Does Health Net Cover Eliquis

Explore Health Net's Eliquis coverage, reasons for denial, tips for obtaining coverage, costs without insurance, and FAQs in this comprehensive guide.
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Health Net Coverage for Eliquis

 

  • Eliquis is generally covered under Health Net's Medicare and commercial plans. Coverage may vary based on the specific plan and region.
  •  

  • For Medicare plans, Eliquis is usually listed under the formulary as a Tier 2 or Tier 3 drug, meaning a prior authorization might be required.
  •  

  • Commercial plans may require step therapy, where less expensive alternatives are tried before Eliquis is covered.
  •  

  • To obtain coverage, a prescription from a healthcare provider is necessary, and the provider may need to demonstrate medical necessity.
  •  

  • Out-of-pocket costs will depend on the plan’s deductible, co-payments, or co-insurance policies.
  •  

  • Patients should check their specific Health Net plan details or contact customer service to confirm coverage and any pre-authorization requirements.

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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 Health Net

 

Evaluate Your Current Health Net Plan

 

  • Review your current Health Net insurance plan to determine if it includes prescription drug coverage.
  •  

  • Check the formulary list to see if Eliquis is covered under your plan.

 

Consult Your Doctor

 

  • Discuss with your doctor whether Eliquis is necessary for your treatment.
  •  

  • Obtain a prescription for Eliquis from your healthcare provider if deemed necessary.

 

Contact Health Net Customer Service

 

  • Call the Health Net customer service number on your insurance card to inquire about coverage for Eliquis.
  •  

  • Ask about any necessary steps, paperwork, or approval processes for acquiring Eliquis coverage.

 

Review and Understand Prior Authorization Requirements

 

  • Inquire if prior authorization is required for Eliquis, which means Health Net needs to approve the prescription before it is covered.
  •  

  • Work with your healthcare provider to complete any required prior authorization forms.

 

File Any Necessary Documentation

 

  • Submit any required documentation or forms provided by your doctor to Health Net for review.
  •  

  • Ensure all information is complete and accurate to prevent delays in processing.

 

Check for Generic Versions or Alternatives

 

  • If Eliquis is not covered, ask about generic versions or alternative medications that have similar effects and may be covered under your plan.
  •  

  • Discuss these options with your healthcare provider to determine their suitability for your treatment.

 

Explore Additional Assistance Programs

 

  • Investigate patient assistance programs that may offer Eliquis at a reduced cost, or offer help with copays, if Health Net does not fully cover it.
  •  

  • Reach out to the Eliquis manufacturer directly for any available patient assistance initiatives.

 

Stay Informed and Follow Up

 

  • Consistently follow up with Health Net to ensure your application for Eliquis coverage is processed.
  •  

  • Keep abreast of any policy changes or updates to your health plan regarding prescription drug coverage.

 

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FAQs

Does Health Net Cover Eliquis

Explore Health Net's Eliquis coverage, reasons for denial, tips for obtaining coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Eliquis Covered by Health Net

 

Health Net Coverage for Eliquis

 

  • Eliquis is generally covered under Health Net's Medicare and commercial plans. Coverage may vary based on the specific plan and region.
  •  

  • For Medicare plans, Eliquis is usually listed under the formulary as a Tier 2 or Tier 3 drug, meaning a prior authorization might be required.
  •  

  • Commercial plans may require step therapy, where less expensive alternatives are tried before Eliquis is covered.
  •  

  • To obtain coverage, a prescription from a healthcare provider is necessary, and the provider may need to demonstrate medical necessity.
  •  

  • Out-of-pocket costs will depend on the plan’s deductible, co-payments, or co-insurance policies.
  •  

  • Patients should check their specific Health Net plan details or contact customer service to confirm coverage and any pre-authorization requirements.

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Health Net's Approved Criteria for Eliquis Coverage

 

Criteria for Coverage of Eliquis under Health Net

 

  • **Diagnosis of Atrial Fibrillation**: The patient must be diagnosed with non-valvular atrial fibrillation (AF) and require anticoagulation for stroke prevention. Supporting documentation from a healthcare provider is necessary.
  •  

  • **Treatment for Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)**: Coverage is available if the patient is undergoing treatment for an acute DVT or PE, or if Eliquis is recommended for reducing the risk of recurrent DVT or PE after initial therapy.
  •  

  • **Prevention of Stroke and Systemic Embolism**: For patients with a condition that poses a risk of stroke and systemic embolism, such as non-valvular atrial fibrillation, Eliquis may be covered as a preventative measure.
  •  

  • **Use in Hip or Knee Replacement Surgery**: Patients who are undergoing hip or knee replacement surgery and are at increased risk for blood clots may receive coverage for Eliquis as an anticoagulant to prevent DVT and PE.
  •  

  • **Physician Recommendation**: A licensed healthcare professional must recommend Eliquis, providing clinical evidence or justification for its need compared to other anticoagulants.
  •  

  • **Patient Age Requirement**: Coverage is typically considered for adult patients, as the safety and efficacy in pediatric populations have not been established.
  •  

  • **No Contraindications**: The patient should not have any known contraindications to Eliquis, such as active bleeding or severe hypersensitivity reactions, which must be documented by a medical professional.

 

Why Health Net Might Deny Eliquis Coverage

 

Reasons Health Net Might Deny Eliquis Coverage

 

  • Medically Unnecessary: Health Net may deny coverage if Eliquis is deemed not medically necessary for your condition based on their guidelines and clinical criteria.
  •  

  • Off-label Use: If Eliquis is prescribed for a condition or in a manner that is not approved by the FDA or not recognized by Health Net's formulary policies, it may not be covered.
  •  

  • Lack of Prior Authorization: Failure to obtain necessary prior authorization or pre-certification from Health Net can result in denial of coverage for Eliquis.
  •  

  • Non-Formulary Medication: Health Net might deny coverage if Eliquis is not included in their approved drug formulary or if there are preferred alternatives available.
  •  

  • Failure to Meet Step Therapy Requirements: If Health Net requires trying alternative medications before covering Eliquis, and these steps are not completed, coverage can be denied.
  •  

  • Non-compliance with Policy Guidelines: Non-adherence to any specific policy guidelines set by Health Net regarding prescription drugs may lead to denial of coverage.
  •  

  • Exclusion in Benefit Plan: Eliquis coverage might be excluded in specific benefit plans provided by Health Net, so individual plan details are crucial.

 

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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 Health Net

 

Evaluate Your Current Health Net Plan

 

  • Review your current Health Net insurance plan to determine if it includes prescription drug coverage.
  •  

  • Check the formulary list to see if Eliquis is covered under your plan.

 

Consult Your Doctor

 

  • Discuss with your doctor whether Eliquis is necessary for your treatment.
  •  

  • Obtain a prescription for Eliquis from your healthcare provider if deemed necessary.

 

Contact Health Net Customer Service

 

  • Call the Health Net customer service number on your insurance card to inquire about coverage for Eliquis.
  •  

  • Ask about any necessary steps, paperwork, or approval processes for acquiring Eliquis coverage.

 

Review and Understand Prior Authorization Requirements

 

  • Inquire if prior authorization is required for Eliquis, which means Health Net needs to approve the prescription before it is covered.
  •  

  • Work with your healthcare provider to complete any required prior authorization forms.

 

File Any Necessary Documentation

 

  • Submit any required documentation or forms provided by your doctor to Health Net for review.
  •  

  • Ensure all information is complete and accurate to prevent delays in processing.

 

Check for Generic Versions or Alternatives

 

  • If Eliquis is not covered, ask about generic versions or alternative medications that have similar effects and may be covered under your plan.
  •  

  • Discuss these options with your healthcare provider to determine their suitability for your treatment.

 

Explore Additional Assistance Programs

 

  • Investigate patient assistance programs that may offer Eliquis at a reduced cost, or offer help with copays, if Health Net does not fully cover it.
  •  

  • Reach out to the Eliquis manufacturer directly for any available patient assistance initiatives.

 

Stay Informed and Follow Up

 

  • Consistently follow up with Health Net to ensure your application for Eliquis coverage is processed.
  •  

  • Keep abreast of any policy changes or updates to your health plan regarding prescription drug coverage.

 

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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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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.

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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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