Does Gateway Health Plan Cover Eliquis

Explore Eliquis coverage insights with Gateway Health Plan, denial reasons, coverage tips, costs without insurance, and FAQs. Get the info you need.
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Coverage for Eliquis under Gateway Health Plan

 

  • **Authorization Required:** Coverage for Eliquis may require prior authorization. Patients typically need a prescription from a healthcare provider who can demonstrate medical necessity.
  •  

  • **Formulary Inclusion:** Eliquis is often included in the plan’s formulary. Coverage can be influenced by the specific plan tier and guidelines.
  •  

  • **Conditions Covered:** Commonly covered conditions include atrial fibrillation, DVT, and pulmonary embolism, for which Eliquis is prescribed to prevent stroke and blood clots.
  •  

  • **Cost and Copayments:** Copayments or coinsurance may apply, depending on the tier and specific plan benefits. Patients should review their individual plan details.
  •  

  • **Criteria and Limitations:** Some plans might have step therapy requirements or may require trying a less expensive medication first.

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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 Eliquis Coverage with Gateway Health Plan

 

Check Your Current Coverage

 

  • Contact Gateway Health Plan customer service to inquire whether Eliquis is currently covered under your plan.
  •  

  • Review your policy documents or access your health plan details online to check coverage for prescription medications.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor to confirm that Eliquis is the right medication for your condition.
  •  

  • Request any necessary documentation or a prescription that can support your need for Eliquis when submitting requests to Gateway Health Plan.

 

Gather Required Information

 

  • Prepare your health plan ID card, prescription details, and any medical records that support the necessity of Eliquis for your treatment.
  •  

  • Ensure that you have up-to-date contact information for any healthcare professionals involved in your care.

 

Contact Gateway Health Plan Member Services

 

  • Call the member services phone number on your ID card to speak with a representative.
  •  

  • Inquire about the process for getting Eliquis covered, including any forms or prior authorization required.

 

Submit a Coverage Request

 

  • Complete any necessary forms provided by Gateway Health Plan for requesting medication coverage.
  •  

  • Include all required documentation such as your prescription, supporting medical records, and medical justifications.
  •  

  • Submit the completed forms and documentation through the method specified by Gateway Health Plan, such as online, by mail, or fax.

 

Follow Up on Your Request

 

  • Keep track of the timeline provided by Gateway Health Plan for a decision on your request.
  •  

  • If you haven’t received a response within the expected timeframe, contact the member services for an update on your request status.

 

Appeal if Necessary

 

  • If your request is denied, ask for detailed reasons for the denial and the necessary steps to file an appeal.
  •  

  • Provide any additional supporting documentation or corrections to information that may address the reasons for denial.
  •  

  • File the appeal as instructed by Gateway Health Plan and track its progress for updates.

 

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FAQs

Does Gateway Health Plan Cover Eliquis

Explore Eliquis coverage insights with Gateway Health Plan, denial reasons, coverage tips, costs without insurance, and FAQs. Get the info you need.
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Is Eliquis Covered by Gateway Health Plan

 

Coverage for Eliquis under Gateway Health Plan

 

  • **Authorization Required:** Coverage for Eliquis may require prior authorization. Patients typically need a prescription from a healthcare provider who can demonstrate medical necessity.
  •  

  • **Formulary Inclusion:** Eliquis is often included in the plan’s formulary. Coverage can be influenced by the specific plan tier and guidelines.
  •  

  • **Conditions Covered:** Commonly covered conditions include atrial fibrillation, DVT, and pulmonary embolism, for which Eliquis is prescribed to prevent stroke and blood clots.
  •  

  • **Cost and Copayments:** Copayments or coinsurance may apply, depending on the tier and specific plan benefits. Patients should review their individual plan details.
  •  

  • **Criteria and Limitations:** Some plans might have step therapy requirements or may require trying a less expensive medication first.

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Gateway Health Plan's Approved Criteria for Eliquis Coverage

 

Approved Criteria for Eliquis Coverage under Gateway Health Plan

 

  • The patient must have a confirmed diagnosis of non-valvular atrial fibrillation (NVAF) and require anticoagulation therapy to reduce the risk of stroke and systemic embolism.
  •  

  • Eliquis may be covered for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients, as well as for reducing the risk of recurrence of DVT and PE following initial therapy.
  •  

  • Coverage is available for patients undergoing hip or knee replacement surgery to prevent deep vein thrombosis and pulmonary embolism.
  •  

  • A history of recurrent systemic embolism or stroke in patients with atrial fibrillation requiring anticoagulation that cannot be adequately controlled with warfarin may qualify for coverage.
  •  

  • Patients with a documented inability to tolerate or achieve adequate INR (International Normalized Ratio) control with warfarin could be eligible for Eliquis coverage as an alternative anticoagulant treatment.
  •  

  • The patient’s medical records must show a negative response or contraindication to other anticoagulants if the patient is being considered for Eliquis treatment due to specific health conditions or contraindications.
  •  

  • At the prescriber's discretion, covered if the patient has demonstrated adherence difficulties with warfarin, necessitating an alternative therapy for improved treatment adherence.
  •  

  • Coverage is contingent upon prior screening for bleeding risks and conditions, ensuring that Eliquis is appropriate and safe for patient use in managing their condition.

 

Why Gateway Health Plan Might Deny Eliquis Coverage

 

Circumstances When Eliquis is Not Covered by Gateway Health Plan

 

  • Eliquis is not prescribed for an FDA-approved indication or a condition included in Gateway's formulary for coverage.
  •  

  • The patient does not meet the specific clinical criteria set by Gateway Health Plan, such as age restrictions or prior authorization requirements.
  •  

  • The request for Eliquis is determined not to be medically necessary following Gateway Health Plan's medical review protocols.
  •  

  • Eliquis is requested for use outside the approved dosing or treatment duration limits specified in the health plan’s formulary guidelines.
  •  

  • The patient has not tried or failed on preferred alternative medications if required by the health plan’s step therapy requirements.
  •  

  • The prescription is for an off-label use that Gateway Health Plan does not recognize as standard treatment for the indicated medical condition.
  •  

  • There is a lack of sufficient clinical evidence to support the usage of Eliquis for the patient’s condition according to the health plan’s criteria.
  •  

  • The prescription does not adhere to the health plan's formulary management strategies, such as generic substitution mandates where applicable.

 

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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 Gateway Health Plan

 

Check Your Current Coverage

 

  • Contact Gateway Health Plan customer service to inquire whether Eliquis is currently covered under your plan.
  •  

  • Review your policy documents or access your health plan details online to check coverage for prescription medications.

 

Consult with Your Healthcare Provider

 

  • Speak with your doctor to confirm that Eliquis is the right medication for your condition.
  •  

  • Request any necessary documentation or a prescription that can support your need for Eliquis when submitting requests to Gateway Health Plan.

 

Gather Required Information

 

  • Prepare your health plan ID card, prescription details, and any medical records that support the necessity of Eliquis for your treatment.
  •  

  • Ensure that you have up-to-date contact information for any healthcare professionals involved in your care.

 

Contact Gateway Health Plan Member Services

 

  • Call the member services phone number on your ID card to speak with a representative.
  •  

  • Inquire about the process for getting Eliquis covered, including any forms or prior authorization required.

 

Submit a Coverage Request

 

  • Complete any necessary forms provided by Gateway Health Plan for requesting medication coverage.
  •  

  • Include all required documentation such as your prescription, supporting medical records, and medical justifications.
  •  

  • Submit the completed forms and documentation through the method specified by Gateway Health Plan, such as online, by mail, or fax.

 

Follow Up on Your Request

 

  • Keep track of the timeline provided by Gateway Health Plan for a decision on your request.
  •  

  • If you haven’t received a response within the expected timeframe, contact the member services for an update on your request status.

 

Appeal if Necessary

 

  • If your request is denied, ask for detailed reasons for the denial and the necessary steps to file an appeal.
  •  

  • Provide any additional supporting documentation or corrections to information that may address the reasons for denial.
  •  

  • File the appeal as instructed by Gateway Health Plan and track its progress for updates.

 

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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.

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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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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.

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