Is Contrave Covered By Blue Cross Blue Shield?
Sometimes.
BCBS coverage for Contrave may be available for chronic weight management if specific requirements are met.
Contrave is FDA-approved for adults with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related condition. Coverage is inconsistent across BCBS plans, and prior authorization is usually required.
Does Contrave Require Prior Authorization?
Yes.
To obtain approval, providers must generally submit:
- A confirmed diagnosis of obesity or overweight with a comorbidity
- Documented failure of lifestyle intervention
- Participation in a structured weight-loss program
- Proposed dosage and treatment plan
Are There Coverage Restrictions?
Yes.
Restrictions may include:
- Age limitation (typically 18+)
- Trial period with weight-loss benchmarks
- Step therapy (trying other medications or non-pharmacologic interventions first)
Is Contrave Covered for Adolescents?
Unlikely.
Contrave is not FDA-approved for patients under 18, and most BCBS plans restrict access accordingly.
What Documentation Is Needed?
A prior authorization request should include:
- BMI and medical history
- Treatment timeline and program participation
- Supporting lab work or comorbidity records
- Physician rationale for using Contrave
What If Coverage Is Denied?
An appeal may be submitted with:
- A detailed letter of medical necessity
- Updated clinical notes
- Documentation of failed prior efforts
Where to Get More Info
- Contrave Savings Program
- FDA Prescribing Info
- Your BCBS member services or plan-specific formulary page
FAQ: BCBS and Contrave Coverage
Does BCBS cover Contrave for weight loss?
Sometimes. Coverage depends on your specific plan and meeting medical criteria.
Is prior authorization required?
Yes. Your doctor must provide documentation of need and previous weight-loss efforts.
Can teens get Contrave?
Not usually. Most plans do not cover it for anyone under 18.
How long does coverage last?
Many plans approve for a limited trial period and require documentation of continued progress.
Are savings or discount cards available?
Yes. Manufacturer coupons may help if insurance denies coverage.
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Medical Disclaimer
This page is for informational purposes only and is not a substitute for medical guidance. Always confirm with your healthcare provider and BCBS plan administrator before beginning treatment.