Does Blue Shield of California Cover Farxiga

Find out if Blue Shield covers Farxiga, potential reasons for denial, ways to secure coverage, costs without insurance, and get answers to FAQs.
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Coverage Details

 

  • Blue Shield of California may cover Farxiga for specific conditions such as type 2 diabetes and heart failure.
  • Coverage is subject to the terms and conditions of your specific health plan.
  • Doctor’s prescription and prior authorization may be required for coverage approval.

 

Basic Rules and Criteria

 

  • Only FDA-approved uses of Farxiga are typically covered. Check if your condition aligns with the approved uses.
  • Patients might need to try alternative medications before getting approval, as part of the step therapy requirement.
  • Coverage decisions often depend on medical necessity as determined by your healthcare provider.
  • Confirm any co-payments or out-of-pocket costs associated with the prescription.Fill out necessary forms timely to avoid delays.
  • Regularly review your plan specifics as coverage terms might change annually.

 

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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 Farxiga Coverage with Blue Shield of California

 

Verify if Farxiga is Covered by Blue Shield of California

 

  • Visit the Blue Shield of California official website and search for the medication formulary or prescription drug list to check if Farxiga (dapagliflozin) is included.
  •  

  • If you have an online account with Blue Shield, you can log in to access the formulary associated with your specific plan.
  •  

  • Contact Blue Shield customer service for confirmation or assistance in verifying coverage for Farxiga under your specific health plan.

 

Consult with Your Healthcare Provider

 

  • Talk to your doctor about your need for Farxiga, ensuring they prescribe it based on your health condition and insurance plan requirements.
  •  

  • Request that your healthcare provider include any necessary medical justification or documentation required by Blue Shield for coverage approval.

 

Submit a Prior Authorization Request

 

  • Check if Farxiga requires prior authorization under your Blue Shield of California plan. This process confirms that the medication is medically necessary.
  •  

  • Your healthcare provider will usually need to initiate the prior authorization process by submitting the required forms to Blue Shield.
  •  

  • Provide any additional information or documentation requested by Blue Shield for the authorization process.

 

Understand Your Plan's Tier and Cost-sharing Details

 

  • Review your Blue Shield policy details, focusing on the prescription drug benefits to understand the tier system, copayments, coinsurance, and deductible requirements for Farxiga.
  •  

  • Reach out to Blue Shield customer service if you have questions about how Farxiga is classified within their formulary tiers and its impact on your out-of-pocket costs.

 

Look for Blue Shield’s Member Assistance Programs

 

  • Explore if Blue Shield offers any member assistance programs or discount opportunities specifically for medications like Farxiga.
  •  

  • Inquire about any available Blue Shield pharmacy resources that can assist in managing the costs of your prescriptions.

 

Alternative Funding Options

 

  • If coverage is limited or denied, ask your healthcare provider about potential alternative medications that are covered or generic options.
  •  

  • Consider applying for manufacturer discount programs or financial assistance from the pharmaceutical company that produces Farxiga.

 

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FAQs

Does Blue Shield of California Cover Farxiga

Find out if Blue Shield covers Farxiga, potential reasons for denial, ways to secure coverage, costs without insurance, and get answers to FAQs.
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Is Farxiga Covered by Blue Shield of California

 

Coverage Details

 

  • Blue Shield of California may cover Farxiga for specific conditions such as type 2 diabetes and heart failure.
  • Coverage is subject to the terms and conditions of your specific health plan.
  • Doctor’s prescription and prior authorization may be required for coverage approval.

 

Basic Rules and Criteria

 

  • Only FDA-approved uses of Farxiga are typically covered. Check if your condition aligns with the approved uses.
  • Patients might need to try alternative medications before getting approval, as part of the step therapy requirement.
  • Coverage decisions often depend on medical necessity as determined by your healthcare provider.
  • Confirm any co-payments or out-of-pocket costs associated with the prescription.Fill out necessary forms timely to avoid delays.
  • Regularly review your plan specifics as coverage terms might change annually.

 

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Blue Shield of California's Approved Criteria for Farxiga Coverage

 

Eligibility Criteria for Farxiga Coverage

 

  • Applicants must have a documented diagnosis of type 2 diabetes mellitus.
  •  

  • Documentation must show that the patient is aged 18 years or older.
  •  

  • Patients must have demonstrated an inadequate response to or have contraindications to metformin and a sulfonylurea, when these agents are indicated.

 

Additional Coverage Criteria

 

  • Patients with heart failure must provide clinical evidence that the medication is being used to reduce the risk of hospitalization due to heart failure.
  •  

  • For patients with chronic kidney disease, laboratory results showing a reduced eGFR (estimated Glomerular Filtration Rate) consistent with the criteria for Farxiga use must be provided.

 

Documentation Requirements

 

  • A prescription from a licensed healthcare provider must be submitted.
  •  

  • All relevant medical history pertinent to the use of Farxiga should be included in the request.
  •  

  • Rationale for choosing Farxiga over other alternative treatments needs to be documented.

 

Reauthorization Criteria

 

  • Evidence of patient benefit and continued need for Farxiga should be included in reauthorization requests.
  •  

  • Documentation of regular check-ups and monitoring of the patient's condition is necessary.

 

Coordination with Healthcare Providers

 

  • Blue Shield of California requires coordination with treating healthcare providers to ensure adherence to treatment and monitor for potential side effects.
  •  

  • Providers are encouraged to report any adverse reactions or clinical inefficacy to ensure the optimal use of Farxiga.

 

Why Blue Shield of California Might Deny Farxiga Coverage

 

Situations Where Blue Shield of California Might Deny Farxiga Coverage

 

  • Farxiga is prescribed for a condition that is not approved by the FDA. Blue Shield of California may not cover the medication if it is used off-label for treatments not recognized by regulatory authorities.
  •  

  • The patient does not meet the specific medical criteria or guidelines set by Blue Shield of California for Farxiga use. This includes cases where alternative treatments are recommended first or when certain medical benchmarks are not met.
  •  

  • Coverage limits specify a quantity or dosage restriction that the prescribed Farxiga exceeds. This may occur if the prescription does not align with approved guidelines or standard dosing protocols.
  •  

  • The prescription is from a provider not in the Blue Shield of California network. This can lead to a denial if the plan does not have out-of-network benefits for medications like Farxiga.
  •  

  • Lack of prior authorization or failure to obtain necessary pre-approval for Farxiga under the specific health plan's policy. Certain prescriptions require detailed justification and prior insurance approval.

 

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How Much Does Farxiga Cost without Insurance?

 

Estimated Cost of Farxiga Without Insurance

 

  • Farxiga, a medication used primarily for the management of type 2 diabetes and certain forms of heart failure, can be quite costly without insurance coverage.
  •  

  • The cash price for Farxiga typically ranges between $500 and $550 for a 30-day supply, depending on the pharmacy and location.
  •  

  • Some pharmacies may offer discount programs or cards that can slightly lower this cost, but significant savings are usually only available through insurance coverage.
  •  

  • Always consider checking with multiple pharmacies or online services where discounts might be more prevalent.

 

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 Farxiga Coverage with Blue Shield of California

 

Verify if Farxiga is Covered by Blue Shield of California

 

  • Visit the Blue Shield of California official website and search for the medication formulary or prescription drug list to check if Farxiga (dapagliflozin) is included.
  •  

  • If you have an online account with Blue Shield, you can log in to access the formulary associated with your specific plan.
  •  

  • Contact Blue Shield customer service for confirmation or assistance in verifying coverage for Farxiga under your specific health plan.

 

Consult with Your Healthcare Provider

 

  • Talk to your doctor about your need for Farxiga, ensuring they prescribe it based on your health condition and insurance plan requirements.
  •  

  • Request that your healthcare provider include any necessary medical justification or documentation required by Blue Shield for coverage approval.

 

Submit a Prior Authorization Request

 

  • Check if Farxiga requires prior authorization under your Blue Shield of California plan. This process confirms that the medication is medically necessary.
  •  

  • Your healthcare provider will usually need to initiate the prior authorization process by submitting the required forms to Blue Shield.
  •  

  • Provide any additional information or documentation requested by Blue Shield for the authorization process.

 

Understand Your Plan's Tier and Cost-sharing Details

 

  • Review your Blue Shield policy details, focusing on the prescription drug benefits to understand the tier system, copayments, coinsurance, and deductible requirements for Farxiga.
  •  

  • Reach out to Blue Shield customer service if you have questions about how Farxiga is classified within their formulary tiers and its impact on your out-of-pocket costs.

 

Look for Blue Shield’s Member Assistance Programs

 

  • Explore if Blue Shield offers any member assistance programs or discount opportunities specifically for medications like Farxiga.
  •  

  • Inquire about any available Blue Shield pharmacy resources that can assist in managing the costs of your prescriptions.

 

Alternative Funding Options

 

  • If coverage is limited or denied, ask your healthcare provider about potential alternative medications that are covered or generic options.
  •  

  • Consider applying for manufacturer discount programs or financial assistance from the pharmaceutical company that produces Farxiga.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Farxiga FAQ

What are the side effects of Farxiga?

 

Common Side Effects of Farxiga

 

  • Increased urination due to its diuretic effect, which may lead to dehydration. Maintain adequate hydration.
  • Potential urinary tract infections or yeast infections in genital areas, due to changes in the urinary environment.

 

Metabolic Effects

 

  • Weight loss can occur, linked to its mechanism of expelling glucose via urine.
  • Electrolyte imbalances, such as elevated potassium levels in blood, may appear in some cases.

 

Serious Reactions

 

  • Ketoacidosis risk: Watch for symptoms like nausea, vomiting, or abdominal pain.
  • Rarely, serious infections like Fournier's gangrene can develop. Seek immediate attention if you notice pain, redness, or swelling in genital or anal areas.

 

Can Farxiga help with weight loss?

 

Can Farxiga Aid Weight Loss?

 

  • Farxiga (dapagliflozin) is primarily a medication for managing type 2 diabetes and heart failure. It helps control blood sugar by promoting the excretion of glucose through urine.
  •  

  • Though not prescribed primarily for weight loss, some patients experience weight reduction as a secondary benefit.
  •  

  • Weight loss occurs because Farxiga facilitates the removal of excess calories in the form of glucose. However, the effect is usually modest and not guaranteed for everyone.
  •  

  • Consult a healthcare professional to understand if Farxiga is suitable for your condition and weight management goals.

 

Is Farxiga used for heart failure treatment?

 

Farxiga for Heart Failure

 

  • Farxiga (dapagliflozin) is primarily a SGLT2 inhibitor, initially developed to treat type 2 diabetes by helping the kidneys excrete glucose.
  •  

  • Recent studies have shown Farxiga's efficacy in heart failure management, particularly heart failure with reduced ejection fraction (HFrEF), by reducing hospitalizations and improving cardiovascular outcomes.
  •  

  • The medication works by decreasing fluid overload and blood pressure, lessening the heart's workload.
  •  

  • Farxiga is approved for heart failure treatment regardless of diabetes status, broadening its use in cardiology.
  •  

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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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