Contrave stands out as an oral option for weight management in a world full of injectable treatments. This pill combines naltrexone and bupropion to target appetite and cravings at the brain level. For many adults facing obesity, it offers a convenient way to support diet and exercise efforts without needles.
The high cost without help often stops people from starting. A one-month supply runs $500 to $840 at full price, depending on the pharmacy. Patients frequently search for what insurance pays for Contrave to make it affordable in 2025.
This guide covers everything from plan specifics to savings tricks, so you can plan your next steps with confidence.
What Is Contrave and Who Qualifies for It?
Contrave comes as extended-release tablets taken twice daily after a dose ramp-up period. It helps adults with a BMI of 30 or higher lose 5–10% of body weight on average when paired with lifestyle changes. Those with BMI 27+ and conditions like hypertension or type 2 diabetes also qualify.
The FDA approved it in 2014 for chronic use, not short-term. No generic exists yet due to patent protection until around 2030. This keeps prices steady but limits options for budget-conscious users.
What Insurance Pays for Contrave? The Direct Answer
Few insurance plans fully pay for Contrave in 2025 because it falls under weight-loss medications, often seen as optional benefits. Medicare Part D and most Medicaid programs exclude it nationwide. About 30–40% of commercial plans cover it partially, but only after meeting strict criteria like BMI thresholds and prior authorization.
Coverage shines in employer-sponsored plans from big companies that added obesity benefits post-2024. Expect copays of $100–$600 monthly when approved, but denials are common without documentation.
How to Secure Coverage for Contrave Under Your Plan
Step 1: Review Your Plan’s Formulary and Benefits
Search your insurer’s website or app for “Contrave” or “naltrexone/bupropion.” Note if it is Tier 3 (higher cost) or requires step therapy, like trying phentermine first. Call the member services line for details on weight-loss riders.
Step 2: Gather Medical Documentation
Track your BMI, weight history, and any comorbidities like high cholesterol or prediabetes. Log 3–6 months of failed diet/exercise attempts with a doctor’s note. This proves medical necessity for approval.
Step 3: Request Prior Authorization from Your Doctor
Your prescriber submits a PA form online or by fax, including diagnosis codes (E66.01 for obesity) and trial failures. Most PAs need this step; approvals take 3–14 days. Follow up weekly if delayed.
Step 4: Appeal Denials and Explore Exceptions
If denied, your doctor can resubmit with more evidence, like heart risk data from trials. Some plans allow peer-to-peer reviews between your doctor and their medical team. Switch pharmacies if one rejects the claim.
Coverage Breakdown by Insurance Type in 2025
| Insurance Type | Typically Pays for Contrave? | Key Requirements for Coverage | Average Out-of-Pocket Cost When Covered |
|---|---|---|---|
| Medicare Part D | No (excluded benefit) | N/A; some Advantage plans may via PA | Full price $500–$840/month |
| Medicaid | Rare (state-dependent) | BMI 30+; PA in covering states like CA, NY | $0–$10 in approved states |
| Commercial/Employer Plans | Yes in 30–40% of plans | BMI 27–30+ with comorbidity; 3-month lifestyle trial | $100–$600/month (copay/coinsurance) |
| Marketplace (ACA) Plans | Limited | Varies by metal tier; often PA required | $200–$700/month |
| Tricare/VA | No | Limited to specific programs; PA needed | Full price or $0–$30 in rare cases |
Why Coverage for Weight-Loss Drugs Like Contrave Remains Spotty
Insurers view Contrave as a lifestyle aid rather than essential care, despite obesity’s links to heart disease and diabetes. High demand for similar drugs like Wegovy strains budgets, leading to exclusions. Federal rules block Medicare from covering anti-obesity meds, influencing private plans too.
Recent 2024 studies on long-term benefits have nudged some employers to expand, but premiums rise as a result. States with high obesity rates push for Medicaid changes, yet only a few act yearly.
Specific Plans and Employers Offering Contrave Coverage
Certain providers stand out for easier access in 2025. UnitedHealthcare covers it under many employer plans with PA for BMI 30+ and a 3-month diet trial. Cigna approves for 4 months initially if you lose 5% body weight, then extends.
Blue Cross Blue Shield varies by state affiliate; Michigan and Texas often include it as preferred over pricier injectables. Large employers like Walmart and IBM added weight-loss riders covering Contrave fully after advocacy efforts. Check your HR portal for updates.
Manufacturer Savings and Assistance Programs
Currax Pharmaceuticals runs the CurAccess program, capping costs at $99/month with free shipping for uninsured or denied patients. It works by routing through partner pharmacies that handle PAs too.
The Contrave Savings Card drops copays to $20 for commercial plans that cover it partially. Medicaid users cannot use the card but qualify for CurAccess as cash-pay. Apply online; activation takes minutes.
Navigating Denials and Building a Strong Case
Denials often cite missing PA or unmet BMI rules. Keep records of all communications and resubmit within 30 days. Patient assistance foundations like PAN cover full costs for low-income qualifiers under 400% federal poverty level.
Switch to telehealth providers specializing in weight management; they handle PAs routinely with high success rates.
Affordable Alternatives When Contrave Isn’t Covered
Oral options like phentermine ($10–$30/month) suit short-term use, while Qsymia ($100–$200) mirrors Contrave’s combo approach with better coverage odds. Generic bupropion alone helps some with cravings at $20/month.
For injectables, Wegovy gets more approvals but costs $300–$1,300 without help. Lifestyle apps with coaching often pair free with employer wellness perks.
Tips for Long-Term Success and Cost Management
Start with a 3-month trial to qualify for extensions; track weight weekly. Pair with free resources like MyFitnessPal for accountability. Renew PAs quarterly to avoid gaps.
Shop pharmacies via GoodRx for $199 cash deals even with insurance. Bulk 90-day supplies cut admin fees when allowed.
Summary
What insurance pays for Contrave boils down to plan type and preparation in 2025. Commercial and employer options cover it most often with PA hurdles, while government programs largely exclude it. Savings like CurAccess make it viable at $99/month regardless. Consult your doctor early, document everything, and explore appeals for the best shot at affordable access.
FAQ
Does Medicare cover Contrave in 2025?
No, standard Part D plans exclude weight-loss drugs like Contrave. Some Medicare Advantage plans might cover via PA, but expect full out-of-pocket costs otherwise. Check your plan’s formulary for exceptions.
How does Medicaid coverage for Contrave vary by state?
It depends on the state; California and New York often cover with PA for BMI 30+, while most others exclude it. Contact your state Medicaid office to confirm eligibility and requirements.
Can I use the Contrave savings card with any insurance?
Yes for commercial plans, capping at $20/month if partially covered. Uninsured pay up to $199 via the card, but Medicaid blocks it—use CurAccess instead for $99.
What if my prior authorization for Contrave gets denied?
Appeal with more doctor notes on trials and comorbidities; 70% succeed on resubmits. Your provider can request peer review or switch to a covered alternative like phentermine.
Is Contrave cheaper than Wegovy with insurance?
Often yes; Contrave copays run $100–$300 versus $400+ for Wegovy. But coverage rates favor injectables in some plans—compare your formulary for specifics.
How long does Contrave prior authorization take?
Typically 3–7 business days for electronic submits, up to 14 for faxes. Mark as urgent if low on supply; follow up directly with your insurer’s pharmacy line.
Dr. Hamza is a medical content reviewer with over 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic conditions. His reviews are grounded in trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Hamza is intended for educational purposes and is not a substitute for professional medical advice.