Does Blue Cross Blue Shield of Alabama Cover Xarelto

Discover if Blue Cross Blue Shield of Alabama covers Xarelto, reasons for denial, coverage tips, costs without insurance, and answers to common Xarelto questions.
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Blue Cross Blue Shield of Alabama Coverage for Xarelto

 

  • Blue Cross Blue Shield of Alabama typically covers Xarelto for certain medical conditions. Xarelto is generally prescribed for preventing blood clots in individuals with conditions like atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism.
  •  

  • For coverage, a doctor must prescribe Xarelto, and it must be deemed medically necessary. The patient may need to try and fail other anticoagulants before Xarelto coverage can be approved (step therapy).
  •  

  • Prior authorization is usually required, meaning that your healthcare provider will need to submit a request detailing the medical necessity of Xarelto for your particular situation.
  •  

  • Coverage can vary based on the specific plan, so checking the details of your plan is crucial to understand copays, deductibles, and formularies.
  •  

  • The medication might be listed on a specific tier, affecting your out-of-pocket cost depending on your plan's tier structure and benefits.

 

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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 Blue Cross Blue Shield of Alabama

 

Check if Xarelto is Covered

 

  • Contact Blue Cross Blue Shield of Alabama (BCBSAL) customer service to confirm if Xarelto is included in your specific health plan's formulary.
  •  

  • Visit the BCBSAL website to access your member portal and review your medication coverage. This can often clarify what prescription drugs are covered.
  •  

  • Consult the list of approved medications provided by BCBSAL to see if Xarelto requires any prior authorization or special approvals.

 

Discuss with Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss your need for Xarelto. Ensure they provide appropriate documentation if the medication needs prior authorization.
  •  

  • Request your doctor's office to initiate contact with BCBSAL if prior authorization is necessary. They will send the required medical necessity documentation on your behalf.

 

Initiate a Formal Request

 

  • Download and complete any required forms for drug coverage requests from BCBSAL’s website.
  •  

  • Submit the completed forms to BCBSAL through the specified channels (mail, fax, or online submission).
  •  

  • Ensure that your doctor provides any additional information requested by BCBSAL to support your case for needing Xarelto.

 

Follow Up on Your Request

 

  • Regularly check the status of your request with BCBSAL either via phone or through your member account online.
  •  

  • Check your mail for any correspondence from BCBSAL regarding the status of your request or any additional information they might need.

 

Appeal if Necessary

 

  • If your request is denied, inquire about the specific reasons for denial with BCBSAL customer support.
  •  

  • Collect any additional documentation or statements from your healthcare provider to support a formal appeal.
  •  

  • Submit an appeal through the provided BCBSAL procedures, clearly outlining why Xarelto is necessary for your treatment based on your medical condition.

 

Explore Alternative Options

 

  • If your appeal is unsuccessful, discuss alternate medications with your healthcare provider.
  •  

  • Consider asking BCBSAL if there are any other covered medications or treatment plans that can be considered instead of Xarelto.

 

Stay Informed

 

  • Keep up to date with any changes in your BCBSAL coverage by regularly reviewing notices and updates from the insurer.
  •  

  • Periodically review your policy to ensure you are informed about your benefits and any medication coverage changes.

 

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FAQs

Does Blue Cross Blue Shield of Alabama Cover Xarelto

Discover if Blue Cross Blue Shield of Alabama covers Xarelto, reasons for denial, coverage tips, costs without insurance, and answers to common Xarelto questions.
Curex allergy drops unboxing

Is Xarelto Covered by Blue Cross Blue Shield of Alabama

 

Blue Cross Blue Shield of Alabama Coverage for Xarelto

 

  • Blue Cross Blue Shield of Alabama typically covers Xarelto for certain medical conditions. Xarelto is generally prescribed for preventing blood clots in individuals with conditions like atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism.
  •  

  • For coverage, a doctor must prescribe Xarelto, and it must be deemed medically necessary. The patient may need to try and fail other anticoagulants before Xarelto coverage can be approved (step therapy).
  •  

  • Prior authorization is usually required, meaning that your healthcare provider will need to submit a request detailing the medical necessity of Xarelto for your particular situation.
  •  

  • Coverage can vary based on the specific plan, so checking the details of your plan is crucial to understand copays, deductibles, and formularies.
  •  

  • The medication might be listed on a specific tier, affecting your out-of-pocket cost depending on your plan's tier structure and benefits.

 

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

 

Criteria for Xarelto Coverage

 

  • Xarelto (rivaroxaban) is covered for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation who have moderate to high risk of stroke. The prescription must be provided by a healthcare professional, confirming the patient's clinical necessity for this specific medication.
  •  

  • Coverage is approved for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and PE in patients over the age of 18 who have experienced these conditions previously. The condition must be documented by a healthcare provider.
  •  

  • Xarelto is covered for thromboprophylaxis in patients undergoing hip replacement surgery for up to 35 days and for knee replacement surgery for up to 12 days. The healthcare provider must certify that the patient is at moderate to high risk for thromboembolic complications.
  •  

  • The drug is approved for use in the prevention of venous thromboembolism (VTE) in acutely ill medical patients at high risk for thromboembolic complications who are not at high risk of bleeding. This situation must be verified by a licensed healthcare provider through medical documentation.
  •  

  • Coverage is available for patients with coronary artery disease (CAD) or peripheral artery disease (PAD) as it relates to the prevention of major cardiovascular events, such as heart attack or stroke, when prescribed by a healthcare provider.

 

Necessary Documentation

 

  • A written prescription from a licensed healthcare provider indicating the necessity for Xarelto based on the patient's diagnosis and condition.
  •  

  • Clinical notes or records that specify the patient's medical history, including any prior occurrences of DVT or PE, if applicable, and risk assessments that justify the need for Xarelto.
  •  

  • Evidence of the planned surgical procedure, if Xarelto is being prescribed for thromboprophylaxis related to surgery, accompanied by a healthcare provider's statement on the associated thromboembolic risk.

 

Why Blue Cross Blue Shield of Alabama Might Deny Xarelto Coverage

 

Reasons Blue Cross Blue Shield of Alabama Might Deny Xarelto Coverage

 

  • No Prior Authorization: Xarelto may require prior authorization, and failure to obtain it can result in denial of coverage.
  •  

  • Off-Label Use: Coverage may be denied if Xarelto is prescribed for a condition not approved by the FDA, as insurers often do not cover off-label uses.
  •  

  • Alternative Treatments: Coverage might be refused if there are less expensive or alternative treatments deemed appropriate and available.
  •  

  • Non-compliance with Step Therapy: If the patient has not tried and failed on a step therapy protocol required by the insurance plan, the use of Xarelto might be denied.
  •  

  • Non-Formulary Drug: Xarelto might be excluded if it is not listed on the formulary plan provided by Blue Cross Blue Shield of Alabama.
  •  

  • Policy Exclusions: Certain insurance policies might exclude Xarelto or specific uses of the drug as per the policy terms.
  •  

  • Lack of Medical Necessity: If the insurance provider determines that the use of Xarelto is not medically necessary based on their criteria, it may not be covered.
  •  

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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 Blue Cross Blue Shield of Alabama

 

Check if Xarelto is Covered

 

  • Contact Blue Cross Blue Shield of Alabama (BCBSAL) customer service to confirm if Xarelto is included in your specific health plan's formulary.
  •  

  • Visit the BCBSAL website to access your member portal and review your medication coverage. This can often clarify what prescription drugs are covered.
  •  

  • Consult the list of approved medications provided by BCBSAL to see if Xarelto requires any prior authorization or special approvals.

 

Discuss with Your Doctor

 

  • Schedule an appointment with your healthcare provider to discuss your need for Xarelto. Ensure they provide appropriate documentation if the medication needs prior authorization.
  •  

  • Request your doctor's office to initiate contact with BCBSAL if prior authorization is necessary. They will send the required medical necessity documentation on your behalf.

 

Initiate a Formal Request

 

  • Download and complete any required forms for drug coverage requests from BCBSAL’s website.
  •  

  • Submit the completed forms to BCBSAL through the specified channels (mail, fax, or online submission).
  •  

  • Ensure that your doctor provides any additional information requested by BCBSAL to support your case for needing Xarelto.

 

Follow Up on Your Request

 

  • Regularly check the status of your request with BCBSAL either via phone or through your member account online.
  •  

  • Check your mail for any correspondence from BCBSAL regarding the status of your request or any additional information they might need.

 

Appeal if Necessary

 

  • If your request is denied, inquire about the specific reasons for denial with BCBSAL customer support.
  •  

  • Collect any additional documentation or statements from your healthcare provider to support a formal appeal.
  •  

  • Submit an appeal through the provided BCBSAL procedures, clearly outlining why Xarelto is necessary for your treatment based on your medical condition.

 

Explore Alternative Options

 

  • If your appeal is unsuccessful, discuss alternate medications with your healthcare provider.
  •  

  • Consider asking BCBSAL if there are any other covered medications or treatment plans that can be considered instead of Xarelto.

 

Stay Informed

 

  • Keep up to date with any changes in your BCBSAL coverage by regularly reviewing notices and updates from the insurer.
  •  

  • Periodically review your policy to ensure you are informed about your benefits and any medication coverage changes.

 

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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.

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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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