Does Blue Cross Blue Shield of Minnesota Cover Xarelto

Explore why Blue Cross Blue Shield of Minnesota may deny Xarelto, how to obtain coverage, costs without insurance, and get answers to frequently asked questions.
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Does Blue Cross Blue Shield of Minnesota Cover Xarelto?

 

  • Blue Cross Blue Shield of Minnesota may cover Xarelto if it is prescribed for approved uses, such as preventing blood clots in patients with atrial fibrillation, treating deep vein thrombosis (DVT), and pulmonary embolism (PE), or for reducing the risk of recurrent DVT and PE.
  •  

  • Coverage is generally contingent on the medication being deemed medically necessary. Each patient's specific health plan will have details on drug formulary and tier levels, which impact cost-sharing responsibilities.
  •  

  • Patients may need prior authorization to ensure it meets the criteria set by Blue Cross Blue Shield of Minnesota for coverage. This typically involves documentation from the healthcare provider explaining the necessity of Xarelto over other treatments.
  •  

  • It is recommended that patients check their individual policy or contact customer service for specific details on coverage limits, co-payments, and any possible deductible requirements associated with Xarelto prescription 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 Xarelto Coverage with Blue Cross Blue Shield of Minnesota

 

Determine Xarelto Coverage Requirements

 

  • Visit the Blue Cross Blue Shield of Minnesota (BCBSMN) website to understand their pharmacy benefits for prescription medications such as Xarelto.
  •  

  • Check if Xarelto is listed on the BCBSMN formulary or preferred drug list, which will indicate if it is covered and at what tier.

 

Verify Your Insurance Plan Details

 

  • Review your insurance policy documents or log into your BCBSMN member account to verify your specific plan’s coverage for prescription drugs.
  •  

  • Contact BCBSMN customer service if you need clarification on coverage tiers, copays, or coinsurance related to Xarelto.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Xarelto with your doctor and ensure that it is medically necessary for your condition.
  •  

  • Ask your healthcare provider to provide necessary documentation or a prescription prior authorization if required by BCBSMN.

 

Submit the Prior Authorization Request

 

  • Download or request a prior authorization form from the BCBSMN website if needed.
  •  

  • Your healthcare provider should complete the form, detailing your diagnosis and medical necessity for Xarelto, then submit it to BCBSMN for review.

 

wait for Approval and Follow-Up

 

  • After submitting the prior authorization request, wait for BCBSMN to process and respond. This usually takes several days to weeks depending on the specifics of your plan and policy.
  •  

  • If your request is approved, you will be notified of your coverage terms and can proceed to fill your Xarelto prescription at your pharmacy.
  •  

  • If the request is denied, review the reasons provided and discuss alternatives or appeal options with your healthcare provider and BCBSMN.

 

Manage Your Prescription Costs

 

  • Use a BCBSMN network pharmacy to minimize costs, as these can offer lower copays compared to out-of-network options.
  •  

  • Consider generic alternatives or patient assistance programs if available, to further reduce your out-of-pocket expenses for Xarelto.

 

Keep Records and Stay Informed

 

  • Maintain detailed records of all communications with BCBSMN, your healthcare provider, and your pharmacy regarding your Xarelto prescription.
  •  

  • Stay informed about any changes in your BCBSMN plan, such as formulary updates or benefit modifications, which may affect your coverage for Xarelto.

 

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FAQs

Does Blue Cross Blue Shield of Minnesota Cover Xarelto

Explore why Blue Cross Blue Shield of Minnesota may deny Xarelto, how to obtain coverage, costs without insurance, and get answers to frequently asked questions.
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Is Xarelto Covered by Blue Cross Blue Shield of Minnesota

 

Does Blue Cross Blue Shield of Minnesota Cover Xarelto?

 

  • Blue Cross Blue Shield of Minnesota may cover Xarelto if it is prescribed for approved uses, such as preventing blood clots in patients with atrial fibrillation, treating deep vein thrombosis (DVT), and pulmonary embolism (PE), or for reducing the risk of recurrent DVT and PE.
  •  

  • Coverage is generally contingent on the medication being deemed medically necessary. Each patient's specific health plan will have details on drug formulary and tier levels, which impact cost-sharing responsibilities.
  •  

  • Patients may need prior authorization to ensure it meets the criteria set by Blue Cross Blue Shield of Minnesota for coverage. This typically involves documentation from the healthcare provider explaining the necessity of Xarelto over other treatments.
  •  

  • It is recommended that patients check their individual policy or contact customer service for specific details on coverage limits, co-payments, and any possible deductible requirements associated with Xarelto prescription coverage.

 

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

 

Criteria for Xarelto Coverage

 

  • The patient has been diagnosed with non-valvular atrial fibrillation and requires anticoagulation therapy to reduce the risk of stroke and systemic embolism.
  •  

  • The patient requires the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) and is suitable for anticoagulation therapy following the initial treatment with a parenteral anticoagulant for 5–10 days.
  •  

  • The patient needs to reduce the risk of recurrent DVT or PE following initial therapy of at least 6 months in duration.
  •  

  • The patient is undergoing hip or knee replacement surgery and requires thromboprophylaxis to prevent DVT and/or PE.
  •  

  • The patient suffers from Coronary Artery Disease (CAD) or Peripheral Artery Disease (PAD) and requires therapy to reduce the risk of major cardiovascular events.
  •  

  • Prescriptions for Xarelto are written by or in consultation with a physician specializing in cardiology, hematology, or a pertinent discipline related to the patient condition.
  •  

  • The dosage prescribed aligns with the patient's medical condition and the licensed indications for Xarelto.

 

Why Blue Cross Blue Shield of Minnesota Might Deny Xarelto Coverage

 

Situations Where Coverage Might Be Denied for Xarelto

 

  • Non-Formulary: If Xarelto is not included in Blue Cross Blue Shield of Minnesota's formulary list, coverage may be denied unless justified through a formal exception process.
  •  

  • Off-Label Use: Xarelto prescribed for conditions not approved by the FDA or not specified within the insurance plan may result in denied coverage.
  •  

  • Lack of Prior Authorization: Some plans may require prior authorization, and failure to obtain this before starting treatment could lead to a denial.
  •  

  • Use of Alternative Medications: If more cost-effective alternatives are available and deemed effective, coverage for Xarelto might be declined in favor of these treatments.
  •  

  • Non-Compliance with Plan Guidelines: Ignoring guidelines specified in the member's policy regarding the appropriate prescription of Xarelto can lead to coverage refusal.
  •  

  • Experimental or Investigative Designation: If Xarelto is being used in an experimental or investigative manner, as determined by Blue Cross Blue Shield of Minnesota, coverage may be denied.
  •  

  • Prescription by Non-Network Providers: Prescriptions from healthcare providers not within the plan's network might not be covered, including those for Xarelto.
  •  

  • Failure to Participate in Step Therapy: If step therapy protocols require trying other medications prior to Xarelto, bypassing this step can result in denied coverage.

 

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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 Minnesota

 

Determine Xarelto Coverage Requirements

 

  • Visit the Blue Cross Blue Shield of Minnesota (BCBSMN) website to understand their pharmacy benefits for prescription medications such as Xarelto.
  •  

  • Check if Xarelto is listed on the BCBSMN formulary or preferred drug list, which will indicate if it is covered and at what tier.

 

Verify Your Insurance Plan Details

 

  • Review your insurance policy documents or log into your BCBSMN member account to verify your specific plan’s coverage for prescription drugs.
  •  

  • Contact BCBSMN customer service if you need clarification on coverage tiers, copays, or coinsurance related to Xarelto.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Xarelto with your doctor and ensure that it is medically necessary for your condition.
  •  

  • Ask your healthcare provider to provide necessary documentation or a prescription prior authorization if required by BCBSMN.

 

Submit the Prior Authorization Request

 

  • Download or request a prior authorization form from the BCBSMN website if needed.
  •  

  • Your healthcare provider should complete the form, detailing your diagnosis and medical necessity for Xarelto, then submit it to BCBSMN for review.

 

wait for Approval and Follow-Up

 

  • After submitting the prior authorization request, wait for BCBSMN to process and respond. This usually takes several days to weeks depending on the specifics of your plan and policy.
  •  

  • If your request is approved, you will be notified of your coverage terms and can proceed to fill your Xarelto prescription at your pharmacy.
  •  

  • If the request is denied, review the reasons provided and discuss alternatives or appeal options with your healthcare provider and BCBSMN.

 

Manage Your Prescription Costs

 

  • Use a BCBSMN network pharmacy to minimize costs, as these can offer lower copays compared to out-of-network options.
  •  

  • Consider generic alternatives or patient assistance programs if available, to further reduce your out-of-pocket expenses for Xarelto.

 

Keep Records and Stay Informed

 

  • Maintain detailed records of all communications with BCBSMN, your healthcare provider, and your pharmacy regarding your Xarelto prescription.
  •  

  • Stay informed about any changes in your BCBSMN plan, such as formulary updates or benefit modifications, which may affect your coverage for Xarelto.

 

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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.

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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