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Insurance Coverage · 2026 Guide

Does Centene Cover Contrave in 2026?

Complete guide to Centene coverage of Contrave in 2026. Learn about prior authorization requirements, BMI criteria, out-of-pocket costs, and how to get approved for Contrave with your Centene plan.

Likely Not Covered Prior Auth: Required opioid antagonist + aminoketone antidepressant combination

Coverage Limitation

Centene currently has limited or no coverage for Contrave for weight loss purposes. Some employer-sponsored plans or Medicare Advantage plans Centene administers may still offer coverage. We'll cover all your options below.

Key details: Largest Medicaid managed care company. Coverage for weight loss drugs is very limited under Medicaid plans. Marketplace plans (Ambetter) may have some coverage.

Contrave Coverage Under Centene

Centene evaluates Contrave (opioid antagonist + aminoketone antidepressant combination) based on clinical criteria and your specific plan's formulary. Understanding your coverage options can save you hundreds of dollars per month.

Criteria Centene Policy
Covers ContraveLikely Not Covered
Requires Prior AuthorizationYes
Step TherapyYes — must try other medications first
BMI Requirement>=30 or >=27 with comorbidity
Covered Drug TypesSaxenda
Est. Monthly Cost (With Insurance)$0-$100 (varies by plan tier)
Est. Monthly Cost (Without Insurance)$320

Weight Loss Drug Alternatives Centene May Cover

While Centene has limited coverage for Contrave, they do cover (or may cover under certain plans):

  • Saxenda — Daily injection TRT for weight management.

How to Check Your Specific Centene Plan

Centene coverage varies significantly between individual, employer-sponsored, and Medicare Advantage plans. Here's how to check yours:

  1. Log in to your Centene member portal — Search for "weight loss medications" or "antiobesity agents" in your plan's formulary.
  2. Call member services — Ask specifically about Contrave coverage and whether your employer plan has added weight loss benefits.
  3. Check with your employer's HR — Many employers exclude weight loss drugs from coverage by default, but some are adding coverage due to the metabolic health benefits.

Consider Telehealth as an Alternative

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Centene Coverage for Contrave: Frequently Asked Questions

Does Centene cover Contrave in 2026?
Centene's coverage of Contrave depends on your specific plan. Based on 2026 formulary data, Centene typically does not include Contrave in its standard formulary for weight loss. However, some employer-sponsored plans may offer coverage. Contact your HR department or check your plan's formulary for the most accurate information.
What are the requirements for Contrave coverage through Centene?
Centene would require (if covered): a BMI of 30 or higher (or 27+ with a weight-related comorbidity), documentation of a physician-prescribed weight management program, and prior authorization. Step therapy may also apply — you may need to try other weight loss medications first.. Their stated requirement is: >=30 or >=27 with comorbidity.
How much does Contrave cost with Centene insurance?
If your Centene plan covers Contrave, your out-of-pocket cost depends on your plan's tier and deductible. Most patients pay between $25-$100/month with coverage. Brand-name Contrave costs approximately $320/month without insurance. If your plan doesn't cover it, compounded alternatives via telehealth cost $299-$499/month.
Does Centene require prior authorization for weight loss drugs?
Centene does require prior authorization for all TRT and weight loss medications. The process typically takes 1-3 weeks and requires your doctor to submit documentation of medical necessity, BMI measurements, and any previous weight loss attempts.
What if my Centene plan doesn't cover Contrave?
If Centene doesn't cover Contrave, you have several options: (1) Check if your employer offers a supplemental plan, (2) Ask about appeals — some cases get approved upon review, (3) Consider manufacturer savings programs, or (4) Explore telehealth providers offering compounded versions of TRT medications at $299-$499/month.