Does Geisinger Health Plan Cover Xarelto

Learn why Geisinger Health Plan may deny Xarelto coverage and discover ways to secure it. Explore Xarelto costs without insurance and get answers in our FAQ.
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Geisinger Health Plan Coverage for Xarelto

 

  • Geisinger Health Plan may cover Xarelto if it is deemed medically necessary for certain conditions such as the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, treatment of deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Coverage typically requires a prescription from a healthcare provider, and the use of Xarelto must align with the Geisinger formulary guidelines.
  •  

  • Physicians may need to demonstrate that Xarelto is the most suitable treatment option, especially if other anticoagulants are not viable.
  •  

  • Prior authorization might be necessary, where additional documentation is submitted to justify the prescription.
  •  

  • Patients should verify their specific plan benefits, as coverage details can vary by plan and individual circumstances.
  •  

  • Co-pays or co-insurance charges might apply, subject to the specifics of the health plan.

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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 Geisinger Health Plan

 

Research Geisinger Health Plan Options

 

  • Visit the official Geisinger Health Plan website to understand the different plans available and check if they offer prescription drug coverage that includes Xarelto.
  •  

  • Review the formulary list provided by Geisinger Health Plan to confirm if Xarelto is covered and understand any specific requirements or restrictions.

 

Contact Customer Service

 

  • Call the customer service number on the Geisinger Health Plan website for direct inquiries about coverage for Xarelto. This will help clarify any questions regarding your specific plan or prescriptions.
  •  

  • Ask for details about any pre-authorization requirements that might be necessary to get Xarelto coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor or healthcare provider about your prescription needs for Xarelto and ensure they are familiar with any documentation that Geisinger might require.
  •  

  • Your healthcare provider can also provide insights on alternative medications if Xarelto is not covered.

 

Enroll or Update Your Insurance Plan

 

  • If you are not already a member, consider enrolling in a Geisinger Health Plan that covers Xarelto, especially during open enrollment periods.
  •  

  • For existing members, update your plan during the next enrollment period if needed, ensuring it provides coverage for Xarelto.

 

Submit Necessary Documentation

 

  • Gather any required documentation, such as a prescription from your doctor, and submit it to Geisinger Health Plan as per their specified process.
  •  

  • Complete any forms required for pre-authorization or special approvals needed for Xarelto coverage.

 

Verify Coverage Details

 

  • Once you have updated or confirmed your plan, check the specific details about co-pays, dosage limits, and pharmacy network to fully understand your coverage.
  •  

  • Ensure that you receive a confirmation of coverage for Xarelto, and keep it for your records.

 

Refill Your Prescription at a Network Pharmacy

 

  • Visit a pharmacy within the Geisinger Health Plan network to fill your Xarelto prescription.
  •  

  • Use your insurance card to receive the coverage benefits and ensure your pharmacy applies the necessary discounts or copays.

 

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FAQs

Does Geisinger Health Plan Cover Xarelto

Learn why Geisinger Health Plan may deny Xarelto coverage and discover ways to secure it. Explore Xarelto costs without insurance and get answers in our FAQ.
Curex allergy drops unboxing

Is Xarelto Covered by Geisinger Health Plan

 

Geisinger Health Plan Coverage for Xarelto

 

  • Geisinger Health Plan may cover Xarelto if it is deemed medically necessary for certain conditions such as the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, treatment of deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Coverage typically requires a prescription from a healthcare provider, and the use of Xarelto must align with the Geisinger formulary guidelines.
  •  

  • Physicians may need to demonstrate that Xarelto is the most suitable treatment option, especially if other anticoagulants are not viable.
  •  

  • Prior authorization might be necessary, where additional documentation is submitted to justify the prescription.
  •  

  • Patients should verify their specific plan benefits, as coverage details can vary by plan and individual circumstances.
  •  

  • Co-pays or co-insurance charges might apply, subject to the specifics of the health plan.

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Geisinger Health Plan's Approved Criteria for Xarelto Coverage

 

Coverage Criteria for Xarelto Under Geisinger Health Plan

 

  • Xarelto is covered for patients who have been diagnosed with non-valvular atrial fibrillation and require anticoagulation to reduce the risk of stroke and systemic embolism.
  •  

  • Candidates with deep vein thrombosis (DVT) or pulmonary embolism (PE) either for treatment or to reduce the risk of recurrence are eligible for Xarelto coverage.
  •  

  • Patients undergoing hip or knee replacement surgery can receive Xarelto to help prevent post-surgical venous thromboembolism (VTE).
  •  

  • Coverage is granted for patients who have had coronary artery disease (CAD) or peripheral artery disease (PAD) and are in need of Xarelto to reduce the risk of major cardiovascular events, which include MI, stroke, and cardiovascular death.
  •  

  • Individuals with acute coronary syndrome (ACS) are eligible when Xarelto is used as an adjunct to aspirin therapy to reduce the risk of thrombotic cardiovascular events.

 

Why Geisinger Health Plan Might Deny Xarelto Coverage

 

Situations Where Geisinger Health Plan Might Deny Xarelto Coverage

 

  • **Non-FDA Approved Uses:** The health plan may deny coverage if Xarelto is prescribed for conditions not approved by the FDA. Off-label uses often require additional documentation or consideration.
  •  

  • **Absence of Medical Necessity:** If the prescribed use of Xarelto is not deemed medically necessary according to the plan's criteria, coverage may be denied. This determination often involves reviewing the patient's medical history and other treatment options.
  •  

  • **Lack of Prior Authorization:** For certain uses, prior authorization might be required. If this step is not completed before filling the prescription, coverage could be denied.
  •  

  • **Policy Exclusions:** Sometimes, specific medications are excluded from coverage based on the health plan's formulary. If Xarelto falls into this category, coverage would be denied.
  •  

  • **Generic Alternatives:** If a more cost-effective generic alternative is available and is deemed equivalent for the patient’s condition, coverage for Xarelto may be denied unless there's documented failure or contraindication.
  •  

  • **Duplicate Therapy:** Coverage may be denied if Xarelto is prescribed along with another anticoagulant unless there is documented medical rationale for combined use.
  •  

  • **Non-Compliance with Step Therapy:** If step therapy protocols are in place and the patient did not try and fail on the preferred medications, Xarelto coverage may be denied.
  •  

 

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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 Geisinger Health Plan

 

Research Geisinger Health Plan Options

 

  • Visit the official Geisinger Health Plan website to understand the different plans available and check if they offer prescription drug coverage that includes Xarelto.
  •  

  • Review the formulary list provided by Geisinger Health Plan to confirm if Xarelto is covered and understand any specific requirements or restrictions.

 

Contact Customer Service

 

  • Call the customer service number on the Geisinger Health Plan website for direct inquiries about coverage for Xarelto. This will help clarify any questions regarding your specific plan or prescriptions.
  •  

  • Ask for details about any pre-authorization requirements that might be necessary to get Xarelto coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor or healthcare provider about your prescription needs for Xarelto and ensure they are familiar with any documentation that Geisinger might require.
  •  

  • Your healthcare provider can also provide insights on alternative medications if Xarelto is not covered.

 

Enroll or Update Your Insurance Plan

 

  • If you are not already a member, consider enrolling in a Geisinger Health Plan that covers Xarelto, especially during open enrollment periods.
  •  

  • For existing members, update your plan during the next enrollment period if needed, ensuring it provides coverage for Xarelto.

 

Submit Necessary Documentation

 

  • Gather any required documentation, such as a prescription from your doctor, and submit it to Geisinger Health Plan as per their specified process.
  •  

  • Complete any forms required for pre-authorization or special approvals needed for Xarelto coverage.

 

Verify Coverage Details

 

  • Once you have updated or confirmed your plan, check the specific details about co-pays, dosage limits, and pharmacy network to fully understand your coverage.
  •  

  • Ensure that you receive a confirmation of coverage for Xarelto, and keep it for your records.

 

Refill Your Prescription at a Network Pharmacy

 

  • Visit a pharmacy within the Geisinger Health Plan network to fill your Xarelto prescription.
  •  

  • Use your insurance card to receive the coverage benefits and ensure your pharmacy applies the necessary discounts or copays.

 

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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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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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