Does Harvard Pilgrim Health Care Cover Eliquis

Explore Harvard Pilgrim Health Care policies on Eliquis coverage, costs, reasons for denial, and tips to secure coverage.
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Eliquis Coverage by Harvard Pilgrim Health Care

 

  • Harvard Pilgrim Health Care generally covers Eliquis if it is deemed medically necessary. Coverage often depends on the specific health plan and formulary tier list.
  •  

  • Prior authorization may be required to ensure the prescription is appropriate for the patient's condition, aligning with the plan's medical policy guidelines.
  •  

  • Situations typically covered include conditions like atrial fibrillation and deep vein thrombosis where Eliquis is the preferred anticoagulant.
  •  

  • Patients may need to try and fail other anticoagulants first, depending on cost management measures in place, such as step therapy protocols.
  •  

  • Co-pays or co-insurance amounts can vary based on the plan's formulary tier for Eliquis; checking the specific plan details will provide clarity.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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 Harvard Pilgrim Health Care

 

Verify Your Plan Coverage

 

  • Start by logging into your Harvard Pilgrim Health Care (HPHC) account through their website. If you don't have an online account, you'll need to create one by providing your member ID and other personal details.
  •  

  • Once logged in, review your health plan benefits to see if prescription medications like Eliquis are included. Look for any specific information about prescription drug formularies or tiered coverage.

 

Consult the Drug Formulary

 

  • Navigate to the pharmacy or drug coverage section on the HPHC website to access the drug formulary. This document lists all the medications that are covered under various plans and provides their coverage levels.
  •  

  • Search for Eliquis in the formulary to determine its coverage level. Pay attention to any prerequisites such as prior authorization, step therapy, or quantity limits.

 

Contact Customer Service

 

  • If you're unsure about coverage specifics, reach out to HPHC's customer service. Contact details are typically found on your member ID card. A representative can provide detailed information about Eliquis coverage and any steps you might need to follow.
  •  

  • Ask about potential out-of-pocket costs for Eliquis, such as copayments or coinsurance, and whether there are any restrictions under your plan.

 

Meet Prior Authorization Requirements

 

  • If Eliquis requires prior authorization, coordinate with your healthcare provider to initiate this process. They will need to submit clinical information and justification for Eliquis on your behalf.
  •  

  • Follow up with both your healthcare provider and HPHC to ensure that the authorization is processed efficiently and that there are no delays in receiving coverage.

 

Review Step Therapy Requirements

 

  • If your plan involves step therapy, you may be required to try one or more alternative medications before Eliquis is approved. Discuss these requirements with your doctor to determine the best course of action.
  •  

  • If you've already tried alternative treatments without success, your doctor can provide evidence to support direct approval of Eliquis.

 

Prescription Fulfillment

 

  • Once authorization and any additional requirements are met, fill your Eliquis prescription at a network pharmacy. Use your HPHC member ID at the pharmacy to ensure coverage is applied.
  •  

  • If you're using mail-order pharmacy services, follow HPHC's procedure to submit your prescription online or by mail.

 

Appeal Denied Claims

 

  • If your coverage request is denied, review the denial letter from HPHC for specific reasons and detailed instructions on how to appeal.
  •  

  • Work with your healthcare provider to gather necessary documentation and submit a formal appeal to HPHC. Stay proactive and communicate regularly with the appeals department until a decision is made.

 

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FAQs

Does Harvard Pilgrim Health Care Cover Eliquis

Explore Harvard Pilgrim Health Care policies on Eliquis coverage, costs, reasons for denial, and tips to secure coverage.
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Is Eliquis Covered by Harvard Pilgrim Health Care

 

Eliquis Coverage by Harvard Pilgrim Health Care

 

  • Harvard Pilgrim Health Care generally covers Eliquis if it is deemed medically necessary. Coverage often depends on the specific health plan and formulary tier list.
  •  

  • Prior authorization may be required to ensure the prescription is appropriate for the patient's condition, aligning with the plan's medical policy guidelines.
  •  

  • Situations typically covered include conditions like atrial fibrillation and deep vein thrombosis where Eliquis is the preferred anticoagulant.
  •  

  • Patients may need to try and fail other anticoagulants first, depending on cost management measures in place, such as step therapy protocols.
  •  

  • Co-pays or co-insurance amounts can vary based on the plan's formulary tier for Eliquis; checking the specific plan details will provide clarity.

 

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Harvard Pilgrim Health Care's Approved Criteria for Eliquis Coverage

 

Harvard Pilgrim Approved Criteria for Eliquis Coverage

 

  • **Patients with Non-Valvular Atrial Fibrillation:** Eliquis may be approved for individuals with non-valvular atrial fibrillation to reduce the risk of stroke and systemic embolism.
  •  

  • **Treatment of Deep Vein Thrombosis (DVT):** Treatment may be covered for individuals diagnosed with deep vein thrombosis to prevent further complications.
  •  

  • **Pulmonary Embolism (PE) Treatment:** Coverage is possible for patients with an existing pulmonary embolism for the purpose of managing and treating the condition.
  •  

  • **DVT and PE Prevention:** For patients at risk, Eliquis is approved for use in preventing the recurrence of deep vein thrombosis and pulmonary embolism.
  •  

  • **Postoperative Venous Thromboembolism (VTE) Prevention:** Patients who have undergone knee or hip replacement surgery may receive coverage for preventing blood clots in the postoperative period.

 

Why Harvard Pilgrim Health Care Might Deny Eliquis Coverage

 

Reasons for Denial of Eliquis Coverage by Harvard Pilgrim Health Care

 

  • **Non-Approved Use**: Coverage for Eliquis may be denied if prescribed for an off-label use that is not FDA-approved and lacks sufficient evidence to support its use in that condition.
  •  

  • **Failure to Meet Prior Authorization Requirements**: If the mandatory prior authorization process is not completed or if insufficient documentation is provided, coverage for Eliquis can be denied.
  •  

  • **Lack of Medical Necessity**: When Eliquis is not considered medically necessary according to Harvard Pilgrim Health Care's medical policy criteria, coverage may be denied.
  •  

  • **Non-Compliance with Step Therapy Protocols**: In cases where other preferred anticoagulants are required to be tried before Eliquis, failure to adhere to such step therapy protocols can lead to denial.
  •  

  • **Non-Formulary Drug**: Eliquis may not be covered if it is considered a non-formulary medication under the patient's specific plan unless exceptions are granted based on individual circumstances.
  •  

  • **Exclusion for Specific Health Plans**: Certain health plans under Harvard Pilgrim may have specific exclusions for covering Eliquis due to its cost-effectiveness or other plan-specific criteria.

 

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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 Harvard Pilgrim Health Care

 

Verify Your Plan Coverage

 

  • Start by logging into your Harvard Pilgrim Health Care (HPHC) account through their website. If you don't have an online account, you'll need to create one by providing your member ID and other personal details.
  •  

  • Once logged in, review your health plan benefits to see if prescription medications like Eliquis are included. Look for any specific information about prescription drug formularies or tiered coverage.

 

Consult the Drug Formulary

 

  • Navigate to the pharmacy or drug coverage section on the HPHC website to access the drug formulary. This document lists all the medications that are covered under various plans and provides their coverage levels.
  •  

  • Search for Eliquis in the formulary to determine its coverage level. Pay attention to any prerequisites such as prior authorization, step therapy, or quantity limits.

 

Contact Customer Service

 

  • If you're unsure about coverage specifics, reach out to HPHC's customer service. Contact details are typically found on your member ID card. A representative can provide detailed information about Eliquis coverage and any steps you might need to follow.
  •  

  • Ask about potential out-of-pocket costs for Eliquis, such as copayments or coinsurance, and whether there are any restrictions under your plan.

 

Meet Prior Authorization Requirements

 

  • If Eliquis requires prior authorization, coordinate with your healthcare provider to initiate this process. They will need to submit clinical information and justification for Eliquis on your behalf.
  •  

  • Follow up with both your healthcare provider and HPHC to ensure that the authorization is processed efficiently and that there are no delays in receiving coverage.

 

Review Step Therapy Requirements

 

  • If your plan involves step therapy, you may be required to try one or more alternative medications before Eliquis is approved. Discuss these requirements with your doctor to determine the best course of action.
  •  

  • If you've already tried alternative treatments without success, your doctor can provide evidence to support direct approval of Eliquis.

 

Prescription Fulfillment

 

  • Once authorization and any additional requirements are met, fill your Eliquis prescription at a network pharmacy. Use your HPHC member ID at the pharmacy to ensure coverage is applied.
  •  

  • If you're using mail-order pharmacy services, follow HPHC's procedure to submit your prescription online or by mail.

 

Appeal Denied Claims

 

  • If your coverage request is denied, review the denial letter from HPHC for specific reasons and detailed instructions on how to appeal.
  •  

  • Work with your healthcare provider to gather necessary documentation and submit a formal appeal to HPHC. Stay proactive and communicate regularly with the appeals department until a decision is made.

 

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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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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.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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