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Does Geisinger Health Plan Cover Plavix

Find out if Geisinger covers Plavix, reasons for possible denial, how to get coverage, cost without insurance, and FAQs in this comprehensive guide.
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Geisinger Health Plan Coverage for Plavix

 

  • Plavix is typically covered under Geisinger Health Plan as a prescription drug. However, coverage details can vary depending on your specific plan type and benefits.

    •  

  • To qualify for coverage, Plavix usually needs to be medically necessary, often for conditions such as preventing blood clots after a heart attack, stroke, or certain heart procedures.

    •  

  • Authorization may be required before filling a prescription. It's crucial to consult with your physician to ensure it is prescribed according to plan requirements.

    •  

  • Patients should confirm whether Plavix is on their plan’s formulary, which is a list of medications covered by the health plan, and understand any co-payments or co-insurance involved.

    •  

  • Contact Geisinger Health Plan customer service for specifics on your plan’s coverage for Plavix to ensure compliance with policy regulations and criteria.

 

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Clinical Support

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 Plavix Coverage with Geisinger Health Plan

 

Check Plan Details

 

  • Review your existing Geisinger Health Plan documentation to see if Plavix is already covered under your current plan.
    •  
  • If you do not have the hard copy, log into your Geisinger Health Plan online account to access the details of your specific plan.

 

Contact Customer Service

 

  • Call Geisinger Health Plan's customer service to verify Plavix coverage. It's beneficial to have your member ID and relevant information ready for a quicker process.
    •  
  • Ask about any specific conditions or requirements that need to be fulfilled to get Plavix covered, such as prior authorization.

 

Obtain Prescription

 

  • Visit your healthcare provider to get a prescription for Plavix if you don't have one already. Ensure they are aware of your intention to get it covered by Geisinger Health Plan.
    •  
  • Ask your healthcare provider if they can assist with providing any necessary medical documentation that supports the need for Plavix.

 

Submit Prior Authorization

 

  • If prior authorization is required, request the necessary forms from Geisinger Health Plan or download them from their website.
    •  
  • Work with your healthcare provider to complete these forms accurately. This often requires a justification for why Plavix is necessary, including medical history and other treatments tried.

 

Review Formularies

 

  • Check Geisinger Health Plan's formulary to ensure Plavix is a covered drug. The formulary will list preferred drugs and possibly offer generic alternatives.
    •  
  • Note any tier placement of Plavix, as this might affect your out-of-pocket costs.

 

Appeal if Necessary

 

  • If your initial request for coverage is denied, review the denial letter carefully to understand the reasons.
    •  
  • Prepare an appeal by gathering supporting documents, including medical records and letters from your healthcare provider, to explain the necessity of Plavix for your condition.

 

Re-evaluate Annually

 

  • Your health plan benefits may change yearly. Re-evaluate your plan or any plan modifications during the open enrollment period to ensure continued coverage for Plavix.
    •  
  • Consider discussing changes directly with a Geisinger Health Plan representative if you anticipate any issues with drug coverage going forward.

 

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

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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

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FAQs

Does Geisinger Health Plan Cover Plavix

Find out if Geisinger covers Plavix, reasons for possible denial, how to get coverage, cost without insurance, and FAQs in this comprehensive guide.
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Is Plavix Covered by Geisinger Health Plan

 

Geisinger Health Plan Coverage for Plavix

 

  • Plavix is typically covered under Geisinger Health Plan as a prescription drug. However, coverage details can vary depending on your specific plan type and benefits.

    •  

  • To qualify for coverage, Plavix usually needs to be medically necessary, often for conditions such as preventing blood clots after a heart attack, stroke, or certain heart procedures.

    •  

  • Authorization may be required before filling a prescription. It's crucial to consult with your physician to ensure it is prescribed according to plan requirements.

    •  

  • Patients should confirm whether Plavix is on their plan’s formulary, which is a list of medications covered by the health plan, and understand any co-payments or co-insurance involved.

    •  

  • Contact Geisinger Health Plan customer service for specifics on your plan’s coverage for Plavix to ensure compliance with policy regulations and criteria.

 

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Geisinger Health Plan's Approved Criteria for Plavix Coverage

 

Criteria for Plavix Coverage by Geisinger Health Plan

 

  • Plavix is covered for patients with a diagnosis of acute coronary syndrome, including unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), or ST-segment elevation myocardial infarction (STEMI) who are medically managed or undergoing percutaneous coronary intervention (PCI).

    •  

  • Patients with recent myocardial infarction, stroke, or established peripheral arterial disease may also qualify for Plavix coverage.

    •  

  • Eligibility includes patients requiring dual antiplatelet therapy following the placement of a coronary artery stent.

    •  

  • Coverage is provided for patients who demonstrate an intolerance or contraindication to aspirin therapy.

    •  

  • Plavix is available for secondary prevention of atherothrombotic events in patients with a high risk of recurrence.

    •  

  • Candidates who have undergone revascularization procedures such as angioplasty or bypass surgery may also qualify based on medical necessity.

    •  

  • Patients at high risk for thrombotic events in certain off-label indications may be considered based on a thorough review of the individual clinical scenario.

    •  

  • Approval requires documentation from the prescribing physician justifying the medical necessity and appropriateness of the treatment.

 

Why Geisinger Health Plan Might Deny Plavix Coverage

 

Circumstances for Denial of Plavix Coverage by Geisinger Health Plan

 

  • Plavix is prescribed outside of FDA-approved indications unless usage is supported by specific alternative criteria.

    •  

  • The patient is using Plavix along with another antiplatelet or anticoagulant medication without a clear medical justification.

    •  

  • Therapeutic duplication is identified, meaning that there's a similar medication providing the same therapeutic effect already covered and prescribed to the patient.

    •  

  • The prescription for Plavix is not accompanied by documentation verifying the necessity based on clinical guidelines or medical evidence.

    •  

  • Noncompliance with the step therapy protocols, such as not completing prior trials with preferred medications in the same therapeutic category.

    •  

  • The patient has not adhered to prior authorization requirements, which may involve demonstrating inefficacy or adverse effects to preferred alternatives before approving Plavix.

    •  

  • Lack of eligibility or coverage under the specific health plan option selected, such as formularies that exclude brand-name medications when a generic is available.

    •  

 

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How Much Does Plavix Cost without Insurance?

 

Approximate Cost of Plavix Without Insurance

 

  • The cost of Plavix, or its generic version clopidogrel, can vary widely depending on the pharmacy and geographical location.

    •  

  • Brand-name Plavix typically costs between $150 to $300 for a 30-day supply at retail prices.

    •  

  • The generic clopidogrel is significantly cheaper, often ranging from $5 to $50 for a 30-day supply when purchased without insurance.

    •  

  • Pricing may fluctuate based on factors such as dosage strength, promotions, or pharmacy discount programs.

    •  

  • Online or mail-order pharmacies might offer additional savings, in comparison to local pharmacies.
Clinical Support

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 Plavix Coverage with Geisinger Health Plan

 

Check Plan Details

 

  • Review your existing Geisinger Health Plan documentation to see if Plavix is already covered under your current plan.
    •  
  • If you do not have the hard copy, log into your Geisinger Health Plan online account to access the details of your specific plan.

 

Contact Customer Service

 

  • Call Geisinger Health Plan's customer service to verify Plavix coverage. It's beneficial to have your member ID and relevant information ready for a quicker process.
    •  
  • Ask about any specific conditions or requirements that need to be fulfilled to get Plavix covered, such as prior authorization.

 

Obtain Prescription

 

  • Visit your healthcare provider to get a prescription for Plavix if you don't have one already. Ensure they are aware of your intention to get it covered by Geisinger Health Plan.
    •  
  • Ask your healthcare provider if they can assist with providing any necessary medical documentation that supports the need for Plavix.

 

Submit Prior Authorization

 

  • If prior authorization is required, request the necessary forms from Geisinger Health Plan or download them from their website.
    •  
  • Work with your healthcare provider to complete these forms accurately. This often requires a justification for why Plavix is necessary, including medical history and other treatments tried.

 

Review Formularies

 

  • Check Geisinger Health Plan's formulary to ensure Plavix is a covered drug. The formulary will list preferred drugs and possibly offer generic alternatives.
    •  
  • Note any tier placement of Plavix, as this might affect your out-of-pocket costs.

 

Appeal if Necessary

 

  • If your initial request for coverage is denied, review the denial letter carefully to understand the reasons.
    •  
  • Prepare an appeal by gathering supporting documents, including medical records and letters from your healthcare provider, to explain the necessity of Plavix for your condition.

 

Re-evaluate Annually

 

  • Your health plan benefits may change yearly. Re-evaluate your plan or any plan modifications during the open enrollment period to ensure continued coverage for Plavix.
    •  
  • Consider discussing changes directly with a Geisinger Health Plan representative if you anticipate any issues with drug coverage going forward.

 

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.

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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.

Plavix FAQ

1. What is Plavix used for?

 

Uses of Plavix

 

  • Plavix, known generically as clopidogrel, is primarily used as an antiplatelet medication.

    •  

  • It helps prevent blood clots, reducing the risk of stroke and heart attack in individuals with cardiovascular conditions.

    •  

  • Often prescribed post-heart attack or stroke, it is also beneficial for patients with peripheral artery disease.

    •  

    Mechanism of Action

     

    • Plavix inhibits platelet aggregation by irreversibly binding to the P2Y12 receptor on platelets.

      •  

    • This action prevents the platelets from clumping together, reducing clot formation in blood vessels.

     

    Considerations

     

    • Plavix is typically taken orally, once a day, with or without food.

      •  

    • Regular monitoring and consultation with a healthcare provider are recommended to ensure its effectiveness and manage potential side effects.

     

2. What are the side effects of Plavix?

 

Common Side Effects of Plavix

 

  • Bleeding symptoms, such as nosebleeds or bleeding gums, are among the most frequent side effects.
  • Some individuals may experience bruising more easily than usual.

 

Less Common Side Effects

 

  • Severe allergic reactions can occur, including skin rash or itching.
  • It's possible to develop gastrointestinal issues like indigestion or abdominal pain.

 

Rare but Serious Side Effects

 

  • In rare instances, patients might experience thrombotic thrombocytopenic purpura—a serious condition affecting blood clotting.
  • Liver function abnormalities, represented by symptoms like jaundice, can also occur.

 

Precautionary Measures

 

  • Always consult a healthcare provider for symptoms that appear unexpectedly.
  • Report any unusual bleeding or symptoms to a doctor promptly.

 

3. Can I take Plavix with aspirin?

 

Combining Plavix and Aspirin

 

  • **Plavix (clopidogrel)** and **aspirin** are both antiplatelet medications. They reduce the risk of clots, lowering the chance of heart attacks or strokes.

    •  

  • This combination can enhance antiplatelet effects but raises bleeding risk.

 

Consult with Your Doctor

 

  • Your healthcare provider will evaluate your risk factors and decide if this combination benefits you.

    •  

  • Contact your doctor if unexplained bruising, prolonged bleeding, or unusual weakness occurs.

 

Special Circumstances

 

  • In certain conditions like acute coronary syndrome or after stent placement, combined use is common but should always be under medical supervision.

 

Have questions left?

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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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.

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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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