Does Affinity Health Plan Cover Xarelto

Discover if Affinity Health Plan covers Xarelto. Learn reasons for denial, steps to secure coverage, cost without insurance, and answers to FAQs.
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Xarelto Coverage by Affinity Health Plan

 

  • Affinity Health Plan typically covers Xarelto, a medication used for preventing blood clots. Coverage might vary, so it is essential to check your specific policy details or contact customer support for confirmation.
  •  

  • Plans may cover Xarelto for conditions such as atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism (PE), pending medical necessity approval by your healthcare provider.
  •  

  • Criteria for coverage often include a prior authorization process, where your healthcare provider must demonstrate a need for Xarelto over other medications.
  •  

  • Coverage may be subject to formulary restrictions, meaning Xarelto needs to be a preferred drug or have no alternative treatments effective in managing your condition.
  •  

  • Out-of-pocket costs may vary based on your specific plan details, including any applicable copayments, deductibles, or co-insurance.

 

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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 Xarelto Coverage with Affinity Health Plan

 

Gather Information About Your Prescription Needs

 

  • Consult your healthcare provider to confirm that Xarelto is the prescribed medication needed for your condition.
  •  

  • Collect detailed prescription information such as dosage and frequency, as you will need to provide these details to Affinity Health Plan.

 

Check Affinity Health Plan's Coverage Policies

 

  • Visit the official Affinity Health Plan website to review their medication coverage policies.
  •  

  • Look for specific information on coverage for Xarelto or contact their customer service for confirmation.
  •  

  • Review the plan's formulary list, which describes the drugs covered and any prerequisites for coverage.

 

Contact Affinity Health Plan's Customer Service

 

  • Call the customer service number provided on your Affinity Health Plan member card for detailed plan information.
  •  

  • Ask about their process for covering Xarelto, including necessary documentation and any steps you need to follow.

 

Consult Your Doctor for Preauthorization

 

  • Discuss the need for a preauthorization with your healthcare provider, as some plans may require this for Xarelto.
  •  

  • Work with your doctor's office to gather any necessary medical documentation that supports your need for Xarelto.

 

Submit Required Documentation

 

  • Prepare all necessary documentation, including prescriptions, medical necessity letters, and any preauthorization forms.
  •  

  • Submit these documents to Affinity Health Plan according to their guidelines. This can typically be done via mail, fax, or online through their member portal.

 

Follow Up with Affinity Health Plan

 

  • After submission, follow up with Affinity Health Plan to ensure your request is being processed.
  •  

  • Ask for status updates and any further actions required on your part to expedite the coverage process.
  • Maintain regular communication until you receive confirmation that Xarelto is covered under your plan.

 

Appeal If Necessary

 

  • If your request for Xarelto coverage is denied, inquire about the appeals process offered by Affinity Health Plan.
  •  

  • Gather any additional supporting documents or letters from your doctor to strengthen your appeal.
  •  

  • Submit the appeal following the instructions from Affinity Health Plan and maintain contact to monitor the status of your appeal.

 

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FAQs

Does Affinity Health Plan Cover Xarelto

Discover if Affinity Health Plan covers Xarelto. Learn reasons for denial, steps to secure coverage, cost without insurance, and answers to FAQs.
Curex allergy drops unboxing

Is Xarelto Covered by Affinity Health Plan

 

Xarelto Coverage by Affinity Health Plan

 

  • Affinity Health Plan typically covers Xarelto, a medication used for preventing blood clots. Coverage might vary, so it is essential to check your specific policy details or contact customer support for confirmation.
  •  

  • Plans may cover Xarelto for conditions such as atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism (PE), pending medical necessity approval by your healthcare provider.
  •  

  • Criteria for coverage often include a prior authorization process, where your healthcare provider must demonstrate a need for Xarelto over other medications.
  •  

  • Coverage may be subject to formulary restrictions, meaning Xarelto needs to be a preferred drug or have no alternative treatments effective in managing your condition.
  •  

  • Out-of-pocket costs may vary based on your specific plan details, including any applicable copayments, deductibles, or co-insurance.

 

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Affinity Health Plan's Approved Criteria for Xarelto Coverage

 

Xarelto Coverage Criteria for Affinity Health Plan

 

  • The patient must have a documented diagnosis of non-valvular atrial fibrillation requiring anticoagulation therapy to reduce the risk of stroke and systemic embolism.
  •  

  • Xarelto may be approved for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and to reduce the risk of their recurrence, provided there is documented evidence of a previous DVT or PE episode.
  •  

  • Coverage may be granted for the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery.
  •  

  • The prescribing physician must provide documented evidence that the patient has had an inadequate response to, or has contraindications for, other anticoagulant therapies such as warfarin.
  •  

  • The prescription must be written by, or in consultation with, a specialist during the initial authorization request. Specialists include but are not limited to cardiologists, hematologists, or a qualified health professional in clot management.
  •  

  • The patient must not be using Xarelto concomitantly with other anticoagulants unless transitioning from one anticoagulant to another under medical supervision.
  •  

  • For continued coverage, the patient's chart must reflect ongoing assessment and necessity for anticoagulation at each request for continuation of therapy.

 

Why Affinity Health Plan Might Deny Xarelto Coverage

 

Exclusion of Xarelto Coverage by Affinity Health Plan

 

  • **Non-Approved Use**: Xarelto may not be covered if prescribed for conditions or treatment uses not approved by the FDA, or off-label use not supported by Affinity Health Plan's guidelines.
  •  

  • **Prior Authorization Not Obtained**: Coverage might be denied if prior authorization for Xarelto is required by the health plan and has not been secured by the prescribing healthcare provider.
  •  

  • **Non-Formulary Drug**: Xarelto could be excluded from coverage if it is not listed on the Affinity Health Plan's formulary, which outlines drugs covered by the plan.
  •  

  • **Step Therapy Requirements Not Met**: The plan might require trying other medications before approving Xarelto. Failure to follow these step therapy protocols may result in denial of coverage.
  •  

  • **Generic Alternative Availability**: If a generic alternative of Xarelto is available and preferred by the plan, use of the brand-name drug might not be covered unless specific criteria are met.
  •  

  • **Prescription by Non-Network Providers**: If Xarelto is prescribed by a provider not included in the Affinity Health Plan's network, coverage might be declined depending on plan specifics.
  •  

  • **Non-Compliance with Pharmacy Benefits Management Requirements**: Failure to comply with requirements set forth by the pharmacy benefits manager (PBM), such as using specified pharmacies or mail-order services, can lead to denial of coverage for Xarelto.
  •  

 

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How Much Does Xarelto Cost without Insurance?

 

Approximate Cost of Xarelto Without Insurance

 

  • The cost for Xarelto, a prescription anticoagulant medication, can vary depending on the dosage and quantity prescribed. On average, the cost of a 30-day supply of Xarelto 20 mg tablets, without insurance, can range from $450 to $540.
  •  

  • Prices may differ at various pharmacies, and patients might find lower prices through discount programs or pharmacy discount cards.
  •  

  • Shopping around and comparing prices at different pharmacies or checking with online retailers can sometimes yield better deals or discounts.
  •  

  • Additional savings may be available through pharmaceutical assistance programs, which are offered by the manufacturer for eligible patients who meet specific criteria.

 

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 Xarelto Coverage with Affinity Health Plan

 

Gather Information About Your Prescription Needs

 

  • Consult your healthcare provider to confirm that Xarelto is the prescribed medication needed for your condition.
  •  

  • Collect detailed prescription information such as dosage and frequency, as you will need to provide these details to Affinity Health Plan.

 

Check Affinity Health Plan's Coverage Policies

 

  • Visit the official Affinity Health Plan website to review their medication coverage policies.
  •  

  • Look for specific information on coverage for Xarelto or contact their customer service for confirmation.
  •  

  • Review the plan's formulary list, which describes the drugs covered and any prerequisites for coverage.

 

Contact Affinity Health Plan's Customer Service

 

  • Call the customer service number provided on your Affinity Health Plan member card for detailed plan information.
  •  

  • Ask about their process for covering Xarelto, including necessary documentation and any steps you need to follow.

 

Consult Your Doctor for Preauthorization

 

  • Discuss the need for a preauthorization with your healthcare provider, as some plans may require this for Xarelto.
  •  

  • Work with your doctor's office to gather any necessary medical documentation that supports your need for Xarelto.

 

Submit Required Documentation

 

  • Prepare all necessary documentation, including prescriptions, medical necessity letters, and any preauthorization forms.
  •  

  • Submit these documents to Affinity Health Plan according to their guidelines. This can typically be done via mail, fax, or online through their member portal.

 

Follow Up with Affinity Health Plan

 

  • After submission, follow up with Affinity Health Plan to ensure your request is being processed.
  •  

  • Ask for status updates and any further actions required on your part to expedite the coverage process.
  • Maintain regular communication until you receive confirmation that Xarelto is covered under your plan.

 

Appeal If Necessary

 

  • If your request for Xarelto coverage is denied, inquire about the appeals process offered by Affinity Health Plan.
  •  

  • Gather any additional supporting documents or letters from your doctor to strengthen your appeal.
  •  

  • Submit the appeal following the instructions from Affinity Health Plan and maintain contact to monitor the status of your appeal.

 

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Xarelto FAQ

What are the common side effects of Xarelto?

 

Common Side Effects of Xarelto

 

  • Bleeding is the most common, including nasal, gum, or gastrointestinal bleeding. Be vigilant for any signs of unusual bleeding and seek medical attention if necessary.
  •  

  • Gastrointestinal issues such as nausea and stomach pain may occur. Taking Xarelto with food can help alleviate these symptoms.
  •  

  • Dizziness and fatigue can affect some individuals, especially when first starting the medication. Ensure you maintain hydration and rest as needed.
  •  

  • In rare cases, allergic reactions may manifest as rash or itching. If this occurs, consult your healthcare provider promptly.

 

Is Xarelto a blood thinner?

 

Is Xarelto a Blood Thinner?

 

  • **Xarelto (rivaroxaban)** is indeed a blood thinner, specifically an anticoagulant, which is crucial for preventing blood clots that can lead to conditions like stroke or deep vein thrombosis (DVT).
  •  

  • It works by inhibiting **factor Xa**, an essential component in the coagulation cascade, reducing the ability of blood to form clots.
  •  

  • As a **direct oral anticoagulant (DOAC)**, it provides several advantages over traditional blood thinners like warfarin, such as having fewer dietary restrictions and not requiring regular blood monitoring.
  •  

  • It's important to take it as prescribed by a healthcare provider, considering potential drug interactions and contraindications.

 

Can you drink alcohol while taking Xarelto?

 

Drinking Alcohol with Xarelto

 

  • Xarelto, a blood thinner, may increase bleeding risk, and alcohol can amplify this risk.
  •  

  • Both substances affect liver function, potentially impacting medication metabolism and effectiveness.
  •  

  • Consuming alcohol while on Xarelto may enhance side effects like dizziness, increasing injury risk.
  •  

  • It’s crucial to consult your healthcare provider to discuss allowable alcohol intake based on your health status and dosage.
  •  

 

General Recommendations

 

  • Moderation is key – if approved, limit alcohol consumption as per medical advice.
  •  

  • Avoid binge drinking, which drastically heightens risk of adverse reactions.
  •  

  • Inform your medical team about recreational activities involving alcohol.

 

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Titration

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.

Got questions? We have answers.

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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