Does Amerigroup Cover Xarelto

Explore why Amerigroup may deny Xarelto, how to secure coverage, cost without insurance, and find answers to common questions in our comprehensive guide.
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Does Amerigroup Cover Xarelto?

 

  • Amerigroup may cover Xarelto, a medication used to prevent blood clots, under specific health plans and conditions. Coverage usually depends on medical necessity and requires prior authorization.
  •  

  • Typically, Xarelto coverage is considered for patients with conditions like atrial fibrillation, deep vein thrombosis, or those undergoing knee or hip replacement surgery.
  •  

  • You need to provide documentation supporting the medical necessity, which might include a history of clots or inability to use other blood thinners.
  •  

  • Patients may also be required to try other formulary medications before Xarelto is approved. This is part of Amerigroup's step therapy (or fail-first) policy.
  •  

  • To confirm Xarelto coverage, contact Amerigroup customer service or consult their formulary document for details on drug coverage tiers and specific plan requirements.

 

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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.

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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 Amerigroup

 

Check Amerigroup Plan Details

 

  • Visit the Amerigroup website and log in to your member account to review your current plan details.
  •  

  • Make sure your current plan offers prescription drug coverage.
  •  

  • Find any documents related to your prescription drug plan to see if Xarelto is listed as a covered medication.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Xarelto for your condition.
  •  

  • Ensure your doctor provides you with all necessary documentation to support the need for Xarelto for treatment purposes.

 

Contact Amerigroup Customer Support

 

  • Call the customer service number on your insurance card to inquire about Xarelto coverage.
  •  

  • Ask if Xarelto is included in the formulary (list of covered medications) and if any restrictions apply.
  •  

  • Request information about prior authorization, step therapy, or quantity limits associated with Xarelto.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if needed.
  •  

  • Ensure all required forms are completed and submitted to Amerigroup promptly.
  •  

  • Provide documentation and medical records that justify the need for Xarelto as part of the submission.

 

Follow Up on Your Request

 

  • Contact Amerigroup to check the status of your prior authorization request after submission.
  •  

  • Be prepared to provide any additional information or documentation if requested by Amerigroup.
  •  

  • Ask for a timeline on when you can expect a decision regarding the coverage request.

 

Understand Appeal Options

 

  • If your request for coverage is denied, review the reasons provided by Amerigroup carefully.
  •  

  • Gather additional supporting documents and statements from your healthcare provider to bolster your case.
  •  

  • Submit an appeal through the official process, using guidance provided in your coverage denial letter.

 

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FAQs

Does Amerigroup Cover Xarelto

Explore why Amerigroup may deny Xarelto, how to secure coverage, cost without insurance, and find answers to common questions in our comprehensive guide.
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Is Xarelto Covered by Amerigroup

 

Does Amerigroup Cover Xarelto?

 

  • Amerigroup may cover Xarelto, a medication used to prevent blood clots, under specific health plans and conditions. Coverage usually depends on medical necessity and requires prior authorization.
  •  

  • Typically, Xarelto coverage is considered for patients with conditions like atrial fibrillation, deep vein thrombosis, or those undergoing knee or hip replacement surgery.
  •  

  • You need to provide documentation supporting the medical necessity, which might include a history of clots or inability to use other blood thinners.
  •  

  • Patients may also be required to try other formulary medications before Xarelto is approved. This is part of Amerigroup's step therapy (or fail-first) policy.
  •  

  • To confirm Xarelto coverage, contact Amerigroup customer service or consult their formulary document for details on drug coverage tiers and specific plan requirements.

 

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Amerigroup's Approved Criteria for Xarelto Coverage

 

Amerigroup's Approved Criteria for Xarelto Coverage

 

  • Xarelto is covered for patients who require anticoagulation for the prevention of stroke and systemic embolism in individuals with non-valvular atrial fibrillation.
  •  

  • Coverage is available for patients undergoing treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in order to reduce the risk of recurrence following initial therapy.
  •  

  • Amerigroup approves Xarelto for patients 18 years or older for the prevention of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery.
  •  

  • Xarelto is authorized for use in patients with coronary artery disease (CAD) or peripheral artery disease (PAD) for the purpose of reducing the risk of major cardiovascular events, including stroke, myocardial infarction, and cardiovascular death.
  •  

  • When prescribed, Xarelto is covered for the long-term secondary prevention of venous thromboembolism.
  •  

  • Authorization for Xarelto is provided when used in combination with aspirin for the prevention of cardiovascular events in patients with coronary artery disease.
  •  

  • The insurance plan covers Xarelto for the initial treatment of acute DVT and/or PE in patients who meet clinical protocol criteria.
  •  

  • Xarelto is also covered in reducing the risk of repeat coronary events such as heart attack, stroke, or death in patients who have had acute coronary syndrome (ACS).

 

Why Amerigroup Might Deny Xarelto Coverage

 

Situations Where Amerigroup Might Deny Xarelto Coverage

 

  • **Not Meeting Medical Necessity Criteria**: Coverage might be denied if the patient does not meet Amerigroup's specific medical necessity criteria for Xarelto. This could occur if the diagnosis does not align with their approved list of conditions for this medication.
  •  

  • **Use for Non-Accepted Indications**: If Xarelto is prescribed for an off-label use that Amerigroup does not recognize or support, coverage may be denied. They typically cover FDA-approved indications or those backed by sufficient clinical evidence.
  •  

  • **Lack of Prior Authorization**: Should there be a requirement for prior authorization and it was not obtained before the prescription, this could lead to denial of coverage. Providers usually need to demonstrate the necessity of the drug before approval.
  •  

  • **Step Therapy Requirements**: Coverage may be denied if step therapy guidelines are not followed. Amerigroup might require trying alternative, often less expensive, medications before approving Xarelto.
  •  

  • **Non-Compliance with Quantity Limits**: If the prescribed dosage exceeds Amerigroup’s quantity limits without appropriate justification, coverage might be denied due to non-compliance with their dosing guidelines.
  •  

  • **Policy or Plan Limitation**: Xarelto might not be included in the patient's specific plan formulary, or the plan may have limitations that specifically exclude coverage for this medication.

 

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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 Amerigroup

 

Check Amerigroup Plan Details

 

  • Visit the Amerigroup website and log in to your member account to review your current plan details.
  •  

  • Make sure your current plan offers prescription drug coverage.
  •  

  • Find any documents related to your prescription drug plan to see if Xarelto is listed as a covered medication.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Xarelto for your condition.
  •  

  • Ensure your doctor provides you with all necessary documentation to support the need for Xarelto for treatment purposes.

 

Contact Amerigroup Customer Support

 

  • Call the customer service number on your insurance card to inquire about Xarelto coverage.
  •  

  • Ask if Xarelto is included in the formulary (list of covered medications) and if any restrictions apply.
  •  

  • Request information about prior authorization, step therapy, or quantity limits associated with Xarelto.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if needed.
  •  

  • Ensure all required forms are completed and submitted to Amerigroup promptly.
  •  

  • Provide documentation and medical records that justify the need for Xarelto as part of the submission.

 

Follow Up on Your Request

 

  • Contact Amerigroup to check the status of your prior authorization request after submission.
  •  

  • Be prepared to provide any additional information or documentation if requested by Amerigroup.
  •  

  • Ask for a timeline on when you can expect a decision regarding the coverage request.

 

Understand Appeal Options

 

  • If your request for coverage is denied, review the reasons provided by Amerigroup carefully.
  •  

  • Gather additional supporting documents and statements from your healthcare provider to bolster your case.
  •  

  • Submit an appeal through the official process, using guidance provided in your coverage denial letter.

 

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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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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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