Does Blue Cross of Idaho Cover Xarelto

Explore Blue Cross of Idaho's Xarelto coverage, reasons for denial, tips for obtaining coverage, costs without insurance, and Xarelto FAQs.
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Does Blue Cross of Idaho Cover Xarelto?
 

  • The coverage for Xarelto under Blue Cross of Idaho depends on the specific health insurance plan and can vary by policy. It's advisable to check your coverage specifics.
  •  
  • Xarelto may be covered if it's deemed medically necessary for conditions such as deep vein thrombosis (DVT), pulmonary embolism, or stroke prevention in patients with atrial fibrillation.
  •  
  • Prescription coverage typically requires prior authorization. This means your healthcare provider needs to submit documentation proving the necessity of Xarelto over other treatment options.
  •  
  • Check if your plan has a formulary tier system. Xarelto might be on a higher tier requiring higher co-pays compared to generics or preferred drugs.
  •  
  • Consult with a pharmacy benefit manager or customer service for your plan to understand any additional criteria that might apply and confirm the level of coverage.

 

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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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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 of Idaho

 

Research Xarelto Coverage

 

  • Visit the Blue Cross of Idaho website to review their formulary list. This will help you determine if Xarelto is covered under your current insurance plan.
  • Contact Blue Cross of Idaho customer service for specific information regarding Xarelto coverage. Ask if your plan covers it and if there are any restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about the necessity of Xarelto and explore if it’s the best fit for your condition.
  • Your healthcare provider can provide you with a prescription and any necessary documentation that might be required for coverage approval.

 

Verify Your Plan Benefits

 

  • Log in to your Blue Cross of Idaho member portal to view your plan details. Confirm your prescription benefits and see how they apply to Xarelto.
  • Look for any specific coverage tiers or prior authorization requirements that might apply to Xarelto in your plan documents.

 

Submit a Prior Authorization (if necessary)

 

  • If prior authorization is needed, your healthcare provider will typically handle the submission to Blue Cross of Idaho.
  • Make sure your doctor provides all necessary clinical information to support the request for Xarelto.
  • Stay in contact with your provider's office to ensure the prior authorization is completed and submitted correctly.

 

Explore Cost-Saving Options

 

  • Check if Blue Cross of Idaho offers any prescription discount programs or assistance for Xarelto.
  • Investigate manufacturer’s savings programs or coupons for Xarelto to help offset any additional costs.
  • Consider generic alternatives or other similar medications if cost remains an issue.

 

Fill the Prescription

 

  • Once you have confirmation of coverage or authorization, take your Xarelto prescription to a participating pharmacy.
  • Ensure the pharmacy processes it under your Blue Cross of Idaho plan for the most accurate cost assessment at the point of sale.

 

Follow Up

 

  • If you encounter issues with coverage or pricing, contact Blue Cross of Idaho directly for assistance.
  • Maintain records of your communication with Blue Cross of Idaho and your healthcare provider in case further action is needed.

 

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FAQs

Does Blue Cross of Idaho Cover Xarelto

Explore Blue Cross of Idaho's Xarelto coverage, reasons for denial, tips for obtaining coverage, costs without insurance, and Xarelto FAQs.
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Is Xarelto Covered by Blue Cross of Idaho

 
Does Blue Cross of Idaho Cover Xarelto?
 

  • The coverage for Xarelto under Blue Cross of Idaho depends on the specific health insurance plan and can vary by policy. It's advisable to check your coverage specifics.
  •  
  • Xarelto may be covered if it's deemed medically necessary for conditions such as deep vein thrombosis (DVT), pulmonary embolism, or stroke prevention in patients with atrial fibrillation.
  •  
  • Prescription coverage typically requires prior authorization. This means your healthcare provider needs to submit documentation proving the necessity of Xarelto over other treatment options.
  •  
  • Check if your plan has a formulary tier system. Xarelto might be on a higher tier requiring higher co-pays compared to generics or preferred drugs.
  •  
  • Consult with a pharmacy benefit manager or customer service for your plan to understand any additional criteria that might apply and confirm the level of coverage.

 

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Blue Cross of Idaho's Approved Criteria for Xarelto Coverage

 

Approved Criteria for Xarelto Coverage

 

  • Xarelto is covered for patients diagnosed with non-valvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism. Patients must have documented evidence of NVAF.
  •  

  • Candidates for Xarelto must be adults who require the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) and for the reduction in the risk of recurrence of DVT and PE. Documentation of DVT or PE diagnosis is required.
  •  

  • Coverage is approved for patients undergoing knee or hip replacement surgery to reduce the risk of DVT, which may lead to PE. Proper surgical documentation should be provided.
  •  

  • Xarelto is endorsed for use in patients with coronary artery disease (CAD) or peripheral artery disease (PAD) to reduce the risk of major cardiovascular events such as cardiovascular death, myocardial infarction, and stroke. A confirmed diagnosis of CAD or PAD is necessary.
  •  

  • Eligibility extends to adults with a confirmed indication for Xarelto as per the prescribing healthcare provider, supported by documented medical necessity and appropriate clinical rationale.
  •  

  • Patients must not have contraindications to Xarelto use, such as active pathological bleeding or severe hypersensitivity to Xarelto components, validated through medical records.
  •  

  • Xarelto dosing must be aligned with FDA-approved labeling for the specified indication, ensuring adherence to recommended dosage guidelines.

 

Documentation and Assessment Requirements

 

  • All claims for Xarelto coverage should include up-to-date clinical documentation supporting the diagnosis and intended use.
  •  

  • Prescribers must provide a detailed assessment of the patient's medical history highlighting the necessity of Xarelto over alternative treatments or therapies.

 

Additional Considerations

 

  • Patients should engage in a regular review process to reassess the necessity and appropriateness of continued Xarelto therapy. Regular follow-up documentation from healthcare providers is recommended.
  •  

  • Insurance coverage for Xarelto may vary based on individual policy terms, deductibles, and co-payment requirements. It is advised to verify specific insurance plan details.

 

Why Blue Cross of Idaho Might Deny Xarelto Coverage

 

Criteria for Denial of Xarelto Coverage

 

  • The patient does not meet the FDA-approved indications for the usage of Xarelto. Blue Cross of Idaho may deny coverage if the medication is prescribed for off-label uses that are not supported by sufficient medical evidence or guidelines recognized by the insurance provider.
  •  

  • Failure to try alternative or cheaper anticoagulant therapies before prescribing Xarelto, if such alternatives are available and deemed medically appropriate by Blue Cross of Idaho's policies.
  •  

  • Xarelto is not covered if the prescription does not meet medical necessity criteria as defined by Blue Cross of Idaho. This can include factors like the patient's specific medical condition, history, and severity of the disease.
  •  

  • Non-compliance with prior authorization requirements set by Blue Cross of Idaho for Xarelto prescriptions. Without prior authorization, the insurance provider might not cover the pharmaceutical cost.
  •  

  • The prescription does not comply with Blue Cross of Idaho’s step therapy protocols, which may require trying preferred drugs first before Xarelto can be considered for coverage.
  •  

  • Prescriptions are denied if they exceed the quantity limits established by Blue Cross of Idaho, which could suggest use beyond the recommended dosage or duration without adequate justification.

 

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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 of Idaho

 

Research Xarelto Coverage

 

  • Visit the Blue Cross of Idaho website to review their formulary list. This will help you determine if Xarelto is covered under your current insurance plan.
  • Contact Blue Cross of Idaho customer service for specific information regarding Xarelto coverage. Ask if your plan covers it and if there are any restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about the necessity of Xarelto and explore if it’s the best fit for your condition.
  • Your healthcare provider can provide you with a prescription and any necessary documentation that might be required for coverage approval.

 

Verify Your Plan Benefits

 

  • Log in to your Blue Cross of Idaho member portal to view your plan details. Confirm your prescription benefits and see how they apply to Xarelto.
  • Look for any specific coverage tiers or prior authorization requirements that might apply to Xarelto in your plan documents.

 

Submit a Prior Authorization (if necessary)

 

  • If prior authorization is needed, your healthcare provider will typically handle the submission to Blue Cross of Idaho.
  • Make sure your doctor provides all necessary clinical information to support the request for Xarelto.
  • Stay in contact with your provider's office to ensure the prior authorization is completed and submitted correctly.

 

Explore Cost-Saving Options

 

  • Check if Blue Cross of Idaho offers any prescription discount programs or assistance for Xarelto.
  • Investigate manufacturer’s savings programs or coupons for Xarelto to help offset any additional costs.
  • Consider generic alternatives or other similar medications if cost remains an issue.

 

Fill the Prescription

 

  • Once you have confirmation of coverage or authorization, take your Xarelto prescription to a participating pharmacy.
  • Ensure the pharmacy processes it under your Blue Cross of Idaho plan for the most accurate cost assessment at the point of sale.

 

Follow Up

 

  • If you encounter issues with coverage or pricing, contact Blue Cross of Idaho directly for assistance.
  • Maintain records of your communication with Blue Cross of Idaho and your healthcare provider in case further action is needed.

 

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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.

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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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