Does CareFirst BlueCross BlueShield Cover Farxiga

Explore Farxiga coverage with CareFirst BlueCross BlueShield and learn how to get it covered, denial reasons, costs without insurance, and FAQs.
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CareFirst BlueCross BlueShield Coverage for Farxiga

 

  • Farxiga is covered under CareFirst BlueCross BlueShield plans, primarily for type 2 diabetes management, heart failure, and chronic kidney disease as medically necessary.
  •  

  • Coverage is contingent upon meeting specific criteria, such as prior authorization requirements and the necessity for the drug as indicated by a healthcare professional.
  •  

  • Most plans require that less expensive or alternative medications have been ineffective or unsuitable before Farxiga is approved.
  •  

  • Consult with your healthcare provider to ensure they provide the appropriate documentation demonstrating the need for Farxiga.
  •  

  • It's advisable to review your specific insurance plan details or contact CareFirst directly for precise coverage information and required documentation.

 

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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 CareFirst BlueCross BlueShield

 

Check Your Plan Coverage

 

  • Log into your CareFirst BlueCross BlueShield member account on their official website. If you don't have an account, you will need to create one using your member ID and personal details.
  • Navigate to the benefits or coverage section in your account dashboard.
  • Look for the 'drug coverage' or 'pharmacy benefits' section. This section will have a list or details of medications that are covered under your specific health plan.
  • Check if Farxiga is covered and under what tier it falls in your plan.

 

Contact Customer Service for Confirmation

 

  • Find the customer service contact number on your insurance card or the CareFirst website.
  • Call the customer service number and provide your plan details to inquire specifically about coverage for Farxiga.
  • Ask for confirmation if Farxiga is covered under your plan, and inquire about any prerequisites such as prior authorization or step therapy requirements.

 

Request Prior Authorization if Needed

 

  • Some plans may require prior authorization for certain medications like Farxiga. Verify this necessity with customer service.
  • If required, get the necessary forms from CareFirst's website or request them through customer service.
  • Have your healthcare provider fill out the form, providing details from your medical history to justify the necessity of Farxiga.
  • Submit the completed form as instructed by CareFirst for review and approval.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Farxiga.
  • Have your provider issue a prescription for Farxiga, given that they agree it is necessary for your treatment.
  • Ensure that your provider sends the prescription to a pharmacy that is within the CareFirst network.

 

Choose a Network Pharmacy

 

  • Use the CareFirst website to find a list of in-network pharmacies.
  • Choose a pharmacy that is convenient for you and make sure they accept Farxiga prescriptions under your plan.
  • Transfer your prescription to this pharmacy if necessary.

 

Fill Your Prescription

 

  • Visit the chosen pharmacy and present your CareFirst insurance card when filling the prescription for Farxiga.
  • Discuss any co-payments or out-of-pocket costs with the pharmacy to ensure you understand any charges you might incur.
  • Ensure that the pharmacy correctly processes your claim with CareFirst so that you receive the appropriate coverage benefits.

 

Monitor Your Benefits

 

  • Regularly review your CareFirst BlueCross BlueShield account for any updates or changes to your benefits that might affect your medication coverage.
  • Stay informed about any changes in Farxiga's formulary status or tier placement, which could affect your costs or coverage status.

 

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FAQs

Does CareFirst BlueCross BlueShield Cover Farxiga

Explore Farxiga coverage with CareFirst BlueCross BlueShield and learn how to get it covered, denial reasons, costs without insurance, and FAQs.
Curex allergy drops unboxing

Is Farxiga Covered by CareFirst BlueCross BlueShield

 

CareFirst BlueCross BlueShield Coverage for Farxiga

 

  • Farxiga is covered under CareFirst BlueCross BlueShield plans, primarily for type 2 diabetes management, heart failure, and chronic kidney disease as medically necessary.
  •  

  • Coverage is contingent upon meeting specific criteria, such as prior authorization requirements and the necessity for the drug as indicated by a healthcare professional.
  •  

  • Most plans require that less expensive or alternative medications have been ineffective or unsuitable before Farxiga is approved.
  •  

  • Consult with your healthcare provider to ensure they provide the appropriate documentation demonstrating the need for Farxiga.
  •  

  • It's advisable to review your specific insurance plan details or contact CareFirst directly for precise coverage information and required documentation.

 

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CareFirst BlueCross BlueShield's Approved Criteria for Farxiga Coverage

 

Criteria for Farxiga Coverage

 

  • CareFirst BlueCross BlueShield covers Farxiga for patients with a diagnosis of Type 2 Diabetes Mellitus to improve glycemic control as an adjunct to diet and exercise.
  •  

  • Farxiga is approved for coverage in patients with chronic kidney disease to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure.
  •  

  • It is covered for patients with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death and hospitalization for heart failure.
  •  

  • The patient must have trialed and failed therapy with metformin, or the use of metformin is contraindicated or inappropriate for the management of their condition.
  •  

  • Coverage is provided when the medication is prescribed by a healthcare professional who specializes in endocrinology, nephrology, or cardiology, or a primary care provider with documented training or experience in managing the related condition.
  •  

  • Farxiga coverage is contingent upon the patient adhering to prescribed lifestyle modifications such as diet and exercise as part of the comprehensive treatment plan.
  •  

  • The patient's medical record must include documentation of an assessment of renal function within the recommended parameters for safe use of Farxiga prior to initiation of therapy.

 

Why CareFirst BlueCross BlueShield Might Deny Farxiga Coverage

 

Criteria for Denial of Farxiga Coverage by CareFirst BlueCross BlueShield

 

  • **Non-Medical Necessity**: The prescription of Farxiga is deemed not medically necessary as per the CareFirst BlueCross BlueShield's medical guidelines and clinical assessments.
  •  

  • **Off-Label Use**: Farxiga is prescribed for conditions not approved by the FDA for this medication and not listed as covered by CareFirst's formulary policy.
  •  

  • **Lack of Prior Authorization**: If prior authorization is required and has not been obtained before purchasing Farxiga, coverage may be denied.
  •  

  • **Non-Formulary Requests**: The medication is not included in the CareFirst BlueCross BlueShield formulary, and an exception request to cover the drug has been denied.
  •  

  • **Prescription Quantities and Limits**: Exceeding prescribed quantity limits set by the insurance plan without an approved exception can result in a denial.
  •  

  • **Generic Availability**: If a generic alternative is available and preferred by the insurance plan, coverage for the brand name Farxiga may be denied.
  •  

  • **Plan Exclusions**: Specific policy exclusions or benefit plan details that explicitly do not cover medications like Farxiga under certain circumstances, regardless of medical need.
  •  

 

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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 CareFirst BlueCross BlueShield

 

Check Your Plan Coverage

 

  • Log into your CareFirst BlueCross BlueShield member account on their official website. If you don't have an account, you will need to create one using your member ID and personal details.
  • Navigate to the benefits or coverage section in your account dashboard.
  • Look for the 'drug coverage' or 'pharmacy benefits' section. This section will have a list or details of medications that are covered under your specific health plan.
  • Check if Farxiga is covered and under what tier it falls in your plan.

 

Contact Customer Service for Confirmation

 

  • Find the customer service contact number on your insurance card or the CareFirst website.
  • Call the customer service number and provide your plan details to inquire specifically about coverage for Farxiga.
  • Ask for confirmation if Farxiga is covered under your plan, and inquire about any prerequisites such as prior authorization or step therapy requirements.

 

Request Prior Authorization if Needed

 

  • Some plans may require prior authorization for certain medications like Farxiga. Verify this necessity with customer service.
  • If required, get the necessary forms from CareFirst's website or request them through customer service.
  • Have your healthcare provider fill out the form, providing details from your medical history to justify the necessity of Farxiga.
  • Submit the completed form as instructed by CareFirst for review and approval.

 

Visit Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss your need for Farxiga.
  • Have your provider issue a prescription for Farxiga, given that they agree it is necessary for your treatment.
  • Ensure that your provider sends the prescription to a pharmacy that is within the CareFirst network.

 

Choose a Network Pharmacy

 

  • Use the CareFirst website to find a list of in-network pharmacies.
  • Choose a pharmacy that is convenient for you and make sure they accept Farxiga prescriptions under your plan.
  • Transfer your prescription to this pharmacy if necessary.

 

Fill Your Prescription

 

  • Visit the chosen pharmacy and present your CareFirst insurance card when filling the prescription for Farxiga.
  • Discuss any co-payments or out-of-pocket costs with the pharmacy to ensure you understand any charges you might incur.
  • Ensure that the pharmacy correctly processes your claim with CareFirst so that you receive the appropriate coverage benefits.

 

Monitor Your Benefits

 

  • Regularly review your CareFirst BlueCross BlueShield account for any updates or changes to your benefits that might affect your medication coverage.
  • Stay informed about any changes in Farxiga's formulary status or tier placement, which could affect your costs or coverage status.

 

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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.

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.

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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