Does EmblemHealth Cover Farxiga

Explore Farxiga coverage with EmblemHealth, why it may be denied, how to secure it, costs without insurance, and key FAQs in our comprehensive guide.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage of Farxiga by EmblemHealth

 

  • EmblemHealth generally covers Farxiga for conditions like type 2 diabetes, provided it's medically necessary.
  •  

  • Coverage may also include heart failure and chronic kidney disease indications, aligning with FDA approvals and guidelines.

 

Criteria for Getting Farxiga Covered

 

  • Prescriptions must be from an in-network provider and adhere to EmblemHealth's formulary guidelines.
  •  

  • Prior authorization might be required to confirm diagnosis and necessity according to health plan specifics.
  •  

  • Members may need to meet criteria regarding previous medications tried and their ineffectiveness.
  •  

  • Patients should check their specific plan for cost-sharing details like copayments or deductibles.
  •  

  • It's advisable to contact EmblemHealth directly or consult their website for the most accurate, up-to-date information.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

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 EmblemHealth

 

Contact EmblemHealth Customer Service

 

  • Begin by reaching out to EmblemHealth Customer Service to confirm if Farxiga is included in your prescription drug plan. Customer support can provide valuable information regarding coverage specifics.
  •  

  • Verify the requirements and potentially required documentation needed to submit a coverage request for Farxiga.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Farxiga with your healthcare provider. Explain your current health condition and why Farxiga is the preferred treatment option.
  •  

  • Request that your healthcare provider supply necessary medical documentation that supports the medical necessity of Farxiga for your treatment plan.

 

Review EmblemHealth's Formulary

 

  • Check EmblemHealth's prescription drug formulary, which is a list of covered medications, to see if Farxiga is listed. This will inform you about any coverage limitations or tier placements.
  •  

  • Identify any alternative medications listed in the formulary that might affect your coverage request.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete and submit a prior authorization form required for Farxiga. This process verifies that the medication is necessary for your treatment.
  •  

  • Include all supportive documentation and medical records that reinforce the necessity of Farxiga in your treatment plan.

 

Appeal if Necessary

 

  • If your initial request for coverage is denied, you have the option to file an appeal with EmblemHealth. Review the denial letter carefully for the reason, and gather additional support documentation if required.
  •  

  • Submit an appeal by providing a detailed explanation and additional evidence to support the medical necessity of Farxiga.

 

Explore Patient Assistance Programs

 

  • If coverage is still denied after an appeal, explore patient assistance programs offered by the manufacturer of Farxiga. These programs can offer financial support or discounts.
  •  

  • Consult with your healthcare provider or pharmacist for details on accessing these programs and their eligibility criteria.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does EmblemHealth Cover Farxiga

Explore Farxiga coverage with EmblemHealth, why it may be denied, how to secure it, costs without insurance, and key FAQs in our comprehensive guide.
Curex allergy drops unboxing

Is Farxiga Covered by EmblemHealth

 

Coverage of Farxiga by EmblemHealth

 

  • EmblemHealth generally covers Farxiga for conditions like type 2 diabetes, provided it's medically necessary.
  •  

  • Coverage may also include heart failure and chronic kidney disease indications, aligning with FDA approvals and guidelines.

 

Criteria for Getting Farxiga Covered

 

  • Prescriptions must be from an in-network provider and adhere to EmblemHealth's formulary guidelines.
  •  

  • Prior authorization might be required to confirm diagnosis and necessity according to health plan specifics.
  •  

  • Members may need to meet criteria regarding previous medications tried and their ineffectiveness.
  •  

  • Patients should check their specific plan for cost-sharing details like copayments or deductibles.
  •  

  • It's advisable to contact EmblemHealth directly or consult their website for the most accurate, up-to-date information.

 

A weight management program tailored to you

Start with Curex

EmblemHealth's Approved Criteria for Farxiga Coverage

 

Criteria for Farxiga Coverage

 

  • Patient must be diagnosed with type 2 diabetes, as documented by a healthcare provider.
  •  

  • Evidence of inadequate glycemic control with at least one other oral glucose-lowering medication is required.
  •  

  • Documentation should show that the patient has not achieved desired blood sugar levels through lifestyle changes such as diet and exercise, despite ongoing efforts.
  •  

  • Coverage is approved for patients with chronic heart failure with reduced ejection fraction (HFrEF) who meet guidelines specified by authoritative cardiology sources.
  •  

  • For patients with chronic kidney disease (CKD), coverage is available when there is evidence of reduced renal function as indicated by specified eGFR levels consistent with approved product labeling.
  •  

  • Prior authorization might require submission of medical records demonstrating the need for Farxiga due to medical history and response to previous treatments.
  •  

  • Approval requires documentation of the absence of contraindications such as hypersensitivity to the active ingredients of Farxiga.

 

Prescription Requirements

 

  • Prescription must be submitted by a credentialed healthcare provider familiar with the patient’s medical history.
  •  

  • The recommended dosing according to approved therapeutic standards should be adhered to, with justification for any deviations if necessary.

 

Additional Considerations

 

  • Regular monitoring of the patient's response to the medication and any potential side effects should be documented in follow-up assessments.
  •  

  • Continued coverage may require periodic submission of progress reports demonstrating therapeutic benefits from the medication.

 

Why EmblemHealth Might Deny Farxiga Coverage

 

Situations Where EmblemHealth Might Deny Farxiga Coverage

 

  • Patient does not meet the medication's specific clinical criteria, such as necessary diagnostic testing not indicating a requirement for Farxiga.
  •  

  • The prescribed usage of Farxiga is off-label without sufficient supporting evidence or justification as per EmblemHealth's guidelines.
  •  

  • Farxiga is not deemed cost-effective compared to other more affordable alternatives or generics available on the market that EmblemHealth considers therapeutically equivalent.
  •  

  • The patient has not tried and failed other first-line treatments or medications that are standard before considering Farxiga, according to EmblemHealth's step therapy protocols.
  •  

  • The prescribed dose or usage is not in accordance with the FDA-approved labeling or exceeds the recommended guidelines without medical necessity justification.
  •  

  • The patient’s insurance plan does not include coverage for Farxiga, either due to formulary exclusions or specific restrictive clauses in the policy terms.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 EmblemHealth

 

Contact EmblemHealth Customer Service

 

  • Begin by reaching out to EmblemHealth Customer Service to confirm if Farxiga is included in your prescription drug plan. Customer support can provide valuable information regarding coverage specifics.
  •  

  • Verify the requirements and potentially required documentation needed to submit a coverage request for Farxiga.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Farxiga with your healthcare provider. Explain your current health condition and why Farxiga is the preferred treatment option.
  •  

  • Request that your healthcare provider supply necessary medical documentation that supports the medical necessity of Farxiga for your treatment plan.

 

Review EmblemHealth's Formulary

 

  • Check EmblemHealth's prescription drug formulary, which is a list of covered medications, to see if Farxiga is listed. This will inform you about any coverage limitations or tier placements.
  •  

  • Identify any alternative medications listed in the formulary that might affect your coverage request.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete and submit a prior authorization form required for Farxiga. This process verifies that the medication is necessary for your treatment.
  •  

  • Include all supportive documentation and medical records that reinforce the necessity of Farxiga in your treatment plan.

 

Appeal if Necessary

 

  • If your initial request for coverage is denied, you have the option to file an appeal with EmblemHealth. Review the denial letter carefully for the reason, and gather additional support documentation if required.
  •  

  • Submit an appeal by providing a detailed explanation and additional evidence to support the medical necessity of Farxiga.

 

Explore Patient Assistance Programs

 

  • If coverage is still denied after an appeal, explore patient assistance programs offered by the manufacturer of Farxiga. These programs can offer financial support or discounts.
  •  

  • Consult with your healthcare provider or pharmacist for details on accessing these programs and their eligibility criteria.

 

Premium Medication you can trust

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.
  •  

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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.

Made in Webflow