Does Cigna Cover Farxiga

Learn about Cigna's Farxiga coverage, potential denials, how to secure coverage, costs without insurance, and get answers to frequently asked questions.
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Does Cigna Cover Farxiga?

 

  • Cigna typically covers Farxiga (dapagliflozin), a medication used for type 2 diabetes, heart failure, and chronic kidney disease, under its prescription drug plans.
  •  

  • Coverage depends on your specific plan, including whether Farxiga is on the formulary list, and any prior authorization or step therapy requirements.
  •  

  • Patients often need to meet certain clinical criteria, such as insufficient control of diabetes with other medications, or a diagnosis of heart failure or chronic kidney disease.
  •  

  • To determine your eligibility, check your Cigna plan details, contact customer service, or consult with your healthcare provider for assistance with the authorization process.
  •  

  • Cost-sharing, such as copayments or coinsurance, will vary based on your specific Cigna policy tier level for Farxiga.

 

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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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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 Cigna

 

Check Farxiga Coverage in Your Plan

 

  • Go to the Cigna website and log in to your account using your credentials. If you do not have an account, you'll need to create one by providing your Cigna ID and other personal information.
  •  

  • Navigate to the pharmacy benefits section to understand your prescription drug coverage. This section should provide information on the medications covered under your plan, including the drug tiers.
  •  

  • Look for the formulary or drug list to see if Farxiga is included. If included, the tier level of Farxiga will indicate your copayment cost and whether there's any restriction on coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Farxiga. Ensure that your provider is aware of your Cigna insurance plan and formulary constraints.
  •  

  • Request that your provider write a prescription for Farxiga and express any medical necessity, which may help in insurance approval.

 

Contact Cigna for Confirmation

 

  • Call Cigna customer service using the number on your insurance card to confirm coverage details for Farxiga. Ask about any prior authorization or step therapy requirements.
  •  

  • Inquire if you need any documentation or if there are additional steps you must follow to obtain coverage, such as filling out specific forms or getting approvals.

 

Submit a Prior Authorization Request if Required

 

  • If prior authorization is required, work with your healthcare provider to submit this request to Cigna. This involves providing clinical evidence that Farxiga is necessary for your treatment.
  •  

  • Ensure that all necessary forms are filled out accurately and submitted promptly, including any supporting documents and medical records.

 

Receive Coverage Decision

 

  • Wait for Cigna to process the prior authorization request. This can take a few days to a couple of weeks, depending on your plan's procedures.
  •  

  • Once processed, Cigna will inform you of their decision through mail or your online account. Ensure you review their decision thoroughly.

 

Explore Appeal Options if Denied

 

  • If Cigna denies coverage, review their reasoning and consult your healthcare provider for additional support or documentation that could assist in an appeal.
  •  

  • Submit an appeal to Cigna by following their specified process detailed in the denial letter, including providing any additional documentation required to support your case.

 

Purchase Farxiga with Coverage

 

  • If approved, use your Cigna prescription benefit to purchase Farxiga at a pharmacy. Provide any necessary identification or forms as advised by Cigna.
  •  

  • Ensure that you understand your copayment responsibility or the cost-sharing structure, and discuss any payment plans if needed with your pharmacy.

 

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FAQs

Does Cigna Cover Farxiga

Learn about Cigna's Farxiga coverage, potential denials, how to secure coverage, costs without insurance, and get answers to frequently asked questions.
Curex allergy drops unboxing

Is Farxiga Covered by Cigna

 

Does Cigna Cover Farxiga?

 

  • Cigna typically covers Farxiga (dapagliflozin), a medication used for type 2 diabetes, heart failure, and chronic kidney disease, under its prescription drug plans.
  •  

  • Coverage depends on your specific plan, including whether Farxiga is on the formulary list, and any prior authorization or step therapy requirements.
  •  

  • Patients often need to meet certain clinical criteria, such as insufficient control of diabetes with other medications, or a diagnosis of heart failure or chronic kidney disease.
  •  

  • To determine your eligibility, check your Cigna plan details, contact customer service, or consult with your healthcare provider for assistance with the authorization process.
  •  

  • Cost-sharing, such as copayments or coinsurance, will vary based on your specific Cigna policy tier level for Farxiga.

 

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Cigna's Approved Criteria for Farxiga Coverage

 

Cigna's Approved Criteria for Farxiga Coverage

 

  • **Chronic Kidney Disease (CKD):** Coverage for Farxiga is approved when the patient has a diagnosis of chronic kidney disease (CKD), and the patient is not on dialysis or has not received a kidney transplant.
  •  

  • **Heart Failure:** Farxiga is covered for patients with a diagnosis of heart failure with reduced ejection fraction (HFrEF), demonstrating clinical symptoms and signs of heart failure.
  •  

  • **Type 2 Diabetes Mellitus:** Patients with type 2 diabetes mellitus are eligible for coverage when they show inadequate control of blood glucose levels with metformin or when metformin is contraindicated or not tolerated.
  •  

  • **A1C Levels:** The patient should have a baseline hemoglobin A1C (HbA1c) of 7% or higher for type 2 diabetes mellitus indications.
  •  

  • **Combination Therapy:** Farxiga can be covered as part of a combination therapy regimen in conjunction with insulin or other oral antihyperglycemic agents when other specific criteria are met.
  •  

  • **Age Requirement:** Patients must be 18 years or older to qualify for coverage under the specified conditions for Farxiga.
  •  

  • **Trial of Other Medications:** Documentation is required to show that the patient has tried and failed, or has contraindications to, other oral antihyperglycemics, where applicable, prior to Farxiga initiation.

 

Additional Considerations

 

  • **Physician's Attestation:** A healthcare provider must submit an attestation of the diagnosis and previous trials of medications, therapy regimens, and relevant lab results.
  •  

  • **Formulary Review:** Coverage may be subject to formulary review processes, which includes a comprehensive evaluation of the necessity and appropriateness of Farxiga for specific patient profiles.

 

Why Cigna Might Deny Farxiga Coverage

 

Non-Medically Necessary Uses

 

  • Cigna may deny coverage for Farxiga if it is not deemed medically necessary based on their established clinical guidelines.

 

Off-Label Use

 

  • Coverage might be denied if Farxiga is prescribed for a condition not approved by the FDA or not included in Cigna's approved list of off-label uses.

 

Lack of Prior Authorization

 

  • Cigna may require prior authorization for Farxiga, and failure to obtain this approval before filling the prescription can lead to denial of coverage.

 

Non-Compliance with Step Therapy

 

  • Clients may need to first try and fail other medications before coverage for Farxiga is approved, in accordance with Cigna's step therapy policies.

 

Policies May Vary by Plan

 

  • Cigna's specific health plan might have unique limitations and exclusions regarding Farxiga that can result in a denial, based on its formulary or benefit design.

 

Lack of Coverage under Pharmacy Benefits

 

  • If the patient's plan does not include coverage for certain prescription medications, including Farxiga, then coverage will likely be denied.

 

Duplicate Therapy

 

  • Coverage might be denied if the patient is already receiving another medication similar to Farxiga, unless there's valid justification for both.

 

Exceeding Quantity Limits

 

  • Cigna may impose quantity limits on Farxiga, and requests for amounts that exceed these limits may be denied unless medically justified.

 

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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 Cigna

 

Check Farxiga Coverage in Your Plan

 

  • Go to the Cigna website and log in to your account using your credentials. If you do not have an account, you'll need to create one by providing your Cigna ID and other personal information.
  •  

  • Navigate to the pharmacy benefits section to understand your prescription drug coverage. This section should provide information on the medications covered under your plan, including the drug tiers.
  •  

  • Look for the formulary or drug list to see if Farxiga is included. If included, the tier level of Farxiga will indicate your copayment cost and whether there's any restriction on coverage.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your healthcare provider to discuss the necessity of Farxiga. Ensure that your provider is aware of your Cigna insurance plan and formulary constraints.
  •  

  • Request that your provider write a prescription for Farxiga and express any medical necessity, which may help in insurance approval.

 

Contact Cigna for Confirmation

 

  • Call Cigna customer service using the number on your insurance card to confirm coverage details for Farxiga. Ask about any prior authorization or step therapy requirements.
  •  

  • Inquire if you need any documentation or if there are additional steps you must follow to obtain coverage, such as filling out specific forms or getting approvals.

 

Submit a Prior Authorization Request if Required

 

  • If prior authorization is required, work with your healthcare provider to submit this request to Cigna. This involves providing clinical evidence that Farxiga is necessary for your treatment.
  •  

  • Ensure that all necessary forms are filled out accurately and submitted promptly, including any supporting documents and medical records.

 

Receive Coverage Decision

 

  • Wait for Cigna to process the prior authorization request. This can take a few days to a couple of weeks, depending on your plan's procedures.
  •  

  • Once processed, Cigna will inform you of their decision through mail or your online account. Ensure you review their decision thoroughly.

 

Explore Appeal Options if Denied

 

  • If Cigna denies coverage, review their reasoning and consult your healthcare provider for additional support or documentation that could assist in an appeal.
  •  

  • Submit an appeal to Cigna by following their specified process detailed in the denial letter, including providing any additional documentation required to support your case.

 

Purchase Farxiga with Coverage

 

  • If approved, use your Cigna prescription benefit to purchase Farxiga at a pharmacy. Provide any necessary identification or forms as advised by Cigna.
  •  

  • Ensure that you understand your copayment responsibility or the cost-sharing structure, and discuss any payment plans if needed with your pharmacy.

 

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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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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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