Does Aetna Cover Farxiga

Explore Aetna's coverage for Farxiga, reasons for denial, steps to secure coverage, costs without insurance, and FAQs in this informative guide.
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Does Aetna Cover Farxiga?

 

  • Aetna typically covers Farxiga if it is considered medically necessary. This aligns with FDA-approved uses for treating Type 2 diabetes, heart failure, or chronic kidney disease.
  •  

  • Coverage often requires following Aetna's drug formulary and adhering to plan-specific guidelines, such as a step-therapy requirement meaning patients may need to try less expensive medications first.
  •  

  • A valid prescription from a healthcare provider and prior authorization are generally needed to confirm the necessity.
  •  

  • Criteria can include age, medical history, and other medications tried. Each plan may have specific guidelines, so reviewing your individual health plan is essential.
  •  

  • It's advisable to consult with Aetna directly or visit the official website to verify your coverage details and any potential out-of-pocket costs for Farxiga.

 

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Farxiga Coverage with Aetna

 

Check Your Prescription Coverage

 

  • Log into your Aetna member account on their official website or app.
  •  

  • Review your prescription drug plan to see if Farxiga is included in your coverage. This information is typically found under the "Prescription" or "Drug Coverage" section.
  •  

  • If you're unsure or can't find this information, contact Aetna customer service for assistance.

 

Consult Your Doctor

 

  • Speak with your doctor to ensure Farxiga is the appropriate medication for your condition.
  •  

  • Request your doctor to provide any necessary documentation that Aetna may require, such as a diagnosis, treatment plan, or medical necessity form.

 

Gather Necessary Information

 

  • Have your Aetna member ID, prescription details, and doctor’s contact information ready.
  •  

  • Gather any previous medical records that support the need for Farxiga if required for approval.

 

Submit a Prior Authorization Request

 

  • If your plan requires it, complete a prior authorization request form. This is often needed for medications like Farxiga.
  •  

  • Your doctor may need to fill out and submit this form on your behalf, including supporting medical documentation. Check with your healthcare provider for their requirements.

 

Await Approval

 

  • Once submitted, wait for Aetna’s decision on the prior authorization. This can take several days to weeks, depending on the completeness of the documentation provided.
  •  

  • Check your Aetna account or contact customer support to track your prior authorization request status.

 

Explore Financial Assistance Options

 

  • If Farxiga is not fully covered, consider looking into financial assistance programs provided by the manufacturer or third-party organizations.
  •  

  • Your doctor or pharmacist can provide information about available savings programs or patient assistance resources.

 

Follow Up Regularly

 

  • Stay in touch with your healthcare provider and Aetna for updates on your coverage process.
  •  

  • Ensure all information is correctly submitted and advocate for re-evaluation if coverage is initially denied.

 

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FAQs

Does Aetna Cover Farxiga

Explore Aetna's coverage for Farxiga, reasons for denial, steps to secure coverage, costs without insurance, and FAQs in this informative guide.
Curex allergy drops unboxing

Is Farxiga Covered by Aetna

 

Does Aetna Cover Farxiga?

 

  • Aetna typically covers Farxiga if it is considered medically necessary. This aligns with FDA-approved uses for treating Type 2 diabetes, heart failure, or chronic kidney disease.
  •  

  • Coverage often requires following Aetna's drug formulary and adhering to plan-specific guidelines, such as a step-therapy requirement meaning patients may need to try less expensive medications first.
  •  

  • A valid prescription from a healthcare provider and prior authorization are generally needed to confirm the necessity.
  •  

  • Criteria can include age, medical history, and other medications tried. Each plan may have specific guidelines, so reviewing your individual health plan is essential.
  •  

  • It's advisable to consult with Aetna directly or visit the official website to verify your coverage details and any potential out-of-pocket costs for Farxiga.

 

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Aetna's Approved Criteria for Farxiga Coverage

 

Criteria for Coverage

 

  • Farxiga is intended for adults with a diagnosis of type 2 diabetes mellitus.
  • Member is 18 years of age or older.
  • Member has not achieved adequate glycemic control on existing therapy, such as metformin, unless contraindicated or not tolerated.
  • Farxiga is prescribed by or in consultation with an endocrinologist or healthcare provider specializing in diabetic management.

 

Additional Conditions for Heart Failure

 

  • Farxiga is approved for members with heart failure with reduced ejection fraction (HFrEF).
  • Demonstrates symptomatic heart failure, classified as NYHA class II-IV.
  • The member is on optimized guideline directed medical therapy for heart failure unless contraindicated.

 

Chronic Kidney Disease Criteria

 

  • Member has a diagnosis of chronic kidney disease (CKD) in adults.
  • Stable dosing of optimal renal and cardiovascular therapy prior to addition of Farxiga.
  • Member has an eGFR ≥ 25 but ≤ 60 mL/min/1.73 m².

 

Renewal Criteria

 

  • Continued approval is contingent upon improvement or maintenance of clinical status.
  • No unacceptable adverse events attributable to Farxiga therapy.
  • Member is compliant with therapy.

 

Why Aetna Might Deny Farxiga Coverage

 

Reasons Aetna Might Deny Farxiga Coverage

 

  • Aetna may deny Farxiga coverage if the patient does not meet the specific clinical guidelines set by Aetna for its use.
  •  

  • Coverage might be denied if Farxiga is not included in the approved formulary list for the patient's insurance plan.
  •  

  • If Farxiga is being prescribed for a condition not approved by the FDA, such as off-label uses, Aetna may refuse coverage.
  •  

  • Aetna may require prior authorization, and failure to obtain it can lead to denial of coverage for Farxiga.
  •  

  • Inadequate documentation from the healthcare provider to support the medical necessity of Farxiga could result in denial.
  •  

  • Aetna might deny coverage if the patient has not tried and failed less expensive medication alternatives first.
  •  

  • For plans with step therapy requirements, if the patient has not completed the required treatment steps, Farxiga coverage could be denied.
  •  

  • If the patient's prescription exceeds the recommended dosage limits set by Aetna, coverage might be denied.

 

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How Much Does Farxiga Cost without Insurance?

 

Estimated Cost of Farxiga Without Insurance

 

  • Farxiga, a medication used primarily for the management of type 2 diabetes and certain forms of heart failure, can be quite costly without insurance coverage.
  •  

  • The cash price for Farxiga typically ranges between $500 and $550 for a 30-day supply, depending on the pharmacy and location.
  •  

  • Some pharmacies may offer discount programs or cards that can slightly lower this cost, but significant savings are usually only available through insurance coverage.
  •  

  • Always consider checking with multiple pharmacies or online services where discounts might be more prevalent.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Farxiga Coverage with Aetna

 

Check Your Prescription Coverage

 

  • Log into your Aetna member account on their official website or app.
  •  

  • Review your prescription drug plan to see if Farxiga is included in your coverage. This information is typically found under the "Prescription" or "Drug Coverage" section.
  •  

  • If you're unsure or can't find this information, contact Aetna customer service for assistance.

 

Consult Your Doctor

 

  • Speak with your doctor to ensure Farxiga is the appropriate medication for your condition.
  •  

  • Request your doctor to provide any necessary documentation that Aetna may require, such as a diagnosis, treatment plan, or medical necessity form.

 

Gather Necessary Information

 

  • Have your Aetna member ID, prescription details, and doctor’s contact information ready.
  •  

  • Gather any previous medical records that support the need for Farxiga if required for approval.

 

Submit a Prior Authorization Request

 

  • If your plan requires it, complete a prior authorization request form. This is often needed for medications like Farxiga.
  •  

  • Your doctor may need to fill out and submit this form on your behalf, including supporting medical documentation. Check with your healthcare provider for their requirements.

 

Await Approval

 

  • Once submitted, wait for Aetna’s decision on the prior authorization. This can take several days to weeks, depending on the completeness of the documentation provided.
  •  

  • Check your Aetna account or contact customer support to track your prior authorization request status.

 

Explore Financial Assistance Options

 

  • If Farxiga is not fully covered, consider looking into financial assistance programs provided by the manufacturer or third-party organizations.
  •  

  • Your doctor or pharmacist can provide information about available savings programs or patient assistance resources.

 

Follow Up Regularly

 

  • Stay in touch with your healthcare provider and Aetna for updates on your coverage process.
  •  

  • Ensure all information is correctly submitted and advocate for re-evaluation if coverage is initially denied.

 

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Farxiga FAQ

What are the side effects of Farxiga?

 

Common Side Effects of Farxiga

 

  • Increased urination due to its diuretic effect, which may lead to dehydration. Maintain adequate hydration.
  • Potential urinary tract infections or yeast infections in genital areas, due to changes in the urinary environment.

 

Metabolic Effects

 

  • Weight loss can occur, linked to its mechanism of expelling glucose via urine.
  • Electrolyte imbalances, such as elevated potassium levels in blood, may appear in some cases.

 

Serious Reactions

 

  • Ketoacidosis risk: Watch for symptoms like nausea, vomiting, or abdominal pain.
  • Rarely, serious infections like Fournier's gangrene can develop. Seek immediate attention if you notice pain, redness, or swelling in genital or anal areas.

 

Can Farxiga help with weight loss?

 

Can Farxiga Aid Weight Loss?

 

  • Farxiga (dapagliflozin) is primarily a medication for managing type 2 diabetes and heart failure. It helps control blood sugar by promoting the excretion of glucose through urine.
  •  

  • Though not prescribed primarily for weight loss, some patients experience weight reduction as a secondary benefit.
  •  

  • Weight loss occurs because Farxiga facilitates the removal of excess calories in the form of glucose. However, the effect is usually modest and not guaranteed for everyone.
  •  

  • Consult a healthcare professional to understand if Farxiga is suitable for your condition and weight management goals.

 

Is Farxiga used for heart failure treatment?

 

Farxiga for Heart Failure

 

  • Farxiga (dapagliflozin) is primarily a SGLT2 inhibitor, initially developed to treat type 2 diabetes by helping the kidneys excrete glucose.
  •  

  • Recent studies have shown Farxiga's efficacy in heart failure management, particularly heart failure with reduced ejection fraction (HFrEF), by reducing hospitalizations and improving cardiovascular outcomes.
  •  

  • The medication works by decreasing fluid overload and blood pressure, lessening the heart's workload.
  •  

  • Farxiga is approved for heart failure treatment regardless of diabetes status, broadening its use in cardiology.
  •  

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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