Does Blue Cross Blue Shield of Illinois Cover Eliquis

Discover if Blue Cross Blue Shield of Illinois covers Eliquis, potential reasons for denial, ways to secure coverage, costs without insurance, and answers to FAQs.
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Coverage for Eliquis

 

  • Blue Cross Blue Shield of Illinois (BCBSIL) may cover Eliquis (apixaban) if it's deemed medically necessary. It's generally covered under prescription drug benefits.
  •  

  • Coverage depends on your specific plan's formulary and tier placement of Eliquis. Check your plan details or speak with a BCBSIL representative for specifics.

 

Criteria for Coverage

 

  • Prior authorization may be required. This process verifies that Eliquis is necessary for the treatment of conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism.
  •  

  • Your doctor may need to provide documentation supporting the prescription, especially if other medications have been ineffective or caused adverse effects.
  •  

  • Refills may be subject to quantity limits based on recommended dosage guidelines and your treatment plan.

 

Useful Tips

 

  • Review your BCBSIL member handbook to understand your benefits, or access your account online for details.
  •  

  • Consult with your healthcare provider to ensure that all necessary paperwork is completed correctly for swift approval.

 

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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 Eliquis Coverage with Blue Cross Blue Shield of Illinois

 

Check Your Plan Details

 

  • Visit the Blue Cross Blue Shield of Illinois website and log into your member portal.
  •  

  • Review your specific plan details to see if Eliquis is included in your prescription drug coverage.
  •  

  • Contact customer service if you have questions about your coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Eliquis with your doctor.
  •  

  • Ensure your doctor is aware of any formulary requirements specific to Blue Cross Blue Shield of Illinois.
  •  

  • Ask your healthcare provider if a prior authorization is needed for Eliquis.

 

Prepare Necessary Documentation

 

  • Gather any medical records that support your need for Eliquis.
  •  

  • If a prior authorization is required, work with your healthcare provider to complete the necessary forms.
  •  

  • Double-check all documentation for completeness and accuracy before submission.

 

Submit a Prior Authorization Request

 

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

  • Follow the submission procedures outlined by Blue Cross Blue Shield of Illinois for a faster response.
  •  

  • Keep a copy of all submitted documents for your records.

 

Check the Status of Your Request

 

  • Log into your Blue Cross Blue Shield of Illinois member portal to check the status of your authorization request.
  •  

  • Contact customer service if there are delays or if you have additional questions about the status.

 

Appeal or Explore Alternatives

 

  • If your request for coverage is denied, review the denial letter and grounds for denial carefully.
  •  

  • Consider working with your healthcare provider to appeal the decision or discuss alternative medications that may be covered.
  •  

  • Contact the customer service team for guidance on the appeals process if necessary.

 

Utilize a Mail Order Pharmacy

 

  • If approved, consider using a mail order pharmacy option provided by Blue Cross Blue Shield for a possibly lower copay or other benefits.
  •  

  • Consult your plan documents or speak with customer service to understand mail order benefits and enroll if appropriate.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Eliquis

Discover if Blue Cross Blue Shield of Illinois covers Eliquis, potential reasons for denial, ways to secure coverage, costs without insurance, and answers to FAQs.
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Is Eliquis Covered by Blue Cross Blue Shield of Illinois

 

Coverage for Eliquis

 

  • Blue Cross Blue Shield of Illinois (BCBSIL) may cover Eliquis (apixaban) if it's deemed medically necessary. It's generally covered under prescription drug benefits.
  •  

  • Coverage depends on your specific plan's formulary and tier placement of Eliquis. Check your plan details or speak with a BCBSIL representative for specifics.

 

Criteria for Coverage

 

  • Prior authorization may be required. This process verifies that Eliquis is necessary for the treatment of conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism.
  •  

  • Your doctor may need to provide documentation supporting the prescription, especially if other medications have been ineffective or caused adverse effects.
  •  

  • Refills may be subject to quantity limits based on recommended dosage guidelines and your treatment plan.

 

Useful Tips

 

  • Review your BCBSIL member handbook to understand your benefits, or access your account online for details.
  •  

  • Consult with your healthcare provider to ensure that all necessary paperwork is completed correctly for swift approval.

 

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Blue Cross Blue Shield of Illinois's Approved Criteria for Eliquis Coverage

 

Eligibility Requirements for Eliquis Coverage

 

  • Members must have a diagnosis that requires anticoagulation therapy, such as atrial fibrillation not caused by a heart valve problem.
  •  

  • Eliquis is prescribed for the treatment and prevention of deep vein thrombosis (DVT) or pulmonary embolism (PE).
  •  

  • Candidates undergoing knee or hip replacement surgery may qualify for Eliquis to prevent DVT or PE.
  •  

  • Members must be 18 years of age or older to qualify for coverage.

 

Prescribing Physician Requirements

 

  • The prescription must be written by a qualified healthcare provider, such as a cardiologist or hematologist, with experience in managing anticoagulation therapy.
  •  

  • Documentation from the prescribing physician must be submitted, demonstrating the medical necessity of Eliquis.

 

Prior Authorization Criteria

 

  • Initial prescription for Eliquis requires a prior authorization, which must be approved before the medication is covered.
  •  

  • Renewal prescriptions require updated medical records indicating continued need for anticoagulation therapy.

 

Documentation and Review Process

 

  • Comprehensive medical history and current medications list must be submitted for review.
  •  

  • All submitted documents are evaluated by Blue Cross Blue Shield of Illinois to ensure compliance with coverage criteria.

 

Cost-Sharing and Coverage Limits

 

  • Members may be subject to cost-sharing measures such as co-payments or co-insurance based on their specific insurance plan.
  •  

  • Coverage may be limited to a specified amount per month as determined by the enrollee's policy.

 

Why Blue Cross Blue Shield of Illinois Might Deny Eliquis Coverage

 

Reasons for Denial of Eliquis Coverage by Blue Cross Blue Shield of Illinois

 

  • Non-Formulary Status: Eliquis may not be included in the specific formulary of your plan. If the drug is classified as a non-formulary medication, it may not be covered.
  •  

  • Lack of Prior Authorization: The insurance plan may require prior authorization for Eliquis. Failing to obtain this authorization before purchasing the medication can result in a denial of coverage.
  •  

  • Off-Label Use: Eliquis may be prescribed for conditions not approved by the FDA or not listed in the insurance plan’s accepted list. Off-label use can lead to a denial of payment.
  •  

  • Step Therapy Requirements: The plan may require trying other, less expensive medications before approving Eliquis. If these conditions are not met, coverage may be denied.
  •  

  • Generic Alternatives: If a generic equivalent is available and deemed appropriate, coverage for Eliquis might be denied in favor of the lower-cost alternative.
  •  

  • Inadequate Medical Documentation: Insufficient evidence supporting the necessity of Eliquis for the patient’s condition can lead to a lack of coverage.
  •  

  • Non-Compliant Pharmacy Usage: Obtaining the medication from a pharmacy outside of the plan's network can result in non-coverage.

 

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How Much Does Eliquis Cost without Insurance?

 

Approximate Cost of Eliquis without Insurance

 

  • The cost of Eliquis, a commonly prescribed blood thinner, can vary based on the pharmacy, location, and any available discounts or coupons. On average, without insurance, Eliquis can cost around $550 to $650 for a 30-day supply.
  •  

  • Some pharmacies or online platforms may offer discounts or generic options that can lower the cost, so it's advisable to shop around. Patients should also inquire about manufacturer coupons or assistance programs that might help reduce the price.
  •  

  • Price comparison tools and websites can be helpful in finding the best available prices for Eliquis in your area.

 

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 Eliquis Coverage with Blue Cross Blue Shield of Illinois

 

Check Your Plan Details

 

  • Visit the Blue Cross Blue Shield of Illinois website and log into your member portal.
  •  

  • Review your specific plan details to see if Eliquis is included in your prescription drug coverage.
  •  

  • Contact customer service if you have questions about your coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Eliquis with your doctor.
  •  

  • Ensure your doctor is aware of any formulary requirements specific to Blue Cross Blue Shield of Illinois.
  •  

  • Ask your healthcare provider if a prior authorization is needed for Eliquis.

 

Prepare Necessary Documentation

 

  • Gather any medical records that support your need for Eliquis.
  •  

  • If a prior authorization is required, work with your healthcare provider to complete the necessary forms.
  •  

  • Double-check all documentation for completeness and accuracy before submission.

 

Submit a Prior Authorization Request

 

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

  • Follow the submission procedures outlined by Blue Cross Blue Shield of Illinois for a faster response.
  •  

  • Keep a copy of all submitted documents for your records.

 

Check the Status of Your Request

 

  • Log into your Blue Cross Blue Shield of Illinois member portal to check the status of your authorization request.
  •  

  • Contact customer service if there are delays or if you have additional questions about the status.

 

Appeal or Explore Alternatives

 

  • If your request for coverage is denied, review the denial letter and grounds for denial carefully.
  •  

  • Consider working with your healthcare provider to appeal the decision or discuss alternative medications that may be covered.
  •  

  • Contact the customer service team for guidance on the appeals process if necessary.

 

Utilize a Mail Order Pharmacy

 

  • If approved, consider using a mail order pharmacy option provided by Blue Cross Blue Shield for a possibly lower copay or other benefits.
  •  

  • Consult your plan documents or speak with customer service to understand mail order benefits and enroll if appropriate.

 

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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.

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Eliquis FAQ

What are the side effects of Eliquis?

 

Common Side Effects of Eliquis

 

  • Mild bleeding or bruising due to its anticoagulant effect.
  • Nausea, which may occur as your body adjusts to the medication.
  • Skin rash or minor allergic reactions.
  • Fatigue or general weakness.

 

Serious Side Effects

 

  • Severe bleeding, including unusual bleeding from gums, nosebleeds, or heavier than usual menstrual bleeding.
  • Red, pink, or brown urine and black or bloody stools indicating internal bleeding.
  • Severe headache, dizziness, or fainting, which could indicate a bleed in the brain.
  • Signs of anemia, such as pale skin, weakness, or fatigue.

 

Consult Your Doctor

 

  • Always report any unusual symptoms to your healthcare provider promptly.
  • Seek emergency medical attention for significant bleeding or symptoms of a serious allergic reaction like difficulty breathing.

 

Is Eliquis a blood thinner?

 

Is Eliquis a Blood Thinner?

 

  • Yes, Eliquis (apixaban) is a blood thinner, also known as an anticoagulant.
  •  

  • It prevents blood clots by inhibiting Factor Xa, which is crucial in the clotting process.
  •  

  • Doctors prescribe Eliquis to reduce stroke risk in patients with atrial fibrillation and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
  •  

  • Ensure regular monitoring and follow-ups with your healthcare provider while on Eliquis for safe management.
  •  

  • Contact a healthcare professional if you have concerns about bleeding risks or interactions with other medications.

 

Can you take Eliquis with alcohol?

 

Alcohol and Eliquis Interaction

 

  • Moderate alcohol consumption might be safe, but heavy drinking can increase bleeding risk.
  •  

  • Consult your healthcare provider to assess your specific condition and alcohol tolerance.

 

Potential Effects of Combining

 

  • Both Eliquis and alcohol affect blood clotting, raising potential for heightened bleeding.
  •  

  • Alcohol can augment Eliquis' effects, complicating the management of conditions like atrial fibrillation.

 

Recommendations for Use

 

  • If you drink, limit to one or two standard drinks occasionally and monitor for bruising or bleeding.
  •  

  • Report any unusual symptoms to your healthcare provider immediately.

 

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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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