{"id":633567,"date":"2025-09-16T11:38:49","date_gmt":"2025-09-16T15:38:49","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=633567"},"modified":"2025-10-22T19:30:06","modified_gmt":"2025-10-22T23:30:06","slug":"does-blue-cross-blue-shield-cover-qsymia","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-blue-shield-cover-qsymia\/","title":{"rendered":"Does Blue Cross Blue Shield cover Qsymia?"},"content":{"rendered":"

Qsymia<\/span><\/a> is a brand-name prescription drug that contains the active ingredients phentermine and topiramate. The Food and Drug Administration (FDA) has approved it for <\/span>weight loss<\/span><\/a> and long-term weight management in adults and pediatric patients 12 years and older with <\/span>obesity<\/span><\/a>, as well as adults who are overweight with at least one weight-related health condition, such as <\/span>high blood pressure<\/span><\/a> or <\/span>high cholesterol<\/span><\/a>. Like all weight-loss drugs, <\/span>Qsymia<\/span><\/a> is recommended for use alongside lifestyle changes like a reduced-calorie diet and increased physical activity. If your healthcare provider has prescribed Qsymia, you will want to know if your Blue Cross Blue Shield (BCBS) plan pays for this medicine. The short answer is: Maybe. There are a lot of moving pieces, so you\u2019ll want to check with your plan for more information about coverage and out-of-pocket costs.\u00a0<\/span><\/p>\n

Does Blue Cross Blue Shield cover Qsymia?<\/span><\/h2>\n

It\u2019s hard to say whether BCBS will cover Qsymia (brand or generic) in general. There are a lot of considerations.\u00a0<\/span><\/p>\n

For example, since Qsymia generics have been <\/span>approved by the FDA<\/span><\/a>, some <\/span>formularies<\/span><\/a> (lists of covered drugs and their tiers) may cover generic versions instead of brand-name Qsymia. And even if the formulary lists brand-name Qsymia as a covered drug, that could change. Drug formularies aren\u2019t updated in real time, so the information you find online may not be up to date.\u00a0<\/span><\/p>\n

For instance, the <\/span>BCBS Federal Employee Program<\/span><\/a> currently lists brand-name Qsymia as a covered drug, but this may not reflect the most recent updates if the formulary has since changed to prefer generics.<\/span><\/p>\n

BCBS not only has commercial health insurance plans (such as through an employer), but also Medicare prescription plans and Medicaid plans. Medicare prescription plans currently <\/span>do not cover drugs used strictly for weight loss<\/span><\/a>, which means Qsymia is not covered. Medicaid coverage varies by state, but the majority of insurance plans under Medicaid typically do not cover Qsymia. A new <\/span>federal pilot program<\/span><\/a> starting in 2026 for Medicaid and 2027 for Medicare may allow some plans to cover GLP-1 drugs such as <\/span>Wegovy<\/span><\/a> or <\/span>Zepbound<\/span><\/a> for weight management (injectable drugs that are given as weekly doses)\u2014but this does not affect Qsymia coverage.<\/span><\/p>\n

However, some weight loss drugs are FDA approved for other conditions, too. For example, <\/span>Zepbound<\/span><\/a> (tirzepatide) is FDA approved for long-term weight management, but it\u2019s also approved for moderate to severe <\/span>obstructive sleep apnea<\/span><\/a> in adults with obesity. In cases like this, someone who cannot get coverage for a weight loss medication may be able to get coverage under another use\u2014if their medical provider prescribes it for another FDA-approved indication. This does not apply to Qsymia, however, which is FDA approved only for weight loss.<\/span><\/p>\n

RELATED:<\/b> BCBS Wegovy prior authorization criteria<\/span><\/a><\/p>\n

How much is Qsymia without insurance?<\/span><\/h2>\n

Without insurance or discounts, you can expect to pay about $311 for 30, 7.5 mg\/46 mg capsules of brand-name Qsymia.\u00a0<\/span><\/p>\n

Using your free <\/span>SingleCare discount card<\/span><\/a>, you can pay as low as $173 for brand-name <\/span>Qsymia<\/span><\/a>. And if you fill your prescription with <\/span>generic phentermine-topiramate<\/span><\/a>, you can pay as little as $79 for a one-month supply.<\/span><\/p>\n

The SingleCare card and coupons are accepted at more than <\/span>35,000 pharmacies<\/span><\/a> in the U.S. and Puerto Rico. You can use the discount for your initial Qsymia prescription and for refills.\u00a0<\/span><\/p>\n

How much does Qsymia cost with BCBS?<\/span><\/h2>\n

It\u2019s hard to generalize an average patient responsibility because costs depend on your specific health plan. If you have a BCBS Medicare or Medicaid prescription plan, it is unlikely that Qsymia will be covered. If you have a commercial BCBS insurance plan, and either brand-name or generic Qsymia is included on your formulary, you can get an accurate estimate of your costs directly from your plan.\u00a0<\/span><\/p>\n

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Save up to 80% on Qsymia with SingleCare<\/p>\n\t\t\t

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t

\n\t\t\t\t
\n\t\t\t\t\tQsymia 7.5-46 mg (30 Capsule)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23602 - Newport News, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"Costco\"\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$67.00\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
\n\t\t\t
\n\t\t\t\"CVS\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$98.46\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Qsymia prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t<\/span><\/p>\n

How to check whether your BCBS plan covers Qsymia\u00a0<\/span><\/h2>\n

Since plans vary in their coverage, the most reliable way to find out whether your plan covers Qsymia is to check the formulary for the exact plan of your health insurance company. You can do this by:<\/span><\/p>\n