Does Blue Cross Blue Shield Cover Farxiga

Explore why BCBS might deny Farxiga coverage, tips to secure it, costs without insurance, and answers to common questions in this detailed guide.
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Blue Cross Blue Shield Coverage for Farxiga

 

  • **Medical Necessity:** Coverage generally requires a doctor's indication that Farxiga is medically necessary for treating type 2 diabetes or heart failure.
  •  

  • **Plan Variability:** Coverage specifics can vary by plan and state. It's important to review your particular Blue Cross Blue Shield plan for details.
  •  

  • **Prior Authorization:** Some plans may require prior authorization, needing your healthcare provider to submit a request detailing why Farxiga is necessary.
  •  

  • **Formulary Inclusion:** Farxiga is often included on formularies, but placement may affect coverage level and co-pays. Verify if it's on the preferred drug list.
  •  

  • **Step Therapy:** Patients might need to try other medications first before Farxiga is covered, depending on their specific insurance plan.
  •  

  • **Co-Payment Requirements:** Coverage may involve certain co-pays or out-of-pocket costs, which could vary based on your policy's terms.

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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 Blue Cross Blue Shield

 

Verify Farxiga Coverage

 

  • Access the Blue Cross Blue Shield (BCBS) website or contact member services to review your plan's formulary, which lists covered medications.
  •  

  • Ensure Farxiga (dapagliflozin) is included in the formulary. If it's not, consider discussing alternatives with your healthcare provider.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the necessity of Farxiga for your treatment plan.
  •  

  • Request a prescription for Farxiga if your provider believes it is the right medication for you.

 

Coordinate with Your Pharmacy

 

  • Choose a BCBS network pharmacy to ensure full coverage benefits.
  •  

  • Ask the pharmacist to run a test claim to determine the co-pay amount or any potential coverage issues before filling the prescription.

 

Complete Prior Authorization if Required

 

  • If Farxiga requires prior authorization, work with your healthcare provider to complete the necessary paperwork.
  •  

  • Submit any required documentation promptly to avoid delays in receiving your medication.

 

Utilize Member Resources

 

  • Log into your BCBS member portal to access health and pharmacy benefits resources.
  •  

  • Explore options like mail order services or 90-day supplies, which might offer reduced co-pays.

 

Appeal If Necessary

 

  • If BCBS denies coverage for Farxiga, file an appeal with supporting documentation from your healthcare provider.
  •  

  • Follow up on the appeal process regularly until a resolution is reached.

 

Review Financial Assistance Programs

 

  • Investigate financial assistance programs offered by the manufacturer of Farxiga or third-party organizations.
  •  

  • Apply for assistance, if eligible, to help cover costs not paid by your insurance.

 

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FAQs

Does Blue Cross Blue Shield Cover Farxiga

Explore why BCBS might deny Farxiga coverage, tips to secure it, costs without insurance, and answers to common questions in this detailed guide.
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Is Farxiga Covered by Blue Cross Blue Shield

 

Blue Cross Blue Shield Coverage for Farxiga

 

  • **Medical Necessity:** Coverage generally requires a doctor's indication that Farxiga is medically necessary for treating type 2 diabetes or heart failure.
  •  

  • **Plan Variability:** Coverage specifics can vary by plan and state. It's important to review your particular Blue Cross Blue Shield plan for details.
  •  

  • **Prior Authorization:** Some plans may require prior authorization, needing your healthcare provider to submit a request detailing why Farxiga is necessary.
  •  

  • **Formulary Inclusion:** Farxiga is often included on formularies, but placement may affect coverage level and co-pays. Verify if it's on the preferred drug list.
  •  

  • **Step Therapy:** Patients might need to try other medications first before Farxiga is covered, depending on their specific insurance plan.
  •  

  • **Co-Payment Requirements:** Coverage may involve certain co-pays or out-of-pocket costs, which could vary based on your policy's terms.

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Blue Cross Blue Shield's Approved Criteria for Farxiga Coverage

 

Farxiga Coverage Criteria by Blue Cross Blue Shield

 

  • **Diagnosis Requirement**: Coverage is approved for patients diagnosed with type 2 diabetes mellitus as documented in medical records.
  •  

  • **Age Requirement**: The patient must be 18 years or older to qualify for coverage.
  •  

  • **Medication Use**: Farxiga must be used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
  •  

  • **Previous Treatment**: Patients should have a history of therapeutic failure, intolerance, or contraindication to metformin or other antidiabetic medications.
  •  

  • **Renal Function**: The patient must demonstrate sufficient renal function, specifically an eGFR at or above 45 mL/min/1.73 m² unless otherwise specified by clinical guidelines or recent studies endorsed by healthcare professionals.
  •  

  • **Specialist Consultation**: A specialist in endocrinology or a healthcare provider experienced in managing diabetes must oversee the treatment plan.
  •  

  • **Documented Need**: Medical records must document the necessity for Farxiga therapy and contain a clear treatment plan and goals.
  •  

  • **Monitoring Plan**: The prescribing physician must have a plan for regular monitoring of the patient’s condition, ensuring effectiveness and safety of the treatment.
  •  

  • **Compliance with Treatment Protocols**: The patient should adhere to prescribed treatment protocols and participate in any recommended diabetes education or lifestyle modification programs.

 

Why Blue Cross Blue Shield Might Deny Farxiga Coverage

 

Reasons for Denial of Farxiga Coverage by Blue Cross Blue Shield

 

  • The prescription does not meet the specific medical necessity criteria set by the insurance plan. This could involve several factors, such as insufficient evidence of a condition that Farxiga is approved to treat or lack of documented unsuccessful prior treatment methods.
  •  

  • The patient has not complied with required step therapy protocols. Blue Cross Blue Shield may require patients to try and fail other medications before progressing to Farxiga.
  •  

  • The requested dosage does not align with FDA-approved guidelines or exceeds plan limitations. Off-label use or higher-than-recommended dosing might lead to denial.
  •  

  • The prescription is for a condition that Farxiga is not FDA-approved to treat. Insurance may deny claims if the medication is used for experimental or investigational purposes.
  •  

  • There is a policy exclusion for the medication based on specific plan details. Some plans may have explicit exclusions due to formulary restrictions or cost considerations.
  •  

  • The patient's pharmacy benefits do not cover brand-name drugs when generic equivalents are available. If an appropriate generic exists, coverage may be denied for the brand Farxiga.
  •  

  • Patient information or paperwork submitted is incomplete or incorrect, leading to processing issues and potential temporary denial until corrected.

 

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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 Blue Cross Blue Shield

 

Verify Farxiga Coverage

 

  • Access the Blue Cross Blue Shield (BCBS) website or contact member services to review your plan's formulary, which lists covered medications.
  •  

  • Ensure Farxiga (dapagliflozin) is included in the formulary. If it's not, consider discussing alternatives with your healthcare provider.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss the necessity of Farxiga for your treatment plan.
  •  

  • Request a prescription for Farxiga if your provider believes it is the right medication for you.

 

Coordinate with Your Pharmacy

 

  • Choose a BCBS network pharmacy to ensure full coverage benefits.
  •  

  • Ask the pharmacist to run a test claim to determine the co-pay amount or any potential coverage issues before filling the prescription.

 

Complete Prior Authorization if Required

 

  • If Farxiga requires prior authorization, work with your healthcare provider to complete the necessary paperwork.
  •  

  • Submit any required documentation promptly to avoid delays in receiving your medication.

 

Utilize Member Resources

 

  • Log into your BCBS member portal to access health and pharmacy benefits resources.
  •  

  • Explore options like mail order services or 90-day supplies, which might offer reduced co-pays.

 

Appeal If Necessary

 

  • If BCBS denies coverage for Farxiga, file an appeal with supporting documentation from your healthcare provider.
  •  

  • Follow up on the appeal process regularly until a resolution is reached.

 

Review Financial Assistance Programs

 

  • Investigate financial assistance programs offered by the manufacturer of Farxiga or third-party organizations.
  •  

  • Apply for assistance, if eligible, to help cover costs not paid by your insurance.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

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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