Does Cigna Cover Xarelto

Discover if Cigna covers Xarelto. Learn why coverage may be denied, ways to secure it, costs without insurance, and get your Xarelto questions answered.
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Cigna Coverage for Xarelto

 

  • Cigna typically covers Xarelto (a blood thinner) for patients who meet certain criteria, such as having conditions related to atrial fibrillation, deep vein thrombosis, or pulmonary embolism.
  •  

  • Coverage often requires a prior authorization, meaning your healthcare provider must demonstrate the necessity of Xarelto for your treatment plan compared to other medications.
  •  

  • It's essential to verify the specific terms of your policy, as formularies (the list of drugs covered by insurance) can vary. Check for "tier status" of Xarelto within your plan since higher-tier drugs may require higher out-of-pocket costs.
  •  

  • Some plans might have alternative step therapy protocols. This means you may need to try and fail with less expensive medications before Xarelto is approved.
  •  

  • Consult with your healthcare provider and contact Cigna customer service to understand the detailed criteria and paperwork needed to secure coverage for Xarelto.

 

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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 Xarelto Coverage with Cigna

 

Verify Your Current Cigna Plan

 

  • Contact Cigna customer service to confirm the details of your current plan and its prescription coverage.
  •  

  • Check if Xarelto is included in Cigna’s formulary - a list of medications covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss the need for Xarelto with your doctor and verify if a prescription for Xarelto is necessary for your condition.
  •  

  • Have your doctor provide any required documentation or reasoning that may support the necessity of Xarelto for your treatment.

 

Locate In-Network Pharmacies

 

  • Use Cigna’s online tool or contact customer service to find in-network pharmacies to ensure coverage for your prescription.
  •  

  • Check if specific pharmacies offer better pricing or coverage for Xarelto under your plan.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if necessary. This process confirms that Xarelto is medically necessary and eligible for coverage.
  •  

  • Be prepared to provide supporting documentation from your healthcare provider as part of the request process.

 

Understand Potential Out-of-Pocket Costs

 

  • Review your plan’s Summary of Benefits to understand copays or coinsurance costs associated with obtaining Xarelto.
  •  

  • Consider reaching out to Cigna for detailed cost estimates based on your prescription and dosage.

 

Appeal Denials if Necessary

 

  • If your coverage request for Xarelto is denied, request a formal explanation from Cigna and gather additional documentation from your healthcare provider.
  •  

  • Submit an appeal through Cigna’s established process, providing all necessary documentation and medical justification for the prescription.

 

Explore Additional Resources

 

  • Investigate additional assistance programs through Xarelto’s manufacturer for further financial support options.
  •  

  • Consider consulting with a Cigna case manager or a patient advocacy group for further assistance and guidance.

 

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FAQs

Does Cigna Cover Xarelto

Discover if Cigna covers Xarelto. Learn why coverage may be denied, ways to secure it, costs without insurance, and get your Xarelto questions answered.
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Is Xarelto Covered by Cigna

 

Cigna Coverage for Xarelto

 

  • Cigna typically covers Xarelto (a blood thinner) for patients who meet certain criteria, such as having conditions related to atrial fibrillation, deep vein thrombosis, or pulmonary embolism.
  •  

  • Coverage often requires a prior authorization, meaning your healthcare provider must demonstrate the necessity of Xarelto for your treatment plan compared to other medications.
  •  

  • It's essential to verify the specific terms of your policy, as formularies (the list of drugs covered by insurance) can vary. Check for "tier status" of Xarelto within your plan since higher-tier drugs may require higher out-of-pocket costs.
  •  

  • Some plans might have alternative step therapy protocols. This means you may need to try and fail with less expensive medications before Xarelto is approved.
  •  

  • Consult with your healthcare provider and contact Cigna customer service to understand the detailed criteria and paperwork needed to secure coverage for Xarelto.

 

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Cigna's Approved Criteria for Xarelto Coverage

 

Eligibility for Xarelto Coverage

 

  • Xarelto may be approved for individuals with a diagnosis of non-valvular atrial fibrillation (AF) for the prevention of stroke and systemic embolism.
  •  

  • Patients diagnosed with deep vein thrombosis (DVT) who require treatment or prevention of recurrence can be eligible for Xarelto coverage.
  •  

  • Cigna may cover Xarelto for individuals who have been diagnosed with pulmonary embolism (PE) and need treatment or prevention of recurrence.
  •  

  • Postoperative patients may receive coverage for Xarelto to prevent venous thromboembolism (VTE) after knee or hip replacement surgery.
  •  

  • Coverage may be provided for patients with coronary artery disease (CAD) or peripheral artery disease (PAD) to reduce the risk of major cardiovascular events.
  •  

  • Xarelto may be covered for individuals with acute coronary syndrome (ACS) for the prevention of subsequent cardiovascular events, as part of a combination therapy regimen.

 

Required Documentation

 

  • A doctor’s prescription specifying the need for Xarelto based on the approved usage criteria must be provided.
  •  

  • Relevant medical records that demonstrate the diagnosis and the necessity for treatment with Xarelto may need to be submitted.
  •  

  • Evidence of prior therapy failures or contraindications to other anticoagulant medications might be required.

 

Dosage and Administration

 

  • Xarelto will typically be covered at specific dosages based on the condition being treated, aligning with the FDA-approved guidelines.
  •  

  • The drug should be administered according to the prescribed dosing schedule to qualify for coverage.

 

Plan-Specific Requirements

 

  • Coverage may vary depending on the specific health plan and associated formulary requirements chosen by the patient.
  •  

  • Step therapy or prior authorization might influence the availability of coverage under certain plans.

 

Why Cigna Might Deny Xarelto Coverage

 

Exclusions for Xarelto Coverage by Cigna

 

  • Cigna may deny Xarelto coverage if the medication is prescribed for off-label use that is not supported by sufficient clinical evidence or recognized guidelines.
  •  

  • Coverage might be denied if the patient has not met specific age criteria for the medication as established by Cigna’s policy.
  •  

  • Xarelto may not be covered if it is deemed a non-preferred drug when there are alternative preferred therapies available that are considered equally effective and safe.
  •  

  • If a patient’s prescription history does not align with Cigna's step therapy requirements, which typically mandate trying certain other medications first, the coverage for Xarelto may be denied.
  •  

  • Cigna may reject coverage if the prescribed dosage exceeds the approved quantity limits set in their formulary guidelines.
  •  

  • Non-compliance with prior authorization requirements can result in a denial of coverage for Xarelto.

 

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How Much Does Xarelto Cost without Insurance?

 

Approximate Cost of Xarelto Without Insurance

 

  • The cost for Xarelto, a prescription anticoagulant medication, can vary depending on the dosage and quantity prescribed. On average, the cost of a 30-day supply of Xarelto 20 mg tablets, without insurance, can range from $450 to $540.
  •  

  • Prices may differ at various pharmacies, and patients might find lower prices through discount programs or pharmacy discount cards.
  •  

  • Shopping around and comparing prices at different pharmacies or checking with online retailers can sometimes yield better deals or discounts.
  •  

  • Additional savings may be available through pharmaceutical assistance programs, which are offered by the manufacturer for eligible patients who meet specific criteria.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Xarelto Coverage with Cigna

 

Verify Your Current Cigna Plan

 

  • Contact Cigna customer service to confirm the details of your current plan and its prescription coverage.
  •  

  • Check if Xarelto is included in Cigna’s formulary - a list of medications covered under your plan.

 

Consult with Your Healthcare Provider

 

  • Discuss the need for Xarelto with your doctor and verify if a prescription for Xarelto is necessary for your condition.
  •  

  • Have your doctor provide any required documentation or reasoning that may support the necessity of Xarelto for your treatment.

 

Locate In-Network Pharmacies

 

  • Use Cigna’s online tool or contact customer service to find in-network pharmacies to ensure coverage for your prescription.
  •  

  • Check if specific pharmacies offer better pricing or coverage for Xarelto under your plan.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if necessary. This process confirms that Xarelto is medically necessary and eligible for coverage.
  •  

  • Be prepared to provide supporting documentation from your healthcare provider as part of the request process.

 

Understand Potential Out-of-Pocket Costs

 

  • Review your plan’s Summary of Benefits to understand copays or coinsurance costs associated with obtaining Xarelto.
  •  

  • Consider reaching out to Cigna for detailed cost estimates based on your prescription and dosage.

 

Appeal Denials if Necessary

 

  • If your coverage request for Xarelto is denied, request a formal explanation from Cigna and gather additional documentation from your healthcare provider.
  •  

  • Submit an appeal through Cigna’s established process, providing all necessary documentation and medical justification for the prescription.

 

Explore Additional Resources

 

  • Investigate additional assistance programs through Xarelto’s manufacturer for further financial support options.
  •  

  • Consider consulting with a Cigna case manager or a patient advocacy group for further assistance and guidance.

 

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Xarelto FAQ

What are the common side effects of Xarelto?

 

Common Side Effects of Xarelto

 

  • Bleeding is the most common, including nasal, gum, or gastrointestinal bleeding. Be vigilant for any signs of unusual bleeding and seek medical attention if necessary.
  •  

  • Gastrointestinal issues such as nausea and stomach pain may occur. Taking Xarelto with food can help alleviate these symptoms.
  •  

  • Dizziness and fatigue can affect some individuals, especially when first starting the medication. Ensure you maintain hydration and rest as needed.
  •  

  • In rare cases, allergic reactions may manifest as rash or itching. If this occurs, consult your healthcare provider promptly.

 

Is Xarelto a blood thinner?

 

Is Xarelto a Blood Thinner?

 

  • **Xarelto (rivaroxaban)** is indeed a blood thinner, specifically an anticoagulant, which is crucial for preventing blood clots that can lead to conditions like stroke or deep vein thrombosis (DVT).
  •  

  • It works by inhibiting **factor Xa**, an essential component in the coagulation cascade, reducing the ability of blood to form clots.
  •  

  • As a **direct oral anticoagulant (DOAC)**, it provides several advantages over traditional blood thinners like warfarin, such as having fewer dietary restrictions and not requiring regular blood monitoring.
  •  

  • It's important to take it as prescribed by a healthcare provider, considering potential drug interactions and contraindications.

 

Can you drink alcohol while taking Xarelto?

 

Drinking Alcohol with Xarelto

 

  • Xarelto, a blood thinner, may increase bleeding risk, and alcohol can amplify this risk.
  •  

  • Both substances affect liver function, potentially impacting medication metabolism and effectiveness.
  •  

  • Consuming alcohol while on Xarelto may enhance side effects like dizziness, increasing injury risk.
  •  

  • It’s crucial to consult your healthcare provider to discuss allowable alcohol intake based on your health status and dosage.
  •  

 

General Recommendations

 

  • Moderation is key – if approved, limit alcohol consumption as per medical advice.
  •  

  • Avoid binge drinking, which drastically heightens risk of adverse reactions.
  •  

  • Inform your medical team about recreational activities involving alcohol.

 

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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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