Paul Sanchez
Qsymia is a prescription weight-loss drug for adults and children 12 years or older with a BMI above a certain threshold. It is not suitable for pregnant women due to the risk of fetal complications. Qsymia is not available for individuals enrolled in any government-funded insurance program that covers prescription drugs, such as Medicare and Medicaid. However, a majority of health insurance plans do cover Qsymia, and patients with commercial insurance coverage can receive discounts on the drug. Without insurance, Qsymia costs $9 per capsule, or $257 per month for 30 capsules.
| Characteristics | Values |
|---|---|
| Cost without insurance | $9 per capsule, or $257 per month for 30, 7.5-46 mg capsules |
| Generic version cost without insurance | More than $250 |
| Cost with insurance | Depends on the plan |
| Commercial insurance coverage | $70 copay |
| Medicare coverage | Not covered |
| Medicaid coverage | Varies by state |
| Medicare Advantage coverage | May provide assistance in paying for Qsymia |
| Availability | Only available at certified specialty pharmacies |
| Discounts | $80 off quantities of 28-30 days for up to 100 subsequent fills |
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What You'll Learn
Medicare Advantage plans may offer assistance in paying for Qsymia
Medicare Part A, for instance, does not cover Qsymia when the drug is administered during an inpatient stay for treatment. However, a Medicare Advantage plan may offer additional assistance in paying for drugs like Qsymia through discounts and negotiated deals with certain prescription drug manufacturers.
You may also 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. For example, if your Medicare co-pay is higher than $197.95, you can save money by using a GoodRx coupon instead.
It is important to note that many major insurance plans no longer cover Qsymia as of 2019. Qsymia is also not available for individuals enrolled in any government-funded insurance program that covers prescription drugs, such as Medicare.
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Qsymia is not covered by government-funded insurance programs
Qsymia is a prescription weight-loss drug that combines phentermine and topiramate extended-release. It is indicated for use in adults and children aged 12 and above who are obese or overweight with weight-related medical problems. Qsymia is not available for individuals enrolled in any government-funded insurance program that covers prescription drugs. This includes programs such as Medicaid, Medicare, TRICARE, VA, Department of Defense, and Indian Health Service.
This means that if you are enrolled in any of these government-funded insurance programs, you will not be able to receive coverage for Qsymia through your insurance. You may need to pay out-of-pocket to purchase Qsymia, which can be quite costly without insurance coverage.
It is important to note that Medicare Advantage plans, which are offered by private insurance companies, may provide some assistance in paying for Qsymia. These plans often include additional benefits not found in Original Medicare, and they may offer discounts or negotiated deals with prescription drug manufacturers. So, while Original Medicare does not cover Qsymia, a Medicare Advantage plan might provide some financial assistance.
Additionally, there are other ways to save on Qsymia even if you are enrolled in a government-funded insurance program. For example, the Qsymia Home Delivery Pharmacy offers a $98 pricing for a 30-day prescription or product pack, which includes free standard shipping on all 90-day orders. There is also the Qsymia Savings Card, which offers various discounts depending on the dosage and quantity purchased. These options can help make Qsymia more affordable for those without insurance coverage.
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Qsymia is not covered by Medicare Part A
Qsymia is a prescription weight-loss medication that contains phentermine and topiramate extended-release. It is approved for use in adults and children aged 12 and above who are obese or overweight with weight-related medical issues. Qsymia should be used alongside a reduced-calorie diet and increased physical activity to achieve and maintain a healthy weight.
Medicare Part A is federal health insurance for individuals aged 65 and older, as well as some individuals under 65 with specific disabilities or conditions. It primarily covers inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also provides coverage for hospice care and certain home healthcare services.
Importantly, Qsymia is not covered by Medicare Part A. This means that if you are enrolled in Medicare Part A and receive Qsymia as part of an inpatient treatment stay, the medication will not be covered. However, it is important to note that Medicare Advantage plans (also known as Part C) may offer additional benefits that could provide assistance in paying for Qsymia. These plans may have negotiated deals with prescription drug manufacturers, potentially resulting in discounts or reimbursement for medication expenses not covered by Medicare Part A.
If you are considering Qsymia as a weight-loss option, it is essential to consult with your healthcare provider to determine if it is suitable for you. They can advise you on potential alternatives, such as surgery or lifestyle changes, and help you navigate insurance coverage and costs.
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Qsymia is available at a discounted price for patients paying cash
Qsymia is a weight-loss drug that can be prescribed to Medicare beneficiaries who need to lose weight to achieve health and preserve life. However, as of 2019, many major insurance plans no longer cover Qsymia. This means that the cost of the drug will be much higher without coverage.
Eligible cash-paying patients may save up to $75 per monthly prescription. Patients paying cash or patients whose commercial insurance coverage does not cover Qsymia are eligible to receive $75 off quantities of 28-30 days for up to 100 subsequent fills. These patients are also eligible to receive $70 off 3.75 mg/23 mg dose quantities of 14-15 days for up to 10 subsequent fills.
Commercially-insured patients with coverage for Qsymia are required to cover the first $70 copay. For quantities of 28-30 days, these patients are eligible to receive $65 off for up to 100 subsequent fills. For 3.75 mg/23 mg dose quantities of 14-15 days, they are eligible to receive $65 off for up to 10 subsequent fills.
It is important to note that Qsymia is not available for individuals enrolled in any government-funded insurance program that covers prescription drugs, such as Medicaid, Medicare, TRICARE, VA, Department of Defense, or Indian Health Service.
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Qsymia is not covered by all health insurance plans
Qsymia is a prescription drug used for weight management in adults and children 12 years or older with a BMI above a certain threshold. It is prescribed alongside a reduced-calorie diet and exercise. However, it is not suitable for pregnant women due to the risk of fetal complications.
Medicaid coverage for Qsymia also varies by state. It is not available for individuals enrolled in any government-funded insurance program that covers prescription drugs, such as Medicaid, TRICARE, VA, and the Department of Defense.
The cost of Qsymia without insurance can be high, with a 30-day supply costing around $250 to $270. Therefore, patients without insurance coverage may want to explore alternative weight loss drugs or utilize savings programs and discount cards to reduce the cost of Qsymia.
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Frequently asked questions
Medicare does not cover Qsymia, a weight-loss drug. However, Medicare Advantage plans may offer assistance in paying for drugs like Qsymia through discounts and negotiated deals with certain prescription drug manufacturers.
Medicaid coverage for Qsymia depends on the state.
Qsymia without insurance costs $9 per capsule, or $257 per month for 30, 7.5-46 mg capsules. The generic version of Qsymia can cost more than $250 without insurance.
A SingleCare prescription discount card can reduce the price of Qsymia to under $200 for a 30-day supply.
Some alternatives to Qsymia include generic phentermine, over-the-counter weight loss drugs, and other prescription medications like Wegovy and Saxenda.
