Does Blue Cross Blue Shield of Massachusetts Cover Xarelto

Explore Blue Cross Blue Shield of Massachusetts Xarelto coverage, costs without insurance, denial reasons, and FAQs for seamless access to your medication.
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Coverage for Xarelto

 

  • Xarelto may be covered under Blue Cross Blue Shield of Massachusetts plans, depending on individual policy details and medical necessity.
  •  

  • Often requires a prior authorization, ensuring it's being prescribed appropriately for conditions like atrial fibrillation or deep vein thrombosis.

 

Criteria for Coverage

 

  • Prescribing physician must provide documentation supporting the medical necessity.
  •  

  • Certain plans may necessitate trying other medications first before Xarelto is approved.
  •  

  • Coverage can vary based on the specific plan benefits and formulary tier placement.

 

Additional Considerations

 

  • Always check with Blue Cross Blue Shield for updates on policy regarding Xarelto, as it can vary and change.
  •  

  • Consult with your healthcare provider to gather necessary documents and ensure all criteria are met for coverage 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.

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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 Massachusetts

 

Contact Blue Cross Blue Shield of Massachusetts Customer Service

 

  • Call the Blue Cross Blue Shield of Massachusetts customer service number found on your insurance card. This will give you direct information tailored to your specific plan.
  •  

  • Ask about coverage specifics for Xarelto, including requirements for prior authorizations, billing information, and any restrictions or limitations for the medication.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of using Xarelto. Ensure that your provider documents the medical need for Xarelto in your medical records.
  •  

  • Ask your healthcare provider to write a detailed prescription that includes the medical justification for using Xarelto. This step is important for the approval process.

 

Verify Pharmacy Network

 

  • Check if your preferred pharmacy is within the Blue Cross Blue Shield of Massachusetts network. Using an in-network pharmacy could affect your coverage and costs.
  •  

  • Ensure that the pharmacy is aware you are a member of Blue Cross Blue Shield and inquire about their process for handling insurance claims for Xarelto.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if required by Blue Cross Blue Shield for Xarelto. This may involve specific forms or documentation that your provider must fill out.
  •  

  • Follow up with both your healthcare provider and Blue Cross Blue Shield to confirm that the request has been submitted and received and to inquire about the processing timeline.

 

Review Your Coverage Details

 

  • Once approved, review the details of your coverage for Xarelto. This includes understanding your co-pay, the quantity limits if any, and whether there are any required follow-up actions.
  •  

  • Keep records of all communications and approvals related to your Xarelto coverage for future reference.

 

Appeal if Necessary

 

  • If your coverage for Xarelto is denied, request information on the appeals process from Blue Cross Blue Shield. They should provide you with guidance on how to submit an appeal.
  •  

  • Work closely with your healthcare provider to gather any additional documentation or justification needed to support your appeal.

 

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FAQs

Does Blue Cross Blue Shield of Massachusetts Cover Xarelto

Explore Blue Cross Blue Shield of Massachusetts Xarelto coverage, costs without insurance, denial reasons, and FAQs for seamless access to your medication.
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Is Xarelto Covered by Blue Cross Blue Shield of Massachusetts

 

Coverage for Xarelto

 

  • Xarelto may be covered under Blue Cross Blue Shield of Massachusetts plans, depending on individual policy details and medical necessity.
  •  

  • Often requires a prior authorization, ensuring it's being prescribed appropriately for conditions like atrial fibrillation or deep vein thrombosis.

 

Criteria for Coverage

 

  • Prescribing physician must provide documentation supporting the medical necessity.
  •  

  • Certain plans may necessitate trying other medications first before Xarelto is approved.
  •  

  • Coverage can vary based on the specific plan benefits and formulary tier placement.

 

Additional Considerations

 

  • Always check with Blue Cross Blue Shield for updates on policy regarding Xarelto, as it can vary and change.
  •  

  • Consult with your healthcare provider to gather necessary documents and ensure all criteria are met for coverage approval.

 

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

 

Xarelto Coverage Criteria

 

  • Xarelto is approved for patients who require anticoagulation therapy for conditions such as non-valvular atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), and the prevention of recurrent DVT and PE.
  •  

  • Candidates eligible for Xarelto must demonstrate a high risk of stroke or systemic embolism, particularly for patients with a history of the aforementioned conditions.
  •  

 

Patient History and Evaluation

 

  • Detailed medical history review showing documented need for anticoagulation due to conditions that pose a risk to thromboembolism.
  •  

  • Confirmation of tried and documented instances of prior anticoagulation therapies, which includes warfarin or low molecular weight heparins, with noted side effects or lack of efficacy leading to the consideration of Xarelto.

 

Special Considerations

 

  • Candidates with renal impairment may still be eligible, provided dosing adjustments are made and adequate monitoring is ensured.
  •  

  • Xarelto may be favored for patients requiring minimal dietary restrictions and those seeking alternatives to warfarin due to specific dietary challenges or compliance issues.

 

Why Blue Cross Blue Shield of Massachusetts Might Deny Xarelto Coverage

 

Reasons for Denial of Xarelto Coverage by Blue Cross Blue Shield of Massachusetts

 

  • Xarelto is prescribed outside of the FDA-approved indications, such as an unapproved condition or illness.
  •  

  • The prescribed dosage of Xarelto does not align with approved guidelines. Off-label or experimental use might also not be covered.
  •  

  • The patient does not meet the specific medical necessity criteria set by Blue Cross Blue Shield of Massachusetts for Xarelto prescription.
  •  

  • Alternative therapies are mandated or preferred by the insurance plan, which could fulfill the treatment need without requiring Xarelto.
  •  

  • Coverage might be denied if there is insufficient documentation or evidence to support the necessity of Xarelto use.
  •  

  • If the patient fails to comply with prior authorization requirements necessary for Xarelto coverage.
  •  

  • Xarelto is considered non-formulary under the patient's specific plan, unless an exception is granted.

 

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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 Massachusetts

 

Contact Blue Cross Blue Shield of Massachusetts Customer Service

 

  • Call the Blue Cross Blue Shield of Massachusetts customer service number found on your insurance card. This will give you direct information tailored to your specific plan.
  •  

  • Ask about coverage specifics for Xarelto, including requirements for prior authorizations, billing information, and any restrictions or limitations for the medication.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the necessity of using Xarelto. Ensure that your provider documents the medical need for Xarelto in your medical records.
  •  

  • Ask your healthcare provider to write a detailed prescription that includes the medical justification for using Xarelto. This step is important for the approval process.

 

Verify Pharmacy Network

 

  • Check if your preferred pharmacy is within the Blue Cross Blue Shield of Massachusetts network. Using an in-network pharmacy could affect your coverage and costs.
  •  

  • Ensure that the pharmacy is aware you are a member of Blue Cross Blue Shield and inquire about their process for handling insurance claims for Xarelto.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if required by Blue Cross Blue Shield for Xarelto. This may involve specific forms or documentation that your provider must fill out.
  •  

  • Follow up with both your healthcare provider and Blue Cross Blue Shield to confirm that the request has been submitted and received and to inquire about the processing timeline.

 

Review Your Coverage Details

 

  • Once approved, review the details of your coverage for Xarelto. This includes understanding your co-pay, the quantity limits if any, and whether there are any required follow-up actions.
  •  

  • Keep records of all communications and approvals related to your Xarelto coverage for future reference.

 

Appeal if Necessary

 

  • If your coverage for Xarelto is denied, request information on the appeals process from Blue Cross Blue Shield. They should provide you with guidance on how to submit an appeal.
  •  

  • Work closely with your healthcare provider to gather any additional documentation or justification needed to support your appeal.

 

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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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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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