Contrave is an oral prescription medication that combines naltrexone and bupropion to help adults manage chronic weight issues. It works by targeting areas in the brain that control hunger and cravings, making it easier to stick to reduced-calorie eating and regular activity. Approved by the FDA for people with a BMI of 30 or higher, or 27 with related conditions like high blood pressure or type 2 diabetes, it offers a non-injectable option in the growing field of weight management treatments.
Many seek Contrave as an alternative to newer injectables, appreciating its pill form and dual-action approach. However, affordability often depends on insurance, since the full retail price can exceed $500-$800 monthly. Coverage varies widely across plans, influenced by policy details, employer choices, and evolving guidelines for obesity treatments.
This guide breaks down which insurers typically cover Contrave, what requirements apply, and practical steps to check your options. With accurate information, you can better navigate costs and explore reliable savings paths alongside your doctor’s guidance.
Understanding Contrave and Its Role in Weight Management
Contrave helps reduce appetite and curb food cravings through its unique ingredient blend. Taken as tablets, usually two in the morning and two in the evening, it supports gradual weight loss when paired with lifestyle changes. Clinical studies show average losses of 5-10% body weight over a year for many users.
Doctors prescribe it after assessing eligibility, including BMI and any weight-related health problems. It’s not for short-term use but for ongoing management under medical supervision. Regular follow-ups track progress and adjust as needed.
While effective for some, results depend on commitment to diet and movement. Contrave fits into broader plans that address obesity as a chronic condition. Discussing it openly with your provider ensures it aligns with your overall health goals.
What Insurance Companies Cover Contrave
Coverage for Contrave remains inconsistent because many plans classify weight-loss drugs as elective rather than essential. Commercial policies from major carriers sometimes include it, especially with prior authorization. Government programs like standard Medicare Part D generally exclude it when used solely for weight management.
Private employer-sponsored plans offer the best shot at coverage, particularly larger ones adding obesity benefits. Individual marketplace plans rarely cover it fully. Checking your specific formulary is essential, as lists change yearly.
Major insurers like Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield may provide partial or conditional coverage. Factors such as BMI documentation, failed prior attempts at weight loss, and demonstrated progress influence approvals. Always verify directly with your plan.
Coverage by Major Private Insurers
Aetna often covers Contrave under certain formularies, though prior authorization is common. Plans may require proof of medical necessity and lifestyle efforts. Some list it as non-preferred, leading to higher copays.
Cigna includes Contrave in select policies, frequently limiting initial coverage to four months. Extensions depend on achieving at least 5% weight loss. Prior authorization paperwork from your doctor is typically needed.
UnitedHealthcare provides coverage in many commercial plans, with guidelines outlining authorization periods. It may align Contrave with other agents like Qsymia for similar criteria. Employer variations affect final decisions.
Blue Cross Blue Shield varies by state and plan type. Some BCBS affiliates prefer Contrave over costlier injectables. Checking the specific formulary or contacting member services clarifies status.
Other carriers, including Humana in certain cases, may offer it conditionally. Employer self-insured plans sometimes impose stricter rules, like minimum BMI or program participation. Direct inquiries prevent surprises.
Medicare and Medicaid Coverage Details
Standard Medicare Part D excludes Contrave for weight loss purposes, following federal rules against covering such drugs. Some Medicare Advantage plans might include broader formularies, but most follow the exclusion. Medigap supplements don’t alter prescription coverage.
Medicaid coverage differs by state, with many programs not including Contrave. A few states cover select weight management meds, but Contrave rarely qualifies. Contact your state’s Medicaid office for current policy.
TRICARE and VA benefits generally limit weight-loss drug access. Exceptions occur rarely and require specific approvals. For seniors or those on government plans, alternative savings become key.
What Insurance Companies Cover Contrave: A Comparison Overview
Plans differ in approval ease, copay levels, and restrictions. Commercial options lead in potential coverage, while government ones lag. Prior authorization is a frequent hurdle across most.
The table below compares typical coverage patterns among major players, based on recent formulary trends and policy updates. Note that individual plans vary, so confirm details personally.
| Insurance Provider | Typical Coverage for Contrave | Common Requirements | Notes on Copays/Deductibles |
|---|---|---|---|
| Aetna | Often covered with PA | BMI ≥30 or ≥27 with conditions, prior weight loss attempts | Higher for non-preferred; varies by plan |
| Cigna | Covered in select plans | PA required, 5% weight loss for continuation | Initial 4-month limit common |
| UnitedHealthcare | Covered under many commercial | PA, lifestyle documentation | Employer plans more likely |
| Blue Cross Blue Shield | Varies by state/affiliate | Formulary check essential | Some prefer over injectables |
| Medicare Part D | Rarely covered for weight loss | Excluded unless other indication | No standard coverage |
| Medicaid (state-dependent) | Limited or none | State-specific rules | Few states include |
This overview highlights trends but isn’t exhaustive. Coverage evolves, especially as obesity treatments gain recognition for long-term health savings.
Prior Authorization and Approval Process
Prior authorization requires your doctor to submit evidence supporting Contrave use. This includes BMI records, past weight loss efforts, and health conditions. Insurers review to confirm medical need.
The process can take days to weeks. Providing complete documentation speeds things up. Your provider’s office often handles submissions, but staying in touch helps.
If denied, appeals are possible with additional proof. Many succeed on reconsideration. Persistence pays off for eligible candidates.
Step therapy might demand trying cheaper options first, like diet programs or generics. Exceptions apply if alternatives aren’t suitable. Discuss concerns with your care team early.
Costs Without Insurance and Savings Options
Full price for Contrave ranges from $500 to $840 monthly, depending on pharmacy and dose. This adds up quickly without assistance. Manufacturer programs bridge the gap effectively.
The CurAccess program from Currax offers Contrave at $99 or less per month, including free shipping for eligible participants. It works for those with or without coverage.
Savings coupon cards reduce costs to as low as $20 for insured users when plans cover it. Cash payers often pay around $199 maximum. These apply at participating pharmacies.
GoodRx or similar discount services lower retail prices significantly. Comparing options ensures the best deal. Manufacturer support remains a reliable fallback.
Patient assistance programs help qualifying low-income individuals access free or reduced medication. Eligibility checks occur through official channels.
Steps to Check and Maximize Your Coverage
Contact your insurance provider directly using the number on your card. Ask about Contrave’s formulary status and any prior authorization needs. Request written confirmation.
Have your doctor review requirements and prepare necessary forms. Early coordination prevents delays. Track progress to meet continuation criteria.
Explore employer benefits if applicable. Some add weight management coverage upon request. HR departments provide guidance.
If coverage falls short, lean on manufacturer savings. Enroll promptly for seamless access. Combine with lifestyle support for best results.
Regular check-ins with your provider monitor effectiveness and adjust approaches. Open dialogue keeps treatment on track.
Summary
Contrave provides a valuable oral option for weight management, but insurance coverage remains patchy in 2025-2026. Commercial plans from Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield offer the strongest potential, often with prior authorization. Medicare Part D and most Medicaid programs exclude it for weight loss alone.
Costs without coverage run high, yet programs like CurAccess bring monthly expenses to $99 or lower reliably. Prior authorization, BMI criteria, and progress documentation influence approvals across carriers.
Checking your specific plan and using available savings maximizes affordability. Work closely with your healthcare team to integrate Contrave safely into your wellness plan.
FAQ
Does Medicare Cover Contrave for Weight Loss?
Medicare Part D typically does not cover Contrave when prescribed solely for weight management due to federal exclusions. Some Medicare Advantage plans might include it under expanded formularies, but this is uncommon. Check your plan details or consider manufacturer savings programs for alternatives.
Which Private Insurance Companies Commonly Cover Contrave?
Major carriers like Aetna, Cigna, UnitedHealthcare, and Blue Cross Blue Shield often cover Contrave in commercial plans, subject to prior authorization. Employer-sponsored policies tend to provide better access than individual marketplace ones. Always verify your specific formulary for current status.
What Are Common Prior Authorization Requirements for Contrave?
Insurers usually require documented BMI of 30+ or 27+ with conditions, evidence of diet and exercise efforts, and sometimes prior weight loss attempts. Your doctor submits this information for review. Demonstrating 5% weight loss may extend coverage in some plans.
How Much Does Contrave Cost Without Insurance Coverage?
Without insurance, Contrave retails between $500 and $840 per month for a standard supply. Prices vary by pharmacy and location. Manufacturer programs and discount cards significantly reduce this amount for eligible users.
Are There Savings Programs Available for Contrave?
Yes, the CurAccess program offers Contrave at $99 or less monthly with free shipping, even without coverage. Savings coupon cards can drop costs to $20 for those with partial insurance. These options help make treatment more accessible long-term.
Does Medicaid Cover Contrave in Most States?
Medicaid coverage for Contrave is limited and varies by state, with many programs excluding weight-loss medications. A few states include select options, but Contrave rarely qualifies. Contact your state’s Medicaid office to confirm current benefits.
Can Employer Plans Influence Contrave Coverage?
Employer-sponsored plans, especially larger ones, are more likely to cover Contrave as part of enhanced benefits. Some self-insured groups set strict criteria like minimum BMI or program participation. Speak with HR for specifics on your policy.
What If My Insurance Denies Contrave Coverage?
Appeals are possible with additional medical documentation from your doctor. Many denials reverse on review. Meanwhile, use manufacturer savings to continue treatment affordably. Exploring alternatives or adjusting plans may help in the future.
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.