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Does Blue Cross Blue Shield of North Carolina Cover Eliquis

Discover Eliquis coverage details with Blue Cross NC, reasons for denial, costs without insurance, and FAQs. Ensure you get the coverage you need.
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Blue Cross Blue Shield of North Carolina Coverage for Eliquis

 

  • Eliquis is typically covered under the prescription drug benefits of Blue Cross Blue Shield of North Carolina (BCBSNC) plans.

    •  

  • Coverage may be subject to certain conditions, including formulary placement, medical necessity, and prior authorization requirements.

    •  

  • For formulary inclusion, BCBSNC assesses the drug's efficacy, safety, and cost-effectiveness.

    •  

  • If Eliquis requires prior authorization, your healthcare provider must submit a request justifying its use based on your medical condition.

    •  

  • To confirm coverage specifics, including out-of-pocket costs, review your plan documents or contact BCBSNC customer service directly.

    •  

  • Patients may need follow-up documentation, like proof of condition diagnosis, to meet pre-established criteria for coverage.

 

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Clinical Support

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 North Carolina

 

Verify Eligibility and Plan Details

 

  • Log in to your Blue Cross Blue Shield of North Carolina (BCBSNC) member portal to review your current plan details, prescription drug coverage, and any applicable formularies.

    •  

  • Check your plan’s formulary list to see if Eliquis is a covered medication and under which tier it is classified. This will give you an understanding of the medication's coverage requirements and potential co-pays.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about your need for Eliquis. Your doctor can help justify the necessity of the medication if further information is required by BCBSNC.

    •  

  • If Eliquis is not initially covered, your healthcare provider may need to assist in submitting a prior authorization request or suggest alternative medications that are covered.

 

Prior Authorization and Appeals

 

  • If your initial request for Eliquis coverage is denied, your healthcare provider can submit a prior authorization form to BCBSNC, providing detailed medical necessity documentation.

    •  

  • In the event of a denial after prior authorization, consider filing an appeal. Work closely with your healthcare provider to gather any additional documentation needed to support your case.

 

Explore Savings Programs

 

  • Investigate the availability of any savings programs or manufacturer coupons for Eliquis, which can help reduce out-of-pocket expenses while awaiting coverage approval.

    •  

  • Check the BCBSNC member portal for any additional savings options or pharmacy benefits you may qualify for.

 

Contact Customer Support

 

  • If you need further assistance, contact BCBSNC customer support. They can guide you through the specifics of your plan and any required steps for obtaining coverage for Eliquis.

    •  

  • Prepare all necessary information before contacting customer support, such as policy number, prescription details, and any previously submitted documents.

 

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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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FAQs

Does Blue Cross Blue Shield of North Carolina Cover Eliquis

Discover Eliquis coverage details with Blue Cross NC, reasons for denial, costs without insurance, and FAQs. Ensure you get the coverage you need.
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Is Eliquis Covered by Blue Cross Blue Shield of North Carolina

 

Blue Cross Blue Shield of North Carolina Coverage for Eliquis

 

  • Eliquis is typically covered under the prescription drug benefits of Blue Cross Blue Shield of North Carolina (BCBSNC) plans.

    •  

  • Coverage may be subject to certain conditions, including formulary placement, medical necessity, and prior authorization requirements.

    •  

  • For formulary inclusion, BCBSNC assesses the drug's efficacy, safety, and cost-effectiveness.

    •  

  • If Eliquis requires prior authorization, your healthcare provider must submit a request justifying its use based on your medical condition.

    •  

  • To confirm coverage specifics, including out-of-pocket costs, review your plan documents or contact BCBSNC customer service directly.

    •  

  • Patients may need follow-up documentation, like proof of condition diagnosis, to meet pre-established criteria for coverage.

 

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Blue Cross Blue Shield of North Carolina's Approved Criteria for Eliquis Coverage

 

Eligibility Criteria for Eliquis Coverage

 

  • The patient must have a formal diagnosis that necessitates the use of Eliquis as prescribed by a licensed healthcare provider.

    •  

  • Eliquis is covered for the treatment of non-valvular atrial fibrillation to reduce the risk of stroke and systemic embolism.

    •  

  • Candidates must have evidence of deep vein thrombosis (DVT) or pulmonary embolism (PE), and Eliquis is indicated for both the treatment and prevention of recurrence.

    •  

  • Patients undergoing hip or knee replacement surgery may be eligible for Eliquis as a measure to prevent post-surgical DVT and PE.

    •  

  • The request for coverage must be part of a comprehensive care plan outlined by the treating physician, emphasizing the necessity of Eliquis in the treatment regimen.

    •  

  • Candidates should have tried and not tolerated or had contraindications to other anticoagulant therapies, unless Eliquis is specifically indicated as the first-line treatment based on the patient's medical history and physician's recommendation.

    •  

  • There should be documented evidence of renal function, as Eliquis dosage may vary accordingly, ensuring appropriate use and avoidance of potential risks associated with impaired kidney function.

 

Required Documentation for Coverage

 

  • A complete medical history outlining the diagnosis necessitating the use of Eliquis, accompanied by any supporting diagnostic tests and evidence.

    •  

  • A detailed plan from the prescribing healthcare provider, detailing the patient's treatment protocol and the role of Eliquis in that plan.

    •  

  • Medical records should include any previously tried alternative treatments, noting adverse reactions or therapeutic failures, where applicable.

    •  

  • Documentation proving renal function status, to assist in determining the appropriate dosage for the patient.

 

Additional Considerations

 

  • Coverage may depend on a step-therapy protocol; the patient may need to fulfill specific steps or prerequisites before the insurance will consider Eliquis coverage.

    •  

  • Approval is contingent on adherence to all formulary guidelines as stipulated by Blue Cross Blue Shield of North Carolina.

    •  

  • Preauthorization might be required, whereby the prescribing physician submits a request elaborating the necessity of using Eliquis over alternative therapies.

 

Why Blue Cross Blue Shield of North Carolina Might Deny Eliquis Coverage

 

Reasons for Denial of Coverage for Eliquis

 

  • The patient does not meet the medical necessity criteria as defined by Blue Cross Blue Shield of North Carolina's guidelines.

    •  

  • The prescription is considered to be for a non-FDA approved use, otherwise known as an off-label use, which is not covered by the plan.

    •  

  • The patient has not attempted or failed required alternative treatments as recommended by the insurer, typically necessary for step therapy protocols.

    •  

  • The prescribed dosage exceeds Blue Cross Blue Shield's maximum allowed quantity or exceeds FDA-approved dosage levels, leading to non-coverage.

    •  

  • The healthcare provider prescribing Eliquis is not within the insurer's network, potentially resulting in a denial based on network policies.

    •  

  • The member's specific plan does not include coverage for Eliquis, possibly due to their formulary tier exclusions or plan design restrictions.

    •  

  • There is a determination of duplication of therapy, indicating that the patient is already covered for another anticoagulant medication that performs the same function.

 

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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.

 

Clinical Support

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 North Carolina

 

Verify Eligibility and Plan Details

 

  • Log in to your Blue Cross Blue Shield of North Carolina (BCBSNC) member portal to review your current plan details, prescription drug coverage, and any applicable formularies.

    •  

  • Check your plan’s formulary list to see if Eliquis is a covered medication and under which tier it is classified. This will give you an understanding of the medication's coverage requirements and potential co-pays.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about your need for Eliquis. Your doctor can help justify the necessity of the medication if further information is required by BCBSNC.

    •  

  • If Eliquis is not initially covered, your healthcare provider may need to assist in submitting a prior authorization request or suggest alternative medications that are covered.

 

Prior Authorization and Appeals

 

  • If your initial request for Eliquis coverage is denied, your healthcare provider can submit a prior authorization form to BCBSNC, providing detailed medical necessity documentation.

    •  

  • In the event of a denial after prior authorization, consider filing an appeal. Work closely with your healthcare provider to gather any additional documentation needed to support your case.

 

Explore Savings Programs

 

  • Investigate the availability of any savings programs or manufacturer coupons for Eliquis, which can help reduce out-of-pocket expenses while awaiting coverage approval.

    •  

  • Check the BCBSNC member portal for any additional savings options or pharmacy benefits you may qualify for.

 

Contact Customer Support

 

  • If you need further assistance, contact BCBSNC customer support. They can guide you through the specifics of your plan and any required steps for obtaining coverage for Eliquis.

    •  

  • Prepare all necessary information before contacting customer support, such as policy number, prescription details, and any previously submitted documents.

 

Premium Medication you can trust

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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Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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.

 

Have questions left?

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
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Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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