Does Fallon Community Health Plan (FCHP) Cover Eliquis

Explore Eliquis coverage with FCHP, understand denial reasons, learn how to secure coverage, discover costs without insurance, and get answers to FAQs.
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Eliquis Coverage by FCHP

 

  • Fallon Community Health Plan (FCHP) generally covers Eliquis for patients diagnosed with conditions such as atrial fibrillation, deep vein thrombosis, or pulmonary embolism, provided it's prescribed by an authorized healthcare professional.
  •  

  • Coverage is subject to FCHP's formulary and may require prior authorization to verify the necessity based on the patient's medical condition and history.
  •  

  • Patients may need to try alternative anticoagulants before Eliquis is approved unless there are documented contraindications to those alternatives.
  •  

  • Co-pays or co-insurance might apply depending on the member's specific FCHP plan, and eligibility for coverage might vary; members are encouraged to consult with FCHP for personalized benefits information.

 

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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.

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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 Eliquis Coverage with Fallon Community Health Plan (FCHP)

 

Get Information About Your Coverage

 

  • Contact Fallon Community Health Plan (FCHP) customer service to inquire about your current prescription drug benefits and whether Eliquis is covered under your plan.
  •  

  • Review your health insurance policy documents, focusing on the prescription drug section, to understand coverage details for Eliquis.
  •  

  • Visit the FCHP website and log in to your member account to access your plan details and any updates about prescription drug coverage.

 

Determine Eligibility for Prescription Drug Coverage

 

  • Check if your plan includes a pharmacy benefits manager (PBM) that handles prescription drugs. This can affect how Eliquis is covered and the process for getting it.
  •  

  • Identify any specific requirements for Eliquis coverage, such as prior authorization or step therapy, which may necessitate trying other medications first.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor or healthcare provider about your need for Eliquis and obtain any necessary documentation or medical justification to support coverage requests.
  •  

  • Your healthcare provider may need to contact FCHP to provide clinical information, which could be required for prior authorization of Eliquis.

 

Submit Prior Authorization if Required

 

  • If your plan requires prior authorization, coordinate with your healthcare provider to submit the necessary forms and supporting medical documentation to FCHP.
  •  

  • Ensure all information provided to FCHP is complete and accurate to prevent delays in the approval process.

 

Review and Use the Formulary

 

  • Check the FCHP formulary, available on their website or through customer service, to confirm that Eliquis is listed and to understand any tiered pricing or co-pay details.
  •  

  • Understanding the formulary can also help you navigate alternatives or generic options if Eliquis is not covered.

 

Appeal if Coverage is Denied

 

  • If your request for Eliquis coverage is denied, you have the right to appeal the decision. Use the appeal process outlined in your plan documents or contact FCHP for guidance.
  •  

  • Gather additional supporting information from your healthcare provider if needed and respond promptly to any requests from FCHP during the appeal process.

 

Stay Updated on Policy Changes

 

  • Regularly check your FCHP account and policy updates for any changes in coverage, procedural alterations, or new conditions that might affect Eliquis coverage.
  •  

  • Be proactive about renewing authorization for Eliquis coverage if required by your plan.

 

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FAQs

Does Fallon Community Health Plan (FCHP) Cover Eliquis

Explore Eliquis coverage with FCHP, understand denial reasons, learn how to secure coverage, discover costs without insurance, and get answers to FAQs.
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Is Eliquis Covered by Fallon Community Health Plan (FCHP)

 

Eliquis Coverage by FCHP

 

  • Fallon Community Health Plan (FCHP) generally covers Eliquis for patients diagnosed with conditions such as atrial fibrillation, deep vein thrombosis, or pulmonary embolism, provided it's prescribed by an authorized healthcare professional.
  •  

  • Coverage is subject to FCHP's formulary and may require prior authorization to verify the necessity based on the patient's medical condition and history.
  •  

  • Patients may need to try alternative anticoagulants before Eliquis is approved unless there are documented contraindications to those alternatives.
  •  

  • Co-pays or co-insurance might apply depending on the member's specific FCHP plan, and eligibility for coverage might vary; members are encouraged to consult with FCHP for personalized benefits information.

 

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Fallon Community Health Plan (FCHP)'s Approved Criteria for Eliquis Coverage

 

Eliquis Coverage Criteria

 

  • **Indication**: Fallon Community Health Plan (FCHP) covers Eliquis for members with a diagnosis of atrial fibrillation (AF) not caused by a heart valve problem, with the purpose of reducing the risk of stroke and systemic embolism.
  •  

  • **DVT and PE Treatment**: Coverage is available for the initial and long-term treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) to reduce the risk of recurrent events.
  •  

  • **DVT and PE Prevention**: Eliquis is covered for members undergoing hip or knee replacement surgery for the prevention of DVT, which may lead to PE.
  •  

  • **Prescription Requirements**: A valid prescription must be provided, and the prescribing healthcare provider should document the indication for use, confirming that the condition meets FCHP-covered criteria.
  •  

  • **Age Limitations**: Coverage is typically available for adult members 18 years and older, unless otherwise specified due to specific health considerations.
  •  

  • **Drug Interaction Considerations**: If a member is on other medications, documentation should show the absence of contraindications or significant drug interactions with Eliquis.
  •  

  • **Dosage and Administration**: Members must adhere to the prescribed dosage and administration guidelines. The healthcare provider must verify that the Eliquis dosage corresponds to the treatment plan outlined for the covered indications.
  •  

  • **Prior Authorization**: Some scenarios might require prior authorization, where documentation supporting the medical necessity of Eliquis is provided to FCHP for approval.
  •  

  • **Step Therapy**: Members are generally required to follow a step-therapy protocol, exhausting other therapy options if applicable, before Eliquis coverage is granted.
  •  

  • **Clinical Evaluation**: Periodic clinical evaluations are expected to ensure ongoing medical necessity and effectiveness of the treatment with Eliquis for the member's condition.

 

Why Fallon Community Health Plan (FCHP) Might Deny Eliquis Coverage

 

Reasons for Denial of Eliquis Coverage by Fallon Community Health Plan (FCHP)

 

  • Non-FDA Approved Use: FCHP may deny coverage for Eliquis if it is prescribed for an indication not approved by the FDA.
  •  

  • Out of Network Prescriptions: If Eliquis is prescribed by a healthcare provider that is not within the FCHP network, coverage may be declined.
  •  

  • Failure to Meet Prior Authorization: If the required prior authorization for Eliquis is not obtained or if the criteria set by FCHP for prior authorization are not met, coverage might be denied.
  •  

  • Alternative Medication Available: FCHP may deny coverage if there is a cost-effective, therapeutically equivalent generic alternative available which has not been tried or documented by the prescriber as ineffective or inappropriate.
  •  

  • Non-Compliance with Step Therapy: Coverage might be refused if the patient has not tried and failed on other formulary medications as required by FCHP's step therapy protocol before moving to Eliquis.
  •  

  • Not Medically Necessary: If FCHP determines that Eliquis is not medically necessary according to their established guidelines, they may deny coverage.
  •  

  • Off-Label Dosage: If Eliquis is prescribed at a dosage that is not standard according to FCHP guidelines or outside the recommended dosage by authorities like the FDA.
  •  

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How Much Does Eliquis Cost without Insurance?

 

Approximate Cost of Eliquis without Insurance

 

  • The cost of Eliquis, a commonly prescribed blood thinner, can vary based on the pharmacy, location, and any available discounts or coupons. On average, without insurance, Eliquis can cost around $550 to $650 for a 30-day supply.
  •  

  • Some pharmacies or online platforms may offer discounts or generic options that can lower the cost, so it's advisable to shop around. Patients should also inquire about manufacturer coupons or assistance programs that might help reduce the price.
  •  

  • Price comparison tools and websites can be helpful in finding the best available prices for Eliquis in your area.

 

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 Eliquis Coverage with Fallon Community Health Plan (FCHP)

 

Get Information About Your Coverage

 

  • Contact Fallon Community Health Plan (FCHP) customer service to inquire about your current prescription drug benefits and whether Eliquis is covered under your plan.
  •  

  • Review your health insurance policy documents, focusing on the prescription drug section, to understand coverage details for Eliquis.
  •  

  • Visit the FCHP website and log in to your member account to access your plan details and any updates about prescription drug coverage.

 

Determine Eligibility for Prescription Drug Coverage

 

  • Check if your plan includes a pharmacy benefits manager (PBM) that handles prescription drugs. This can affect how Eliquis is covered and the process for getting it.
  •  

  • Identify any specific requirements for Eliquis coverage, such as prior authorization or step therapy, which may necessitate trying other medications first.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor or healthcare provider about your need for Eliquis and obtain any necessary documentation or medical justification to support coverage requests.
  •  

  • Your healthcare provider may need to contact FCHP to provide clinical information, which could be required for prior authorization of Eliquis.

 

Submit Prior Authorization if Required

 

  • If your plan requires prior authorization, coordinate with your healthcare provider to submit the necessary forms and supporting medical documentation to FCHP.
  •  

  • Ensure all information provided to FCHP is complete and accurate to prevent delays in the approval process.

 

Review and Use the Formulary

 

  • Check the FCHP formulary, available on their website or through customer service, to confirm that Eliquis is listed and to understand any tiered pricing or co-pay details.
  •  

  • Understanding the formulary can also help you navigate alternatives or generic options if Eliquis is not covered.

 

Appeal if Coverage is Denied

 

  • If your request for Eliquis coverage is denied, you have the right to appeal the decision. Use the appeal process outlined in your plan documents or contact FCHP for guidance.
  •  

  • Gather additional supporting information from your healthcare provider if needed and respond promptly to any requests from FCHP during the appeal process.

 

Stay Updated on Policy Changes

 

  • Regularly check your FCHP account and policy updates for any changes in coverage, procedural alterations, or new conditions that might affect Eliquis coverage.
  •  

  • Be proactive about renewing authorization for Eliquis coverage if required by your plan.

 

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Eliquis FAQ

What are the side effects of Eliquis?

 

Common Side Effects of Eliquis

 

  • Mild bleeding or bruising due to its anticoagulant effect.
  • Nausea, which may occur as your body adjusts to the medication.
  • Skin rash or minor allergic reactions.
  • Fatigue or general weakness.

 

Serious Side Effects

 

  • Severe bleeding, including unusual bleeding from gums, nosebleeds, or heavier than usual menstrual bleeding.
  • Red, pink, or brown urine and black or bloody stools indicating internal bleeding.
  • Severe headache, dizziness, or fainting, which could indicate a bleed in the brain.
  • Signs of anemia, such as pale skin, weakness, or fatigue.

 

Consult Your Doctor

 

  • Always report any unusual symptoms to your healthcare provider promptly.
  • Seek emergency medical attention for significant bleeding or symptoms of a serious allergic reaction like difficulty breathing.

 

Is Eliquis a blood thinner?

 

Is Eliquis a Blood Thinner?

 

  • Yes, Eliquis (apixaban) is a blood thinner, also known as an anticoagulant.
  •  

  • It prevents blood clots by inhibiting Factor Xa, which is crucial in the clotting process.
  •  

  • Doctors prescribe Eliquis to reduce stroke risk in patients with atrial fibrillation and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
  •  

  • Ensure regular monitoring and follow-ups with your healthcare provider while on Eliquis for safe management.
  •  

  • Contact a healthcare professional if you have concerns about bleeding risks or interactions with other medications.

 

Can you take Eliquis with alcohol?

 

Alcohol and Eliquis Interaction

 

  • Moderate alcohol consumption might be safe, but heavy drinking can increase bleeding risk.
  •  

  • Consult your healthcare provider to assess your specific condition and alcohol tolerance.

 

Potential Effects of Combining

 

  • Both Eliquis and alcohol affect blood clotting, raising potential for heightened bleeding.
  •  

  • Alcohol can augment Eliquis' effects, complicating the management of conditions like atrial fibrillation.

 

Recommendations for Use

 

  • If you drink, limit to one or two standard drinks occasionally and monitor for bruising or bleeding.
  •  

  • Report any unusual symptoms to your healthcare provider immediately.

 

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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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