Medical weight loss programs available online

To help you prepare for your first doctor's visit, it is helpful to gather the following information:  

• List any other medications (if any) you previously tried for your specific condition, along with the corresponding dates of use and why you feel the medications did not work for you.  

• If you have specific lab results that support your need for the medication, you can upload it to your chart before your first doctor’s visit or email it to info@plushcare.com.    

• If you are seeking weight loss medication, please provide documentation and/or receipts from any earlier diet/exercise programs. 
  
  

The concept of weight management refers to maintaining your goal weight long term. After losing weight, you will need to continue many of the diet and lifestyle modifications you initially made to lose the weight, to keep the weight off. Our doctors make weight management easy, continuing to monitor your treatment progress after you reach your goal weight, to ensure sustainability.

Our board-certified doctors can prescribe weight loss medications, after conducting an initial doctor consultation online and ordering any necessary evaluations to the lab nearest you. After completing any necessary testing, your doctor will discuss the best medication options for you. It is important to note that medication is only effective in combination with healthy lifestyle changes.

Most branded weight loss medications require a prior authorization in order for insurance to cover the cost. Your PlushCare physician and care team will reach out to your insurer on your behalf, and this process can take several business days. If you are denied the prior authorization or do not have health insurance, you may still purchase the medication at the full cash price.

Medical weight loss programs are effective because they incorporate dietary and lifestyle changes in addition to effective medication, under supervision of a board-certified doctor. Medication for weight management is an effective component in losing and keeping off weight, but only when complemented by appropriate dietary choices and exercise.

Yes, we are in network with most major insurance providers. You'll have the option to search for and select your insurance provider when you book an online appointment in order to determine if your insurance is in network.

It is important to know that not every insurance plan will cover the cost of medications.  Prior to seeing your medical provider, we recommend checking your plan’s benefits to see if weight loss medicine is covered, and if so, for what particular diagnoses. Most branded weight loss medications require prior authorization in order for insurance to cover the cost. Your doctor and care team can reach out to your insurer on your behalf, which can take several business days. If you are denied the prior authorization, you can still purchase the medication at the full cash price.

Our weight loss program can help you get to a healthy weight. If you have type 2 diabetes, a BMI of 30, or a BMI of 27 with one weight-related medical condition, you may be a candidate for medications such as Wegovy®, Saxenda®, Topiramate, Wellbutrin, or Contrave® for weight loss, or diabetes medications such as Ozempic® and Mounjaro®.

BMI is calculated by dividing an individual's weight in kilograms (kg), by the square of their height in meters (m2).

We do not treat patients with symptoms of an active eating disorder with weight loss medication, including bulimia nervosa, anorexia nervosa, or binge eating disorder. But don't worry - even if you aren't enrolled in the weight loss program, you can still join PlushCare and speak with a doctor about any of your health concerns.

Weight loss should begin with healthy lifestyle modifications, including incorporating a healthy diet and regular exercise plan. To learn more about weight loss treatment plans and find the best approach for you, talk to one of our doctors today about your options.

There is scientific evidence that losing 5-10% of your body weight can improve many obesity-related conditions including diabetes, high blood pressure, cardiovascular disease, high cholesterol, and more.

Yes, we are in network with most major insurance providers.

However, most branded weight loss medications require prior authorization in order for insurance to cover the cost. Your PlushCare physician and care team will reach out to your insurer on your behalf, and this process can take several business days. If you are denied the prior authorization or do not have health insurance, you may still purchase the medication at the full cash price.

Prices vary depending on the medication type, and whether or not you use insurance to pay for it. Most branded weight loss medications require prior authorization in order for insurance to cover the cost. We recommend checking with your insurance to see if these weight loss medications are covered as they usually cost about $1000 per month out of pocket. With our in-app Rx Discount Card, patients have saved from 7-20% on these medications.

While you are scheduling your second weight loss visit, you will be asked for your insurance information. This includes your insurance RX number, BIN number, PCN number, insurance identification number, and your address listed with your insurance provider.  This information is often listed on your insurance card. If you have any trouble finding this information or need to confirm information on file with your insurance, please contact your insurance before filling out our PA form. 

Our information will need to match your insurance provider’s information. If the information does not match their records, there may be delays in processing your prior authorization. If we need more information, we will reach out to you for clarification. Please make sure you check your email regularly in case we reach out to you. If you were not asked for this information or there are changes to this information since you submitted it, please email info@plushcare.com so that we can process your prior authorization. 

If applicable, please list the other medications you previously tried for your specific condition. You will want to list the dates you took these medications and why these medications did not work for you. If you have specific lab results that support your need for the medication, you can also send that to our prior authorization department when filling out your prior authorization Form.  If you are applying for weight loss medication, please provide documentation / receipts from any earlier diet/exercise programs.

The information that we need to submit your prior authorization is collected in your doctor appointments, by getting your lab work done, and by entering your insurance information before your second visit. 

Our prior authorization process starts automatically once your doctor prescribes medications to treat weight loss or  type 2 diabetes. You will receive a confirmation email that your information was received and in the queue. It usually takes 3-7 business days for our team to compile the necessary information to submit your PA, but this can vary. If we need more information from you, we will reach out via email.  Please make sure that you check your email regularly.  The prior authorization can be delayed if we do not have all the information that we need to submit a complete PA.    If you were prescribed a medication that needs a prior authorization and you did not receive a confirmation email from us, please reach out to our support team. 

If you have a change in your demographics or insurance information, please contact info@plushcare.com so that we can submit your PA with the correct information and avoid unnecessary PA denials. 

If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed, you can let us know by calling 1-888-729-0438 or by emailing info@plushcare.com. You may be asked to fill out a short intake form with information about your insurance and prescription history. 

Once your PA is submitted, you’ll receive an email titled “PRIOR AUTH SUBMISSION”. Your insurance will now review the documentation provided and issue a determination. The insurance processing times vary; the average is 7-14 days. We’ll notify you once we receive an outcome. Sometimes your insurance will send you an PA outcome without sending it to us. If you receive a PA outcome and have not heard from us, please send a photo of your letter to us. 

If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION”. You can also contact your pharmacy benefit plan directly. If you contact your plan, please call your pharmacy benefit manager (PBM) as they will handle the prior authorization for your prescription and not your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card- common PBMs are ExpressScripts, CVS Caremark, and OptumRx.  

If you did call your PBM and they do not have your prior authorization, even though you received communication from us that we submitted the prior authorization, please give us a call at 1-888-729-0438. 

Knowing what your insurance plan covers will help you decide on a treatment plan with your doctor. You should look online or call your insurance company to find out if your pharmacy benefits plan (PBM) covers FDA-approved weight loss medications, including Contrave®, Saxenda®, Wegovy®, or Zepbound™.  Ozempic®, Mounjaro®, and Rybelsus® are FDA-approved diabetes medications that are covered only for patients who have type 2 diabetes; these medications are not covered for weight loss. 

Contact your insurance about other weight loss medications:

If your medication is not covered, we advise that you contact your insurance to verify what medications are covered, including details on dosages and if coverage is only for patients with specific diagnoses. Once you know what medications are covered by your plan, book a follow-up with your provider to discuss an alternate medication. As always, prescriptions are up to your doctor’s discretion. Please contact us if you need assistance.

Try a cash pay medication:

Some medications are not covered by insurance, but may be cheaper overall. If you are interested in exploring one of these options, please book an appointment to discuss with your doctor. We are not affiliated with these companies.

Contrave is a cash pay option for $99 dollars for home delivery.

Use your HSA or FSA:

You can save an average of 30% by using pre-tax HSA or FSA dollars for your medications. 

The status of your prior authorization depends on what step you are at within the process: 

If you’ve been prescribed an injectable medication for weight loss or type 2 diabetes, our team will automatically start compiling the necessary information. This usually takes 3-7 business days but can vary. If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed, you can let us know by calling 1-888-729-0438 or by emailing info@plushcare.com. You may be asked to fill out a short intake form with information about your insurance and prescription history.  

Once your PA is submitted, you’ll receive an email titled “PRIOR AUTH SUBMISSION”. Your insurance will now review the documentation provided and issue a determination. On average, prior authorizations can take 7-14 business days to process, however, processing times vary. We’ll notify you once we receive an outcome. Sometimes your insurance will send you a PA determination without sending it to us. If you receive a PA determination and have not heard from us, please send a photo of your letter to us. 

If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION” or contact your pharmacy benefit plan directly. Please make sure you call your pharmacy benefit manager (PBM) as they are responsible for managing the prior authorization for your prescription, rather than your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card- common PBMs are ExpressScripts, CVS Caremark, and OptumRx. 

If you have contacted your PBM and they do not have your prior authorization on file, even though you received communication from us confirming its submission, please give us a call at 1-888-729-0438.