Does Blue Cross Blue Shield cover Contrave?

In this article:

• Does Blue Cross Blue Shield cover Contrave?
• How to get approved
• How much does Contrave cost?
• How to check if you're covered
• How to save

In this article

• Does Blue Cross Blue Shield cover Contrave?
• How to get approved
• How much does Contrave cost?
• How to check if you're covered
• How to save

In 2024, 55% of Americans said they would like to lose weight, according to a Gallup survey. In recent years, many people have been turning to weight-loss medications like Contrave (naltrexone/bupropion) to help. Contrave has been proven to help increase dopamine and reduce appetite, leading to decreased body weight for many people. But those benefits come at a cost, which might leave you wondering if insurance will cover it.

If you have Blue Cross Blue Shield (BCBS) health insurance, it might cover Contrave, but it all depends on the plan and your specific medical condition. Read on for details.

Does Blue Cross Blue Shield cover Contrave?

Sometimes, yes. Sometimes, no. Here’s why: The Blue Cross and Blue Shield Association is actually a collection of 33 independent companies and licensees, each providing service to different states. Each of these companies has its own health plans and policies, which means there are many different BCBS plans out there, and the prescription drug coverage criteria can vary.

Some plans may cover weight management medications like Contrave, but others might not. Here are a few of the factors that may determine your plan’s coverage.

Medical Condition

Some BCBS plans might have requirements you need to meet before receiving coverage for Contrave. For example, Contrave is FDA-approved for adults with a body mass index (BMI) of 30+, or a BMI of 27+ with at least one weight-related health condition like high blood pressure (hypertension), Type 2 diabetes, or high cholesterol. Often, insurance plans will only issue coverage for people who meet these requirements.

Formulary

This is a drug list that shows how the plan classifies and covers different drugs. Most plans will sort medications into various tiers, with generics occupying the lowest tier, then preferred brands, then non-preferred brands, and specialty drugs on the higher tiers. Typically, the lower tiers receive better coverage, and the highest tiers receive much less, or none at all.

Some plans will list Contrave as a non-preferred brand, while others might prefer it to expensive GLP-1 drugs like Wegovy or Saxenda. The only way to know for sure is to check your plan’s formulary. Even then, some copays, deductibles, or co-insurance might apply.

Even when a plan doesn’t cover brand-name Contrave, it might cover generic naltrexone and bupropion individually. Neither of these is a suitable substitute for Contrave by itself, but some healthcare providers may prescribe them together. You just have to be careful to follow their dosage instructions and follow up with your healthcare provider. 

Note: Medicare does not cover any weight-loss drugs, so you likely won’t receive coverage if you have a BCBS Medicare plan.

Prior Authorization

For certain brand-name drugs (particularly expensive ones), insurance companies will want to confirm that they are medically necessary before providing coverage. This is called prior authorization. Not every plan requires prior authorization, but if so, it will be listed on the formulary. 

How to get approved for Contrave

The first step in getting approved for Contrave is visiting your healthcare provider. They will likely perform a physical exam, ask you some questions about your lifestyle habits, and record your height and weight to determine your BMI. Tell your healthcare provider you are interested in trying Contrave, and they will let you know whether they think it’s a good option for you.

If your BCBS plan requires prior authorization, the healthcare provider may also need to submit additional paperwork, such as documentation of specific symptoms, conditions, side effects to other drugs, or even notes on prior weight management programs.

Sometimes, BCBS requires a process called step therapy. This is when you need to attempt a diet and exercise plan for a certain amount of time first, or other, less expensive drugs, before moving on to Contrave. 

“That said, it’s crucial to recognize who should not take this medication,” says Dr. Logan G. Galbraith, MD, a physician at Invigor Medical. “Contrave should not be used by individuals who are currently taking opioids or have a history of opioid dependence, as it can trigger withdrawal symptoms, which can be severe and may require hospitalization.”

Additionally, Contrave may interact with monoamine oxidase inhibitors (MAOIs), opioids, other weight loss drugs, some seizure medications, some diabetes medications, and other medicines. That’s why “if someone is considering Contrave, it’s essential they consult with their healthcare provider to review their current medications and medical history, since the biggest risk would be a bad interaction,” Dr. Galbraith says.

How much does Contrave cost?

Like many prescription drugs, Contrave can be pricey for people paying entirely out of pocket. It may cost around $843 for 120 8-90 mg extended-release tablets—around a 30-day supply. Over an entire year, that can add up to more than $10,000. Fortunately, many people receive assistance from insurance or other sources to help pay for it.

According to Contrave’s website, the lowest people might pay for the drug with insurance coverage is around a $20 copay per month. But again, this depends on the plan. If your plan classifies Contrave as a non-preferred drug, you might have to pay more.

How to check whether your Blue Cross Blue Shield plan covers Contrave 

It’s all about finding your formulary, which are typically available online. Go to the website for your specific independent licensee of BCBS, and you will likely find a “Resources” tab where you can view or download the formularies for each plan. Some websites even have a medication lookup feature where you can select your plan and search for Contrave, and it will give you the coverage details.

You can also find information about your drug list by logging into your member portal. There is also a toll-free number on your member ID card to reach a member support representative who can provide details about your coverage.

How to save on Contrave

If you don’t have health insurance, or your plan doesn’t cover Contrave, don’t panic. There are other ways to save on Contrave and avoid paying the full out-of-pocket cost. For example, SingleCare offers free coupons that can reduce the cost of Contrave from $843 to as low as $614. Annually, those savings can add up to over $2,700. All you have to do is sign up, then present your SingleCare card at a participating pharmacy.

Additionally, Contrave’s manufacturer offers a savings card and a patient assistance program (CurAccess) that can help decrease costs, with or without insurance. And you can always ask your healthcare provider if they know of any other savings or financial resources.

Lifestyle changes can also help you lose weight more effectively while taking Contrave, so you might not need to take it as long. “We know that behavior modification remains one of the most effective approaches to weight loss, especially since there’s no ‘magic’ fat burner currently on the market,” Dr. Galbraith says.

Either way, talk to your healthcare provider. They can help you find savings and develop a personalized weight-loss plan.