Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Xarelto

Explore Florida Blue's Xarelto coverage, cost without insurance, and tips to secure approval. Discover answers to common questions in our detailed guide.
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Coverage of Xarelto by Florida Blue

 

  • Xarelto, an anticoagulant, is generally covered under Florida Blue health plans, often falling under tiers that require prior authorization.
  •  

  • Coverage typically applies for conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism, among others.
  •  

    Criteria and Rules for Coverage

     

    • Eligibility often requires a prescription from a healthcare provider, demonstrating the necessity based on medical history and current condition.
    •  

    • Prior authorizations may be required, with documentation from your doctor explaining the need for Xarelto over other anticoagulants.
    •  

    • Cost-sharing, like copayments or coinsurance, is based on your specific plan’s formulary and benefits structure.

     

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Your Coverage Plan

 

  • Log in to your Florida Blue member account or contact customer service to check if your current plan covers Xarelto.
  •  

  • Review your plan's drug formulary, which is a list of prescription medications that are covered. Look specifically for Xarelto under your plan's tier structure.

 

Understand Your Prescription Benefits

 

  • Determine the specifics of your prescription drug coverage, including copayments, coinsurance, and any annual deductible that applies to medications.
  •  

  • Take note of whether your plan requires prior authorization for Xarelto, meaning your doctor must justify the need for this specific medication.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about the necessity of Xarelto and discuss any possible alternative medications that may be covered if Xarelto is not.
  •  

  • If required, ask your doctor to submit prior authorization forms to Florida Blue on your behalf. This step is crucial if Xarelto requires validation from your healthcare provider.

 

Contact Florida Blue Customer Service

 

  • Call the customer service number on the back of your insurance card to discuss coverage details directly with a representative.
  •  

  • Inquire about the specifics of getting Xarelto covered under your current plan, including any paperwork or steps that need completion.

 

Appeal if Necessary

 

  • If your request for coverage is denied, ask Florida Blue about the appeals process to potentially have your prescription for Xarelto reconsidered.
  •  

  • Prepare necessary documentation from your healthcare provider that supports the need for Xarelto.

 

Review Financial Assistance Options

 

  • Check if you qualify for any patient assistance programs offered by the manufacturer as a supplementary way to afford Xarelto.
  •  

  • Consider discussing further assistance options with your healthcare provider, such as alternative financial aid programs that might be available.

 

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FAQs

Does Florida Blue (Blue Cross Blue Shield of Florida) Cover Xarelto

Explore Florida Blue's Xarelto coverage, cost without insurance, and tips to secure approval. Discover answers to common questions in our detailed guide.
Curex allergy drops unboxing

Is Xarelto Covered by Florida Blue (Blue Cross Blue Shield of Florida)

 

Coverage of Xarelto by Florida Blue

 

  • Xarelto, an anticoagulant, is generally covered under Florida Blue health plans, often falling under tiers that require prior authorization.
  •  

  • Coverage typically applies for conditions like atrial fibrillation, deep vein thrombosis, or pulmonary embolism, among others.
  •  

    Criteria and Rules for Coverage

     

    • Eligibility often requires a prescription from a healthcare provider, demonstrating the necessity based on medical history and current condition.
    •  

    • Prior authorizations may be required, with documentation from your doctor explaining the need for Xarelto over other anticoagulants.
    •  

    • Cost-sharing, like copayments or coinsurance, is based on your specific plan’s formulary and benefits structure.

     

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Florida Blue (Blue Cross Blue Shield of Florida)'s Approved Criteria for Xarelto Coverage

 

Criteria for Florida Blue Coverage for Xarelto

 

  • Eligible patients must have a diagnosis of atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), or have undergone hip or knee replacement surgery, where Xarelto is medically necessary for thromboembolism prevention or treatment.
  •  

  • For the prevention of stroke and systemic embolism, Xarelto is covered for individuals with non-valvular atrial fibrillation who have a high risk of stroke based on clinical guidelines.
  •  

  • Patients with a history of DVT or PE who require continued anticoagulation therapy to reduce the risk of recurrence may be covered under the plan after meeting the criteria for initial treatment.
  •  

  • Coverage includes Xarelto as part of the post-operative care plan for patients who have recently undergone hip or knee replacement surgeries to prevent blood clot formation.
  •  

  • Xarelto therapy must be initiated based on a prescriber's assessment and documented rationale that it is the most appropriate anticoagulant for the patient's condition.
  •  

  • There must be documentation showing previous trials with other anticoagulants such as warfarin, resulting in adverse effects or inadequate therapeutic response, when applicable.
  •  

  • Continued coverage for Xarelto is contingent upon the regular monitoring of the patient's health status and demonstration of clinical benefit in the patient’s treatment plan.

 

Why Florida Blue (Blue Cross Blue Shield of Florida) Might Deny Xarelto Coverage

 

Reasons for Denial of Xarelto Coverage

 

  • **Non-Formulary Status:** Xarelto might not be included in the formulary list of covered medications, as insurers tend to favor less expensive alternatives.
  •  

  • **Prior Authorization Requirements:** If prior authorization is required and not obtained, coverage for Xarelto could be denied. The insurer might mandate detailed clinical documentation to justify medical necessity.
  •  

  • **Step Therapy Protocols:** Florida Blue may require step therapy, necessitating the use of alternative medications before approving Xarelto. Denial could occur if these conditions are not satisfied.
  •  

  • **Off-Label Use:** Prescription of Xarelto for conditions not approved by the FDA or not supported by accepted clinical guidelines may result in denial of coverage.
  •  

  • **Lack of Medical Necessity:** If Florida Blue determines that Xarelto is not medically necessary based on the member’s specific condition or health plan criteria, coverage might be denied.
  •  

  • **Policy Exclusions:** Specific health plans may have exclusions that preclude coverage of certain types of medications, potentially affecting the approval of Xarelto.
  •  

  • **Incomplete or Incorrect Documentation:** Submission of incomplete or incorrect information during the claims process can lead to denial. This includes errors in supporting documents required for a coverage determination.

 

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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 Florida Blue (Blue Cross Blue Shield of Florida)

 

Verify Your Coverage Plan

 

  • Log in to your Florida Blue member account or contact customer service to check if your current plan covers Xarelto.
  •  

  • Review your plan's drug formulary, which is a list of prescription medications that are covered. Look specifically for Xarelto under your plan's tier structure.

 

Understand Your Prescription Benefits

 

  • Determine the specifics of your prescription drug coverage, including copayments, coinsurance, and any annual deductible that applies to medications.
  •  

  • Take note of whether your plan requires prior authorization for Xarelto, meaning your doctor must justify the need for this specific medication.

 

Consult Your Healthcare Provider

 

  • Speak with your doctor about the necessity of Xarelto and discuss any possible alternative medications that may be covered if Xarelto is not.
  •  

  • If required, ask your doctor to submit prior authorization forms to Florida Blue on your behalf. This step is crucial if Xarelto requires validation from your healthcare provider.

 

Contact Florida Blue Customer Service

 

  • Call the customer service number on the back of your insurance card to discuss coverage details directly with a representative.
  •  

  • Inquire about the specifics of getting Xarelto covered under your current plan, including any paperwork or steps that need completion.

 

Appeal if Necessary

 

  • If your request for coverage is denied, ask Florida Blue about the appeals process to potentially have your prescription for Xarelto reconsidered.
  •  

  • Prepare necessary documentation from your healthcare provider that supports the need for Xarelto.

 

Review Financial Assistance Options

 

  • Check if you qualify for any patient assistance programs offered by the manufacturer as a supplementary way to afford Xarelto.
  •  

  • Consider discussing further assistance options with your healthcare provider, such as alternative financial aid programs that might be available.

 

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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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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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