Does Blue Cross Blue Shield of Alabama Cover Farxiga

Explore if Blue Cross Blue Shield of Alabama covers Farxiga. Learn about coverage, costs, and FAQs in this detailed guide to managing your Farxiga prescriptions.
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Coverage Overview for Farxiga

 

  • Farxiga is covered by Blue Cross Blue Shield of Alabama primarily for managing Type 2 diabetes and heart failure.
  •  

  • Coverage may be subject to specific criteria, including prior authorization or meeting certain health guidelines.

 

Criteria and Steps for Coverage

 

  • A healthcare provider must prescribe Farxiga, detailing the medical necessity related to the patient's condition.
  •  

  • Patients may need to try other treatments first unless exceptions apply due to specific health needs.
  •  

  • Check the formulary and policy documents for any updates on drug coverage specifics as plans can change.

 

Additional Requirements

 

  • Maintain continuous enrollment in the Blue Cross Blue Shield of Alabama plan covering prescription drugs.
  •  

  • Adhere to any step therapy protocols, which may require trying less expensive drugs first.

 

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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 of Alabama

 

Verify Your Prescription Coverage

 

  • Log in to your Blue Cross Blue Shield of Alabama member account through their official website. This account provides detailed information about your specific health plan and any covered medications.
  •  

  • Check your prescription drug list (formulary) to determine if Farxiga is included. This can often be found under the pharmacy benefits section.
  •  

  • Review your plan details to confirm if there are any special requirements for Farxiga coverage, such as prior authorization or step therapy.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor about the necessity of Farxiga for your condition, ensuring they understand any plan requirements, such as trying alternative medications first.
  •  

  • Request that your physician provides necessary documentation or evidence to support the need for Farxiga, which may be required for prior authorization.

 

Contact Blue Cross Blue Shield of Alabama

 

  • Reach out to the customer service department using the contact information on their website or your insurance card for personalized assistance.
  •  

  • Inquire about coverage details for Farxiga, including any applicable co-pays, tiers, or out-of-pocket costs associated with the medication.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if required. This typically involves completing a form and providing medical justification.
  •  

  • Ensure that all necessary documents are included, and submit them through the appropriate channel as directed by Blue Cross Blue Shield of Alabama.

 

Appeal a Denied Coverage Decision

 

  • If your coverage request for Farxiga is denied, review the denial letter carefully to understand the rationale and gather any supporting documents that counter the basis of the denial.
  •  

  • File an appeal by following the instructions provided by Blue Cross Blue Shield of Alabama. It may involve submitting additional documentation or requesting a reevaluation.

 

Utilize Customer Support Resources

 

  • Leverage Blue Cross Blue Shield of Alabama’s resources such as online chat, email support, or in-person consultations to get additional help in understanding your benefits and navigating the appeal process.
  •  

  • Consider speaking with a customer support representative specialized in pharmacy benefits to gain deeper insights into obtaining Farxiga coverage.

 

Explore Financial Assistance Programs

 

  • Investigate manufacturer assistance programs or patient assistance foundations if Farxiga remains unaffordable, even after obtaining insurance coverage.
  •  

  • Check if you meet the eligibility requirements for these programs and apply as needed to receive further financial support.

 

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FAQs

Does Blue Cross Blue Shield of Alabama Cover Farxiga

Explore if Blue Cross Blue Shield of Alabama covers Farxiga. Learn about coverage, costs, and FAQs in this detailed guide to managing your Farxiga prescriptions.
Curex allergy drops unboxing

Is Farxiga Covered by Blue Cross Blue Shield of Alabama

 

Coverage Overview for Farxiga

 

  • Farxiga is covered by Blue Cross Blue Shield of Alabama primarily for managing Type 2 diabetes and heart failure.
  •  

  • Coverage may be subject to specific criteria, including prior authorization or meeting certain health guidelines.

 

Criteria and Steps for Coverage

 

  • A healthcare provider must prescribe Farxiga, detailing the medical necessity related to the patient's condition.
  •  

  • Patients may need to try other treatments first unless exceptions apply due to specific health needs.
  •  

  • Check the formulary and policy documents for any updates on drug coverage specifics as plans can change.

 

Additional Requirements

 

  • Maintain continuous enrollment in the Blue Cross Blue Shield of Alabama plan covering prescription drugs.
  •  

  • Adhere to any step therapy protocols, which may require trying less expensive drugs first.

 

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Blue Cross Blue Shield of Alabama's Approved Criteria for Farxiga Coverage

 

Criteria for Farxiga Coverage

 

  • Farxiga is approved for patients with a diagnosis of type 2 diabetes mellitus who are unable to achieve glycemic control with a maximum tolerated dose of metformin or when metformin is contraindicated.
  •  

  • The patient must have documented inadequate control of blood glucose levels as demonstrated by hemoglobin A1c (HbA1c) levels, ensuring that other antidiabetic agents have been ineffective or are not suitable for the specific patient case.
  •  

  • Farxiga may be covered for patients diagnosed with chronic kidney disease (CKD) who meet the estimated glomerular filtration rate (eGFR) criteria as specified by the prescribing information and clinical guidelines.
  •  

  • Coverage is applicable for patients with heart failure with reduced ejection fraction (HFrEF) who are symptomatic despite receiving optimal therapy, which may include beta blockers and renin-angiotensin system inhibitors.
  •  

  • The drug must be prescribed by or in consultation with an endocrinologist, nephrologist, or cardiologist who is familiar with the treatment guidelines for the applicable condition.
  •  

  • For renewal of coverage, documentation of therapeutic benefit, such as improvement in glycemic control parameters, kidney function, or heart failure symptoms, is required based on the primary condition being treated with Farxiga.
  •  

  • Continued coverage is contingent upon adherence to the prescribed treatment regimen, which includes Farxiga as part of a comprehensive care plan combining lifestyle modifications and concurrent medical management.

 

Why Blue Cross Blue Shield of Alabama Might Deny Farxiga Coverage

 

Non-FDA Approved Uses

 

  • Coverage may be denied for uses that are not approved by the FDA. Farxiga is typically prescribed for specific health conditions, and any use outside of these indications may not be covered.

 

Lack of Medical Necessity

 

  • If Farxiga is deemed not medically necessary by the insurer, coverage could be denied. This could occur if there is insufficient documentation to support the necessity of Farxiga for the specific patient's condition.

 

Failure to Meet Step Therapy Requirements

 

  • Farxiga may not be covered if the patient has not tried other, less expensive medications first, as part of a step therapy approach. If the protocol requires trying other options before Farxiga, non-compliance can lead to denial.

 

Not Following Prescribing Guidelines

 

  • If the prescription does not follow Blue Cross Blue Shield of Alabama's specific prescribing guidelines, coverage may be denied. This includes incorrect dosage or frequency not aligning with recommended treatment protocols.

 

Policy Exclusions

 

  • Certain policy plans might specifically exclude coverage for certain medications or treatment types, including Farxiga. It's crucial to check individual policy documentation for any such exclusions.

 

Preauthorization Not Obtained

 

  • If preauthorization is required by Blue Cross Blue Shield of Alabama and is not obtained prior to filling a Farxiga prescription, this can be grounds for denial of coverage.

 

Network Provider Restrictions

 

  • Coverage might be denied if Farxiga is not prescribed or filled by an in-network provider as specified by the insurance plan.

 

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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 of Alabama

 

Verify Your Prescription Coverage

 

  • Log in to your Blue Cross Blue Shield of Alabama member account through their official website. This account provides detailed information about your specific health plan and any covered medications.
  •  

  • Check your prescription drug list (formulary) to determine if Farxiga is included. This can often be found under the pharmacy benefits section.
  •  

  • Review your plan details to confirm if there are any special requirements for Farxiga coverage, such as prior authorization or step therapy.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor about the necessity of Farxiga for your condition, ensuring they understand any plan requirements, such as trying alternative medications first.
  •  

  • Request that your physician provides necessary documentation or evidence to support the need for Farxiga, which may be required for prior authorization.

 

Contact Blue Cross Blue Shield of Alabama

 

  • Reach out to the customer service department using the contact information on their website or your insurance card for personalized assistance.
  •  

  • Inquire about coverage details for Farxiga, including any applicable co-pays, tiers, or out-of-pocket costs associated with the medication.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if required. This typically involves completing a form and providing medical justification.
  •  

  • Ensure that all necessary documents are included, and submit them through the appropriate channel as directed by Blue Cross Blue Shield of Alabama.

 

Appeal a Denied Coverage Decision

 

  • If your coverage request for Farxiga is denied, review the denial letter carefully to understand the rationale and gather any supporting documents that counter the basis of the denial.
  •  

  • File an appeal by following the instructions provided by Blue Cross Blue Shield of Alabama. It may involve submitting additional documentation or requesting a reevaluation.

 

Utilize Customer Support Resources

 

  • Leverage Blue Cross Blue Shield of Alabama’s resources such as online chat, email support, or in-person consultations to get additional help in understanding your benefits and navigating the appeal process.
  •  

  • Consider speaking with a customer support representative specialized in pharmacy benefits to gain deeper insights into obtaining Farxiga coverage.

 

Explore Financial Assistance Programs

 

  • Investigate manufacturer assistance programs or patient assistance foundations if Farxiga remains unaffordable, even after obtaining insurance coverage.
  •  

  • Check if you meet the eligibility requirements for these programs and apply as needed to receive further financial support.

 

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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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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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