Does Fallon Community Health Plan (FCHP) Cover Xarelto

Discover if Fallon Community Health Plan covers Xarelto, why claims may be denied, costs without insurance, and FAQs about Xarelto coverage.
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Coverage of Xarelto by Fallon Community Health Plan (FCHP)

 

  • FCHP covers Xarelto primarily for conditions such as atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), and prevention of these conditions post-surgery.
  •  

  • To be eligible, prescriptions must align with FDA-approved uses, guided by clinical guidelines ensuring medical necessity.
  •  

  • Prior authorization may be required. This involves a healthcare provider submitting documentation proving necessity.
  •  

  • Patients need to be within the specified criteria, such as age, diagnosis, and history, depending on health plan specifics.
  •  

  • Formulary tier placement affects coverage level and out-of-pocket costs, which can be verified on the FCHP formulary list.

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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.

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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 Fallon Community Health Plan (FCHP)

 

Research Your Plan

 

  • Visit the Fallon Community Health Plan (FCHP) website to review your current plan benefits. Understand if Xarelto is included under your prescription drug coverage.
  •  

  • Check your specific plan's formulary to see if Xarelto is listed. You might need to log into your account or download the latest formulary PDF from their resources.

 

Contact Member Services

 

  • Call FCHP member services for assistance. Use the phone number printed on your insurance card to connect directly with a representative.
  •  

  • Ask for detailed information regarding coverage for Xarelto, including any specific prerequisites or steps required for coverage.

 

Discuss with Your Healthcare Provider

 

  • Reach out to your healthcare provider to discuss your need for Xarelto. Have a conversation about medical necessity and possible alternatives if required.
  •  

  • Ensure your healthcare provider can provide documentation supporting the necessity of Xarelto for your condition, which may be needed for prior authorization.

 

Obtain Prior Authorization

 

  • If prior authorization is required, work with your healthcare provider to submit the necessary documentation and request to FCHP.
  •  

  • Follow up with FCHP to ensure that all paperwork is processed and ask for an estimated timeline for approval or rejection.

 

Review Any Cost-Saving Programs

 

  • Explore if FCHP offers any cost-saving programs or partnerships with pharmaceutical companies that could lower the cost of Xarelto.
  •  

  • Investigate if there are any coupons or discount programs from the manufacturer of Xarelto that might be applicable along with your insurance coverage.

 

File an Appeal if Necessary

 

  • If your request for coverage is denied, review the denial letter to understand the reasons provided by FCHP.
  •  

  • Work with your provider to gather any additional necessary documentation and submit an appeal according to the instructions provided by FCHP.

 

Stay Informed

 

  • Regularly check for any updates or changes in your FCHP prescription drug plan or the formulary list to stay informed about your coverage status.
  •  

  • Maintain regular communication with both FCHP and your healthcare provider to ensure that you are fully aware of your benefits and any changes that might affect your coverage for Xarelto.

 

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FAQs

Does Fallon Community Health Plan (FCHP) Cover Xarelto

Discover if Fallon Community Health Plan covers Xarelto, why claims may be denied, costs without insurance, and FAQs about Xarelto coverage.
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Is Xarelto Covered by Fallon Community Health Plan (FCHP)

 

Coverage of Xarelto by Fallon Community Health Plan (FCHP)

 

  • FCHP covers Xarelto primarily for conditions such as atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), and prevention of these conditions post-surgery.
  •  

  • To be eligible, prescriptions must align with FDA-approved uses, guided by clinical guidelines ensuring medical necessity.
  •  

  • Prior authorization may be required. This involves a healthcare provider submitting documentation proving necessity.
  •  

  • Patients need to be within the specified criteria, such as age, diagnosis, and history, depending on health plan specifics.
  •  

  • Formulary tier placement affects coverage level and out-of-pocket costs, which can be verified on the FCHP formulary list.

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

 

Criteria for Xarelto Coverage by Fallon Community Health Plan (FCHP)

 

  • Xarelto is covered for individuals diagnosed with non-valvular atrial fibrillation (NVAF) for the purpose of reducing the risk of stroke and systemic embolism.
  •  

  • FCHP covers Xarelto for the treatment and prevention of deep vein thrombosis (DVT) in patients undergoing knee or hip replacement surgery.
  •  

  • Patients diagnosed with pulmonary embolism (PE) may receive coverage for Xarelto for both treatment and secondary prevention purposes.
  •  

  • FCHP approves Xarelto for reducing the risk of recurrence in patients who have been previously treated for DVT or PE.
  •  

  • Coverage is extended to patients requiring prophylaxis for venous thromboembolism (VTE) during hospitalization for acute illness.
  •  

  • For individuals with coronary artery disease (CAD) or peripheral artery disease (PAD), Xarelto is covered to reduce the risk of major cardiovascular events.
  •  

  • Patients with a documented history of intolerance or contraindication to warfarin may qualify for Xarelto under FCHP coverage.
  •  

  • FCHP may require prior authorization, and clinical guidelines must be met as per the plan’s policy details.
  •  

 

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

 

Reasons for Denial of Xarelto Coverage by FCHP

 

  • **Non-Formulary Status:** If Xarelto is not listed on Fallon Community Health Plan’s formulary, it may be denied unless an exception is granted.
  •  

  • **Lack of Medical Necessity:** Coverage may be denied if the medical documentation submitted does not demonstrate the necessity for Xarelto over other available alternatives.
  •  

  • **Non-Approved Diagnosis:** If Xarelto is prescribed for an off-label use that has not been approved by FCHP, this could result in denial of coverage.
  •  

  • **Step Therapy Requirement:** If FCHP requires step therapy protocols and Xarelto is prescribed without first trying the recommended treatment steps or alternative medications, coverage may be refused.
  •  

  • **Policy Exclusions:** Coverage might be denied due to specific policy exclusions relevant to anticoagulant therapies, as outlined in the terms and conditions of the plan.
  •  

  • **Lack of Prior Authorization:** If there is a requirement for prior authorization from FCHP for Xarelto and it was not obtained, this may lead to a denial of coverage.

 

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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 Fallon Community Health Plan (FCHP)

 

Research Your Plan

 

  • Visit the Fallon Community Health Plan (FCHP) website to review your current plan benefits. Understand if Xarelto is included under your prescription drug coverage.
  •  

  • Check your specific plan's formulary to see if Xarelto is listed. You might need to log into your account or download the latest formulary PDF from their resources.

 

Contact Member Services

 

  • Call FCHP member services for assistance. Use the phone number printed on your insurance card to connect directly with a representative.
  •  

  • Ask for detailed information regarding coverage for Xarelto, including any specific prerequisites or steps required for coverage.

 

Discuss with Your Healthcare Provider

 

  • Reach out to your healthcare provider to discuss your need for Xarelto. Have a conversation about medical necessity and possible alternatives if required.
  •  

  • Ensure your healthcare provider can provide documentation supporting the necessity of Xarelto for your condition, which may be needed for prior authorization.

 

Obtain Prior Authorization

 

  • If prior authorization is required, work with your healthcare provider to submit the necessary documentation and request to FCHP.
  •  

  • Follow up with FCHP to ensure that all paperwork is processed and ask for an estimated timeline for approval or rejection.

 

Review Any Cost-Saving Programs

 

  • Explore if FCHP offers any cost-saving programs or partnerships with pharmaceutical companies that could lower the cost of Xarelto.
  •  

  • Investigate if there are any coupons or discount programs from the manufacturer of Xarelto that might be applicable along with your insurance coverage.

 

File an Appeal if Necessary

 

  • If your request for coverage is denied, review the denial letter to understand the reasons provided by FCHP.
  •  

  • Work with your provider to gather any additional necessary documentation and submit an appeal according to the instructions provided by FCHP.

 

Stay Informed

 

  • Regularly check for any updates or changes in your FCHP prescription drug plan or the formulary list to stay informed about your coverage status.
  •  

  • Maintain regular communication with both FCHP and your healthcare provider to ensure that you are fully aware of your benefits and any changes that might affect your coverage for Xarelto.

 

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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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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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