Does Blue Cross Blue Shield of Illinois Cover Xarelto

Explore if Blue Cross Blue Shield of Illinois covers Xarelto, potential denials, costs without insurance, and tips for obtaining coverage.
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Coverage for Xarelto

 

  • Blue Cross Blue Shield of Illinois (BCBSIL) generally provides coverage for Xarelto, a medication used to prevent blood clots. It typically falls under the prescription drug plan, but coverage specifics can vary depending on the individual policy.
  •  

  • To qualify for coverage, Xarelto must be medically necessary as determined by a healthcare provider. Prior authorization may be required, and the provider might need to submit documentation supporting the prescription.

 

Criteria for Coverage

 

  • The formulary, or list of covered medications, plays a crucial role. Xarelto must be on BCBSIL’s formulary for a policyholder’s plan, which may affect copayment costs.
  •  

  • Members should check their specific policy details, as coverage can vary significantly between plans, including HMO, PPO, or Medicare plans.
  •  

  • It might be necessary to try generic or preferred formulary alternatives first, unless your doctor provides evidence that Xarelto is the most appropriate treatment option.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Xarelto Coverage with Blue Cross Blue Shield of Illinois

 

Verify Your Benefits

 

  • Contact Blue Cross Blue Shield of Illinois (BCBSIL) customer service to verify if your specific health plan has coverage for Xarelto. You can find their phone number on the back of your insurance card.
  •  

  • Log into your BCBSIL account online. You can review your plan details and see if Xarelto is listed under covered medications there.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Xarelto for your treatment. Ensure they are aware that you are looking to get it covered by your insurance.
  •  

  • Ask your provider to supply a prescription or provide a letter of medical necessity if your insurance requires additional justification for Xarelto coverage.

 

Check the Formulary

 

  • Review the BCBSIL drug formulary (a list of covered medications) online to see if Xarelto is included. If it’s listed, you may have coverage for the drug.
  •  

  • If Xarelto is not on the formulary, consider discussing with your doctor about alternative medications that are covered, or prepare to submit a formulary exception request.

 

Obtain Prior Authorization

 

  • If Xarelto requires prior authorization, ask your healthcare provider to initiate the process. They will likely need to provide clinical information supporting the use of Xarelto for your condition.
  •  

  • Follow up with BCBSIL and your provider to ensure the prior authorization is approved and submitted correctly. Be proactive in this process as it can sometimes take several days to weeks.

 

Explore Additional Assistance

 

  • If coverage is denied, or if out-of-pocket costs are too high, consider reaching out to the manufacturer of Xarelto. They may offer patient assistance programs or coupons to reduce costs.
  •  

  • Check with BCBSIL if there are any available financial aid or medication discount programs you can utilize.

 

Utilize In-Network Pharmacies

 

  • Fill your Xarelto prescription at an in-network pharmacy to ensure you get the best coverage and lowest co-pay under your BCBSIL plan.
  •  

  • Use the BCBSIL website or app to find nearby in-network pharmacies.

 

Monitor Your Claims

 

  • After getting your Xarelto prescription filled, regularly check your insurance claim statements to ensure the medication is covered as expected.
  •  

  • Contact BCBSIL for discrepancies or if any claims are denied, to dispute or inquire about appealing the decision.

 

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FAQs

Does Blue Cross Blue Shield of Illinois Cover Xarelto

Explore if Blue Cross Blue Shield of Illinois covers Xarelto, potential denials, costs without insurance, and tips for obtaining coverage.
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Is Xarelto Covered by Blue Cross Blue Shield of Illinois

 

Coverage for Xarelto

 

  • Blue Cross Blue Shield of Illinois (BCBSIL) generally provides coverage for Xarelto, a medication used to prevent blood clots. It typically falls under the prescription drug plan, but coverage specifics can vary depending on the individual policy.
  •  

  • To qualify for coverage, Xarelto must be medically necessary as determined by a healthcare provider. Prior authorization may be required, and the provider might need to submit documentation supporting the prescription.

 

Criteria for Coverage

 

  • The formulary, or list of covered medications, plays a crucial role. Xarelto must be on BCBSIL’s formulary for a policyholder’s plan, which may affect copayment costs.
  •  

  • Members should check their specific policy details, as coverage can vary significantly between plans, including HMO, PPO, or Medicare plans.
  •  

  • It might be necessary to try generic or preferred formulary alternatives first, unless your doctor provides evidence that Xarelto is the most appropriate treatment option.

 

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

 

Xarelto Coverage Criteria by Blue Cross Blue Shield of Illinois

 

  • Xarelto is covered when prescribed for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). The patient must have a diagnosis substantiated by relevant clinical documentation.
  •  

  • Covers the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and PE following initial therapy. Documentation confirming diagnosis is required.
  •  

  • Approved for the reduction of the risk of major cardiovascular events (cardiovascular death, myocardial infarction, and stroke) in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD). Clinical evidence supporting these conditions must be presented.
  •  

  • Xarelto is covered for venous thromboembolism prophylaxis in acutely ill medical patients at risk for thromboembolic complications who are not at a high risk of bleeding. Patient records should reflect the nature of illness and associated risks.
  •  

  • This medication is approved for use in combination with aspirin to reduce the risk of major cardiovascular events in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD), with relevant clinical justification and documentation.
  •  

  • Covers up to a maximum of 15mg and 20mg once daily dosing for qualifying conditions, as prescribed by a licensed healthcare provider.
  •  

  • The prescribed duration must align with the FDA-approved labeling or generally accepted medical norms, and this must be corroborated by suitable patient records.
  •  

  • A thorough review requirement must be fulfilled with a trial of other anticoagulation treatments if specified in the patient's insurance plan or medical history.

 

Why Blue Cross Blue Shield of Illinois Might Deny Xarelto Coverage

 

Xarelto Non-Coverage Situations

 

  • Non-medically necessary use: Blue Cross Blue Shield of Illinois does not cover Xarelto if it is deemed not medically necessary as per their guidelines and clinical review criteria.
  •  

  • Off-label use: Coverage is denied when Xarelto is used for conditions beyond those approved by the FDA or outside of Blue Cross Blue Shield of Illinois' policy parameters.
  •  

  • Non-formulary status: Xarelto may be excluded if not listed on the plan’s formulary. This could be due to the existence of a preferred alternative medication.
  •  

  • Lack of prior authorization: If the plan requires prior authorization for Xarelto and this approval has not been obtained, coverage will be denied.
  •  

  • Treatment duplicity: If the patient is receiving another anticoagulant therapy that effectively treats the condition, Xarelto coverage may not be provided due to treatment duplication concerns.
  •  

  • Exclusivity terms: If the terms of the insurance policy explicitly exclude certain drugs under the group policy conditions, Xarelto might not be covered regardless of medical necessity.

 

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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 Illinois

 

Verify Your Benefits

 

  • Contact Blue Cross Blue Shield of Illinois (BCBSIL) customer service to verify if your specific health plan has coverage for Xarelto. You can find their phone number on the back of your insurance card.
  •  

  • Log into your BCBSIL account online. You can review your plan details and see if Xarelto is listed under covered medications there.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Xarelto for your treatment. Ensure they are aware that you are looking to get it covered by your insurance.
  •  

  • Ask your provider to supply a prescription or provide a letter of medical necessity if your insurance requires additional justification for Xarelto coverage.

 

Check the Formulary

 

  • Review the BCBSIL drug formulary (a list of covered medications) online to see if Xarelto is included. If it’s listed, you may have coverage for the drug.
  •  

  • If Xarelto is not on the formulary, consider discussing with your doctor about alternative medications that are covered, or prepare to submit a formulary exception request.

 

Obtain Prior Authorization

 

  • If Xarelto requires prior authorization, ask your healthcare provider to initiate the process. They will likely need to provide clinical information supporting the use of Xarelto for your condition.
  •  

  • Follow up with BCBSIL and your provider to ensure the prior authorization is approved and submitted correctly. Be proactive in this process as it can sometimes take several days to weeks.

 

Explore Additional Assistance

 

  • If coverage is denied, or if out-of-pocket costs are too high, consider reaching out to the manufacturer of Xarelto. They may offer patient assistance programs or coupons to reduce costs.
  •  

  • Check with BCBSIL if there are any available financial aid or medication discount programs you can utilize.

 

Utilize In-Network Pharmacies

 

  • Fill your Xarelto prescription at an in-network pharmacy to ensure you get the best coverage and lowest co-pay under your BCBSIL plan.
  •  

  • Use the BCBSIL website or app to find nearby in-network pharmacies.

 

Monitor Your Claims

 

  • After getting your Xarelto prescription filled, regularly check your insurance claim statements to ensure the medication is covered as expected.
  •  

  • Contact BCBSIL for discrepancies or if any claims are denied, to dispute or inquire about appealing the decision.

 

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Xarelto FAQ

What are the common side effects of Xarelto?

 

Common Side Effects of Xarelto

 

  • Bleeding is the most common, including nasal, gum, or gastrointestinal bleeding. Be vigilant for any signs of unusual bleeding and seek medical attention if necessary.
  •  

  • Gastrointestinal issues such as nausea and stomach pain may occur. Taking Xarelto with food can help alleviate these symptoms.
  •  

  • Dizziness and fatigue can affect some individuals, especially when first starting the medication. Ensure you maintain hydration and rest as needed.
  •  

  • In rare cases, allergic reactions may manifest as rash or itching. If this occurs, consult your healthcare provider promptly.

 

Is Xarelto a blood thinner?

 

Is Xarelto a Blood Thinner?

 

  • **Xarelto (rivaroxaban)** is indeed a blood thinner, specifically an anticoagulant, which is crucial for preventing blood clots that can lead to conditions like stroke or deep vein thrombosis (DVT).
  •  

  • It works by inhibiting **factor Xa**, an essential component in the coagulation cascade, reducing the ability of blood to form clots.
  •  

  • As a **direct oral anticoagulant (DOAC)**, it provides several advantages over traditional blood thinners like warfarin, such as having fewer dietary restrictions and not requiring regular blood monitoring.
  •  

  • It's important to take it as prescribed by a healthcare provider, considering potential drug interactions and contraindications.

 

Can you drink alcohol while taking Xarelto?

 

Drinking Alcohol with Xarelto

 

  • Xarelto, a blood thinner, may increase bleeding risk, and alcohol can amplify this risk.
  •  

  • Both substances affect liver function, potentially impacting medication metabolism and effectiveness.
  •  

  • Consuming alcohol while on Xarelto may enhance side effects like dizziness, increasing injury risk.
  •  

  • It’s crucial to consult your healthcare provider to discuss allowable alcohol intake based on your health status and dosage.
  •  

 

General Recommendations

 

  • Moderation is key – if approved, limit alcohol consumption as per medical advice.
  •  

  • Avoid binge drinking, which drastically heightens risk of adverse reactions.
  •  

  • Inform your medical team about recreational activities involving alcohol.

 

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Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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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.

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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?

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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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