Does Centene Corporation Cover Farxiga

Explore Centene's coverage for Farxiga, reasons for denial, cost info, and FAQs. Learn how to secure coverage with our helpful guide.
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Centene Corporation Coverage for Farxiga

 

  • Centene Corporation typically covers Farxiga under its prescription drug plans, primarily for managing Type 2 diabetes and heart failure.
  •  

  • Coverage eligibility usually requires a prescription from a healthcare provider, confirming the necessity of Farxiga for the patient's treatment plan.
  •  

  • Patients should confirm specific coverage details with their Centene health plan, as coverage rules and drug formularies may vary by state and plan type.
  •  

  • Pre-authorization might be necessary to ensure the drug is medically necessary and appropriate for the patient's condition before Centene provides coverage.
  •  

  • Patients need to adhere to the formulary guidelines and might have to try other medications before switching to Farxiga if it's not included in their plan's preferred drugs.

 

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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.

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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 Farxiga Coverage with Centene Corporation

 

Understand Your Insurance Plan with Centene

 

  • Start by reviewing your current insurance plan with Centene Corporation to understand coverage details.
  •  

  • Check if Farxiga is listed on the formulary, which is the list of medications covered by your plan.
  •  

  • If Farxiga is not on the formulary, look for transition policies or temporary coverage options.

 

Contact Customer Service

 

  • Contact Centene’s customer service for specific inquiries regarding Farxiga coverage under your plan.
  •  

  • Request clarification on any terms or coverage specifics that are unclear to you.
  •  

  • Inquire about any necessary documentation or prerequisites needed to cover Farxiga.

 

Consult with Your Healthcare Provider

 

  • Speak with your healthcare provider about starting or continuing Farxiga treatment.
  •  

  • Ensure that they provide any medical necessity notes or documentation required by Centene for approval.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization form if Farxiga requires it.
  •  

  • Ensure all sections of the form are accurately completed and submitted to Centene for review.
  •  

  • Monitor the status of your prior authorization request and respond promptly to any additional information requests.

 

Explore Financial Assistance Programs

 

  • If you face challenges with coverage, research patient assistance programs offered by the manufacturer or third-party organizations.
  •  

  • Centene may also have specialty pharmacy services that can help manage Farxiga costs.

 

Appeal Denials If Necessary

 

  • If your initial request for coverage is denied, read through the denial letter to understand the reasons given.
  •  

  • Prepare an appeal with supporting documentation, including letters from your healthcare provider emphasizing medical necessity.
  •  

  • Submit the appeal within the timeframe specified in the denial letter and follow up regularly.

 

Review and Renew Annually

 

  • Review your insurance plan’s benefits annually during the open enrollment period for any changes in coverage for Farxiga.
  •  

  • Consider consulting with a Centene representative to discuss any updates or options available for medication coverage.

 

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FAQs

Does Centene Corporation Cover Farxiga

Explore Centene's coverage for Farxiga, reasons for denial, cost info, and FAQs. Learn how to secure coverage with our helpful guide.
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Is Farxiga Covered by Centene Corporation

 

Centene Corporation Coverage for Farxiga

 

  • Centene Corporation typically covers Farxiga under its prescription drug plans, primarily for managing Type 2 diabetes and heart failure.
  •  

  • Coverage eligibility usually requires a prescription from a healthcare provider, confirming the necessity of Farxiga for the patient's treatment plan.
  •  

  • Patients should confirm specific coverage details with their Centene health plan, as coverage rules and drug formularies may vary by state and plan type.
  •  

  • Pre-authorization might be necessary to ensure the drug is medically necessary and appropriate for the patient's condition before Centene provides coverage.
  •  

  • Patients need to adhere to the formulary guidelines and might have to try other medications before switching to Farxiga if it's not included in their plan's preferred drugs.

 

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Centene Corporation's Approved Criteria for Farxiga Coverage

 

Farxiga Coverage Criteria by Centene Corporation

 

  • **Diagnosis of Type 2 Diabetes Mellitus (T2DM):** The patient must have a confirmed diagnosis of Type 2 Diabetes Mellitus.
  •  

  • **Inadequate Control with Metformin:** The patient has demonstrated inadequate glycemic control despite lifestyle modifications and receiving the maximum tolerated dose of metformin, unless contraindicated.
  •  

  • **Use in Heart Failure:** Farxiga is covered for Heart Failure in patients with reduced or preserved ejection fraction, irrespective of diabetes status, to reduce the risk of hospitalization and cardiovascular death.
  •  

  • **Chronic Kidney Disease (CKD) Indication:** It is approved for patients with CKD to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure, regardless of the presence of diabetes.
  •  

  • **Adult Patients Only:** Coverage applies strictly to adult patients. Farxiga is not approved for use in pediatric populations within this coverage context.
  •  

  • **Physician Recommendation:** The patient must receive a recommendation for Farxiga from a healthcare provider who is familiar with the management of T2DM, heart failure, or CKD.
  •  

  • **Patient Monitoring and Follow-up:** There must be a clear plan for ongoing monitoring and follow-up care to assess the therapy's impact and manage any potential side effects.
  •  

 

Why Centene Corporation Might Deny Farxiga Coverage

 

Reasons for Denial of Farxiga Coverage

 

  • Non-Formulary Status: Farxiga may be classified as a non-formulary medication, meaning it is not included in Centene Corporation's list of covered drugs.
  •  

  • Lack of Prior Authorization: If a patient or healthcare provider does not obtain prior authorization for Farxiga, Centene Corporation might deny coverage.
  •  

  • Exclusion from Covered Conditions: Farxiga may be denied if it is prescribed for a condition that is not covered under the patient's plan. This could include uses that are considered investigational or not approved by the FDA for the prescribed indication.
  •  

  • Mismatches in Dosage Requirements: Dosages prescribed that do not align with Centene’s approved therapeutic guidelines could lead to denial.
  •  

  • Policy Limitations on Specific Medications: There may be policy-specific exclusions that outright deny coverage for Farxiga regardless of medical necessity or other factors.
  •  

  • Failure to Meet Clinical Criteria: Centene Corporation may have specific clinical criteria that need to be met for a drug to be covered. If Farxiga does not meet these outlined criteria, coverage might be denied.

 

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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 Centene Corporation

 

Understand Your Insurance Plan with Centene

 

  • Start by reviewing your current insurance plan with Centene Corporation to understand coverage details.
  •  

  • Check if Farxiga is listed on the formulary, which is the list of medications covered by your plan.
  •  

  • If Farxiga is not on the formulary, look for transition policies or temporary coverage options.

 

Contact Customer Service

 

  • Contact Centene’s customer service for specific inquiries regarding Farxiga coverage under your plan.
  •  

  • Request clarification on any terms or coverage specifics that are unclear to you.
  •  

  • Inquire about any necessary documentation or prerequisites needed to cover Farxiga.

 

Consult with Your Healthcare Provider

 

  • Speak with your healthcare provider about starting or continuing Farxiga treatment.
  •  

  • Ensure that they provide any medical necessity notes or documentation required by Centene for approval.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization form if Farxiga requires it.
  •  

  • Ensure all sections of the form are accurately completed and submitted to Centene for review.
  •  

  • Monitor the status of your prior authorization request and respond promptly to any additional information requests.

 

Explore Financial Assistance Programs

 

  • If you face challenges with coverage, research patient assistance programs offered by the manufacturer or third-party organizations.
  •  

  • Centene may also have specialty pharmacy services that can help manage Farxiga costs.

 

Appeal Denials If Necessary

 

  • If your initial request for coverage is denied, read through the denial letter to understand the reasons given.
  •  

  • Prepare an appeal with supporting documentation, including letters from your healthcare provider emphasizing medical necessity.
  •  

  • Submit the appeal within the timeframe specified in the denial letter and follow up regularly.

 

Review and Renew Annually

 

  • Review your insurance plan’s benefits annually during the open enrollment period for any changes in coverage for Farxiga.
  •  

  • Consider consulting with a Centene representative to discuss any updates or options available for medication coverage.

 

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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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