Does Blue Cross Blue Shield of Michigan Cover Eliquis

Discover if Blue Cross Blue Shield of Michigan covers Eliquis, explore coverage details, cost info, and learn how to navigate insurance for this medication.
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Eliquis Coverage by Blue Cross Blue Shield of Michigan

 

  • Blue Cross Blue Shield of Michigan (BCBSM) may cover Eliquis depending on your specific health plan. Coverage typically revolves around necessity and adherence to prescription drug guidelines.
  •  

  • Eligibility usually requires prior authorization, where your physician must confirm that Eliquis is medically necessary for conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism. Alternative drugs might also need to be trialed first.
  •  

  • Formulary inclusion is a key factor; check if Eliquis is listed under your plan’s formulary, which influences copayment levels and coverage limits.
  •  

  • Patients often need to meet criteria such as documented contraindication to other medications or failure of other treatment options to ensure coverage.

 

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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 Michigan

 

Understand Your Plan Details

 

  • Log into your Blue Cross Blue Shield of Michigan (BCBSM) account to review your current insurance plan's details. Understand your prescription drug coverage, including any formulary restrictions or prior authorization requirements.
  •  

  • Check the list of covered drugs (formulary) to see if Eliquis is included. This information may help you determine if any special steps need to be taken or if it's already covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Eliquis for your condition. Ensure they understand your insurance limitations and express your need for insurance coverage assistance.
  •  

  • Ask your provider to prepare any required documentation justifying the medical necessity of Eliquis, which may be needed for prior authorization.

 

Contact BCBSM Customer Service

 

  • Call the customer service number found on the back of your BCBSM insurance card. Request information regarding Eliquis coverage under your specific plan and ask if there are any steps or documentation needed for approval.
  •  

  • Inquire about any forms required for prior authorization or if specific types of requests need to be initiated by your healthcare provider.

 

Submit Prior Authorization

 

  • If required, coordinate with your healthcare provider to submit a prior authorization request to BCBSM. This form will usually need to include the medical necessity and other relevant information.
  •  

  • Ensure all submitted documentation is complete and factual to avoid delays in processing your request.

 

Follow Up and Appeal if Necessary

 

  • Monitor the status of your prior authorization request through BCBSM’s member portal or by calling their customer service. Follow up if there are any delays.
  •  

  • If your request is denied, inquire about the reason and consider appealing the decision. Request information on the appeal process from BCBSM, and gather any additional support from your healthcare provider.

 

Explore Financial Assistance Options

 

  • If BCBSM does not cover Eliquis or if the cost is still high after insurance, explore financial assistance programs offered by the manufacturer or third-party organizations to help with the cost.
  •  

  • Discuss alternative medications with your healthcare provider that may be covered by BCBSM if Eliquis is unaffordable or remains uncovered.

 

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Eliquis

Discover if Blue Cross Blue Shield of Michigan covers Eliquis, explore coverage details, cost info, and learn how to navigate insurance for this medication.
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Is Eliquis Covered by Blue Cross Blue Shield of Michigan

 

Eliquis Coverage by Blue Cross Blue Shield of Michigan

 

  • Blue Cross Blue Shield of Michigan (BCBSM) may cover Eliquis depending on your specific health plan. Coverage typically revolves around necessity and adherence to prescription drug guidelines.
  •  

  • Eligibility usually requires prior authorization, where your physician must confirm that Eliquis is medically necessary for conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism. Alternative drugs might also need to be trialed first.
  •  

  • Formulary inclusion is a key factor; check if Eliquis is listed under your plan’s formulary, which influences copayment levels and coverage limits.
  •  

  • Patients often need to meet criteria such as documented contraindication to other medications or failure of other treatment options to ensure coverage.

 

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

 

Eligibility Criteria for Eliquis Coverage Under Blue Cross Blue Shield of Michigan

 

  • Patient must have a diagnosis of non-valvular atrial fibrillation (NVAF) and require anticoagulation to reduce the risk of stroke and systemic embolism.
  •  

  • Coverage is available for patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) and who require treatment to reduce the risk of recurrence.
  •  

  • Eliquis may be covered for the prophylaxis of deep vein thrombosis (DVT) in patients who have undergone hip or knee replacement surgery.
  •  

  • Patients who have a contraindication or have experienced an adverse reaction to warfarin or other anticoagulants may be eligible if Eliquis is deemed clinically appropriate.
  •  

  • For initial therapy, demonstrate baseline indications pertinent to the use of Eliquis and the absence of contraindications for its use.
  •  

  • Verification of renal function is required, and coverage may depend on kidney function levels being compatible with Eliquis treatment guidelines.
  •  

  • For continued coverage, documentation of therapeutic response and reassessment of risk-benefit ratio of ongoing Eliquis therapy is necessary.
  •  

 

Why Blue Cross Blue Shield of Michigan Might Deny Eliquis Coverage

 

Reasons for Denial of Eliquis Coverage

 

  • If Eliquis is used for an off-label indication that is not approved by the FDA or does not meet the plan’s medical necessity criteria.
  •  

  • When a member does not meet the predefined clinical criteria for coverage, such as specific diagnoses or prior treatment failure with other medications.
  •  

  • If there is a lack of prior authorization or failure to follow pre-authorization processes as required by the insurance plan.
  •  

  • In cases where generic or less costly alternatives are available and considered appropriate for the patient's condition.
  •  

  • If the prescription exceeds the dosage limits set by the plan or is prescribed for a duration longer than approved coverage allows.
  •  

  • If there is insufficient evidence in the medical records to justify the need for Eliquis, such as missing relevant test results or documentation.
  •  

  • For prescriptions from providers who are out of network, unless specific exceptions or out-of-network benefits apply.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 Michigan

 

Understand Your Plan Details

 

  • Log into your Blue Cross Blue Shield of Michigan (BCBSM) account to review your current insurance plan's details. Understand your prescription drug coverage, including any formulary restrictions or prior authorization requirements.
  •  

  • Check the list of covered drugs (formulary) to see if Eliquis is included. This information may help you determine if any special steps need to be taken or if it's already covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Eliquis for your condition. Ensure they understand your insurance limitations and express your need for insurance coverage assistance.
  •  

  • Ask your provider to prepare any required documentation justifying the medical necessity of Eliquis, which may be needed for prior authorization.

 

Contact BCBSM Customer Service

 

  • Call the customer service number found on the back of your BCBSM insurance card. Request information regarding Eliquis coverage under your specific plan and ask if there are any steps or documentation needed for approval.
  •  

  • Inquire about any forms required for prior authorization or if specific types of requests need to be initiated by your healthcare provider.

 

Submit Prior Authorization

 

  • If required, coordinate with your healthcare provider to submit a prior authorization request to BCBSM. This form will usually need to include the medical necessity and other relevant information.
  •  

  • Ensure all submitted documentation is complete and factual to avoid delays in processing your request.

 

Follow Up and Appeal if Necessary

 

  • Monitor the status of your prior authorization request through BCBSM’s member portal or by calling their customer service. Follow up if there are any delays.
  •  

  • If your request is denied, inquire about the reason and consider appealing the decision. Request information on the appeal process from BCBSM, and gather any additional support from your healthcare provider.

 

Explore Financial Assistance Options

 

  • If BCBSM does not cover Eliquis or if the cost is still high after insurance, explore financial assistance programs offered by the manufacturer or third-party organizations to help with the cost.
  •  

  • Discuss alternative medications with your healthcare provider that may be covered by BCBSM if Eliquis is unaffordable or remains uncovered.

 

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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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Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

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

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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