Does Blue Cross Blue Shield of Texas Cover Eliquis

Explore Blue Cross Blue Shield of Texas coverage for Eliquis, costs, and tips to secure coverage, plus FAQ for informed decisions on your medication.
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Coverage Criteria

 

  • Blue Cross Blue Shield of Texas generally covers Eliquis if it's deemed medically necessary and prescribed for FDA-approved uses, such as reducing stroke risk in atrial fibrillation or treating deep vein thrombosis.

 

Basic Rules

 

  • The patient may be required to have tried other medications first, based on the medication's formulary tier placement.
  • Coverage usually involves prior authorization to verify medical necessity.

 

Tips for Obtaining Coverage

 

  • Consult with healthcare providers to ensure all necessary documentation for justifying Eliquis use is available for the insurance company.
  • Stay informed on formulary updates, as coverage and tier placement can change.

 

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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.

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

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Eliquis Coverage with Blue Cross Blue Shield of Texas

 

Understand Your Plan Benefits

 

  • Visit the Blue Cross Blue Shield of Texas (BCBSTX) website to log in to your account and review your specific plan details. This will help you understand what your coverage includes regarding prescription medication.
  •  

  • Download the policy document section pertaining to prescription drug coverage. Look for information related to tier levels, copayments, and drugs under the formulary.

 

Check the Formulary List

 

  • Access the BCBSTX formulary list through their website. This document will detail which medications are covered under your particular insurance plan and at what tier.
  •  

  • Search for Eliquis (apixaban) to determine which tier it is assigned to and what the copayments will be.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Eliquis for your treatment plan, ensuring they understand your insurance coverage situation.
  •  

  • Request them to provide documentation or a letter of medical necessity if needed. This may help when requesting coverage approval or appealing a denial.

 

Contact BCBSTX Pharmacy Services

 

  • Call the customer service number provided on the back of your insurance card and ask to be connected to Pharmacy Services.
  •  

  • Inquire about the steps necessary to ensure Eliquis is covered, the expected copayment amount, and any required prior authorization or exception process.

 

Request Prior Authorization If Required

 

  • If prior authorization is needed, ask your healthcare provider to submit a request to BCBSTX. Ensure they include a detailed explanation of your medical necessity for Eliquis.
  •  

  • Follow up with both your healthcare provider and the insurance company to monitor the status of your prior authorization request.

 

Consider Alternate Coverage Options

 

  • If Eliquis is not initially covered, discuss with your doctor possible alternatives or generic options that may be included under your plan.
  •  

  • Explore patient assistance programs offered by the manufacturer if insurance coverage remains unattainable.

 

Appeal a Denial

 

  • If coverage is denied, review the denial letter from BCBSTX thoroughly to understand the reasons provided.
  •  

  • Work with your doctor to gather additional documentation and submit an appeal to the insurance company. Include all relevant medical records and any additional commentary from your healthcare provider to strengthen your case.

 

Stay Informed

 

  • Regularly check updates from BCBSTX regarding any changes to the formulary or your specific plan offerings during the plan year.
  •  

  • Keep records of all communications, submissions, and approvals (or denials) received. This information might be useful for future correspondence or appeals.

 

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FAQs

Does Blue Cross Blue Shield of Texas Cover Eliquis

Explore Blue Cross Blue Shield of Texas coverage for Eliquis, costs, and tips to secure coverage, plus FAQ for informed decisions on your medication.
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Is Eliquis Covered by Blue Cross Blue Shield of Texas

 

Coverage Criteria

 

  • Blue Cross Blue Shield of Texas generally covers Eliquis if it's deemed medically necessary and prescribed for FDA-approved uses, such as reducing stroke risk in atrial fibrillation or treating deep vein thrombosis.

 

Basic Rules

 

  • The patient may be required to have tried other medications first, based on the medication's formulary tier placement.
  • Coverage usually involves prior authorization to verify medical necessity.

 

Tips for Obtaining Coverage

 

  • Consult with healthcare providers to ensure all necessary documentation for justifying Eliquis use is available for the insurance company.
  • Stay informed on formulary updates, as coverage and tier placement can change.

 

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

 

Eligibility Criteria for Eliquis Coverage

 

  • Individuals must have a diagnosis of atrial fibrillation (AF) not caused by a heart valve issue, and they require a stroke prevention medication.
  •  

  • Patients who have been diagnosed with deep vein thrombosis (DVT) or pulmonary embolism (PE) and need Eliquis for treatment must be covered.
  •  

  • Individuals who have recently undergone knee or hip replacement surgery and need Eliquis to prevent DVT are eligible.
  •  

  • There must be documented evidence indicating that the patient cannot tolerate or has had significant side effects from other anticoagulant medications, such as warfarin.
  •  

  • The prescribing doctor should provide a comprehensive rationale for selecting Eliquis over alternative treatments, including specific patient health conditions that justify its use.

 

Dosage and Administration Requirements

 

  • Eliquis must be prescribed in accordance with the FDA-approved labeling concerning dosage specific to the patient’s medical condition.
  •  

  • Dosages that deviate from the standard prescription must be documented with a justification specific to the patient's health requirements.

 

Prior Authorization Process

 

  • Physicians are required to submit a prior authorization request that includes detailed medical history, current treatment plan, and reasons for selecting Eliquis.
  •  

  • The patient’s current medications list should be inclusive to avoid any potential drug interaction concerns.

 

Reevaluation and Continuation of Therapy

 

  • The continuation of Eliquis coverage may require periodic reevaluation to assess treatment effectiveness and necessity based on the patient’s current health status and treatment outcomes.
  •  

  • Insurance may need updated documentation from the healthcare provider regarding the patient's progress and any changes in their medical condition.

 

Why Blue Cross Blue Shield of Texas Might Deny Eliquis Coverage

 

Potential Non-Coverage Criteria for Eliquis

 

  • **Non-Formulary Drug:** Eliquis may be considered a non-formulary medication under certain plans, meaning it is not included in the list of approved drugs covered by the insurance.
  •  

  • **Prior Authorization Required but Not Obtained:** If prior authorization is required and the request has not been submitted or approved, coverage for Eliquis may be denied.
  •  

  • **Step Therapy Protocol Not Followed:** Coverage might be denied if the patient has not tried and failed on other, possibly less expensive, medications as per step therapy requirements.
  •  

  • **Excluded Condition:** Usage of Eliquis for conditions not approved by the insurance plan might result in a denial of coverage.
  •  

  • **Lack of Medical Necessity:** Coverage could be denied if the insurance provider determines that Eliquis is not medically necessary for the patient's specific condition.
  •  

  • **Out-of-Network Provider:** If the prescription is provided by a healthcare provider who is not within the insurance network, this could lead to a denial of coverage.
  •  

  • **Quantity Limits Exceeded:** Requests for Eliquis that exceed the quantity limits set by the insurance plan may not be covered.

 

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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.

 

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 Texas

 

Understand Your Plan Benefits

 

  • Visit the Blue Cross Blue Shield of Texas (BCBSTX) website to log in to your account and review your specific plan details. This will help you understand what your coverage includes regarding prescription medication.
  •  

  • Download the policy document section pertaining to prescription drug coverage. Look for information related to tier levels, copayments, and drugs under the formulary.

 

Check the Formulary List

 

  • Access the BCBSTX formulary list through their website. This document will detail which medications are covered under your particular insurance plan and at what tier.
  •  

  • Search for Eliquis (apixaban) to determine which tier it is assigned to and what the copayments will be.

 

Consult Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of Eliquis for your treatment plan, ensuring they understand your insurance coverage situation.
  •  

  • Request them to provide documentation or a letter of medical necessity if needed. This may help when requesting coverage approval or appealing a denial.

 

Contact BCBSTX Pharmacy Services

 

  • Call the customer service number provided on the back of your insurance card and ask to be connected to Pharmacy Services.
  •  

  • Inquire about the steps necessary to ensure Eliquis is covered, the expected copayment amount, and any required prior authorization or exception process.

 

Request Prior Authorization If Required

 

  • If prior authorization is needed, ask your healthcare provider to submit a request to BCBSTX. Ensure they include a detailed explanation of your medical necessity for Eliquis.
  •  

  • Follow up with both your healthcare provider and the insurance company to monitor the status of your prior authorization request.

 

Consider Alternate Coverage Options

 

  • If Eliquis is not initially covered, discuss with your doctor possible alternatives or generic options that may be included under your plan.
  •  

  • Explore patient assistance programs offered by the manufacturer if insurance coverage remains unattainable.

 

Appeal a Denial

 

  • If coverage is denied, review the denial letter from BCBSTX thoroughly to understand the reasons provided.
  •  

  • Work with your doctor to gather additional documentation and submit an appeal to the insurance company. Include all relevant medical records and any additional commentary from your healthcare provider to strengthen your case.

 

Stay Informed

 

  • Regularly check updates from BCBSTX regarding any changes to the formulary or your specific plan offerings during the plan year.
  •  

  • Keep records of all communications, submissions, and approvals (or denials) received. This information might be useful for future correspondence or appeals.

 

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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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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.

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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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