweighing the benefits. This decision was made after fen-phen, a combination of fenfluramine and phentermine, led to heart valve damage and was removed from shelves in 1997.

However, the Affordable Care Act in 2010 expanded coverage for interventions like bariatric surgery to treat obesity, but it didn't address weight loss medications. This means that Medicare still doesn't cover phentermine, despite the growing recognition of obesity as a disease.

In fact, the American Medical Association has ratified a resolution calling obesity a disease, which should lead to weight loss drugs being covered as medical treatment. The AMA is urging all payers to ensure coverage parity for evidence-based treatment of obesity, including FDA-approved medications without exclusions.

A bill in Congress, the Treat and Reduce Obesity Act of 2023, aims to change this policy and allow Medicare to cover weight loss medications. If passed, this could lead to coverage for phentermine and other weight loss medications.

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Brand-name phentermine can be pricey, but it's not always a straightforward answer. Adipex-P, a brand-name version of phentermine, can cost around $11–25 for a month's supply of 37.5 mg tablets without insurance.

The cost of brand-name phentermine can vary based on factors like location and pharmacy. For example, at Walgreens, Adipex-P costs $20.79 for a 30-day supply of 37.5 mg tablets, while at Walmart, it costs $10.82.

Here's a breakdown of the cost of brand-name phentermine at different pharmacies:

It's worth noting that Lomaira, another brand-name version of phentermine, is only available in one dosage strength and can cost around $21–$41 for a 30-count of 8 mg tablets without insurance.

Phentermine coverage varies greatly depending on your state and insurance plan. Medicaid coverage is largely dependent on meeting certain income requirements, which differ from state to state.

You can contact your state's Medicaid agency to find out if phentermine is covered by your state's Medicaid policy. Only a handful of state programs cover weight loss medications.

Many health insurance plans do not cover weight loss drugs, and Medicare plans also do not cover them. Medicaid covers these drugs in only a few states, such as Michigan.

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Phentermine is generally not covered by TRICARE or VA benefits because it's primarily used for weight loss. TRICARE and VA benefits typically exclude weight loss drugs.

Both TRICARE and VA benefits have similar exclusion policies as Medicare and Medicaid, which also exclude weight loss medications.

Phentermine is considered a non-essential medication by these plans.

To get a prescription for phentermine, you should visit a healthcare provider you trust, either in person or virtually. It's essential to find a physician who is comfortable prescribing phentermine and can walk you through the pros and cons of the medication.

Phentermine is not suitable for everyone, so it's crucial to find a healthcare professional with the right expertise. Dr. Garcia-Webb emphasizes the importance of finding a physician who is knowledgeable about phentermine.

Your primary care physician or family practitioner is a good place to start. If they don't have the necessary expertise, ask for a referral to an obesity medicine specialist. These specialists have the right training and certification to determine if phentermine is a suitable option for you.

If even a SingleCare steeply discounted price for phentermine is difficult to manage, you may qualify for Medicaid. Phentermine will either be free or cost very little if it is covered.

Medicaid coverage differs by state, so it's essential to contact your state's Medicaid agency to find out if phentermine is covered. Only a handful of state programs cover weight loss medications.

To qualify for Medicaid, you'll need to meet certain income requirements, which vary from state to state. You can find eligibility and enrollment requirements by visiting your state's Medicaid website or calling local healthcare officials.

Only a few states allow Medicaid to pay for weight loss medications, so it's crucial to examine the policies carefully.

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Phentermine is considered one of the most affordable weight loss drugs on the market.

Without insurance, generic phentermine can cost around $8–$25 for a 30-day supply, while the brand-name version, Adipex-P, can cost around $11–25 for the same duration.

Many insurance plans, including Medicare Part D, may not cover phentermine because it's a weight loss medication.

Phentermine is a budget-friendly option for those seeking a prescription weight loss aid, costing less than $10 without insurance.

Most insurance plans don't cover weight loss medication, like phentermine, without prior authorization.

If you're looking to save on phentermine, you can use savings cards from the manufacturer or discount cards from prescription discount sites.

Here are some estimated costs of phentermine without insurance: