Does Health Net Cover Xarelto

Learn if Health Net covers Xarelto, understand potential denial reasons, explore coverage options, costs without insurance, and get answers to common questions.
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Coverage of Xarelto by Health Net

 

  • Health Net may cover Xarelto, a prescription blood thinner, as part of its formulary. Coverage varies based on specific health plans and policy types.
  •  

  • Common coverage scenarios include preventing strokes in patients with nonvalvular atrial fibrillation, treating deep vein thrombosis (DVT), and pulmonary embolism (PE), as well as reduction of recurrence in these conditions.
  •  

  • To obtain coverage, you typically need a prescription from a healthcare provider. Prior authorization by Health Net is often required to assess necessity and ensure it's the appropriate medication over alternatives.
  •  

  • Coverage may involve copayments or coinsurance, which varies based on your plan's tier levels and benefits structure. Verify with Health Net or your pharmacy benefits for plan-specific details.
  •  

  • Patients may need to demonstrate medical necessity if Health Net's standard formulary protocols do not automatically include Xarelto for their condition.

 

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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.

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 Health Net

 

Gather Necessary Information

 

  • Collect your personal Health Net member ID and policy details, which will be essential when contacting Health Net.
  •  

  • Obtain a prescription for Xarelto from your healthcare provider, noting any specific dosage and duration of treatment.

 

Check Health Net's Formulary

 

  • Visit the Health Net website to access their drug formulary. This list will help you determine whether Xarelto is covered under your current plan.
  •  

  • If available online, download or view the current formulary document and search for "Xarelto" to verify its coverage status.

 

Contact Health Net Customer Service

 

  • Call the customer service number found on the back of your Health Net insurance card to inquire about Xarelto coverage details.
  •  

  • Ask for specific information such as tier level, copay amounts, and any restrictions or prior authorizations needed.

 

Understand Prior Authorization Requirements

 

  • If Xarelto requires prior authorization, request the necessary forms from Health Net or download them from their website if available.
  •  

  • Coordinate with your healthcare provider to complete the prior authorization process, ensuring all forms and documentation are accurately filled out.

 

Submit a Claim for Xarelto

 

  • After obtaining prior authorization (if needed), submit a claim through your healthcare provider or pharmacy using your Health Net member information.
  •  

  • Ensure that all necessary documentation, such as prescriptions and prior authorization approval, is attached to avoid claim denial.

 

Review and Appeal if Needed

 

  • Once your claim for Xarelto is processed, review the explanation of benefits (EOB) provided by Health Net to confirm coverage details and out-of-pocket costs.
  •  

  • If coverage is denied or not adequate, inquire about the appeals process through Health Net’s customer service, and provide additional documentation if required.

 

Consider Medication Alternative Assistance Programs

 

  • If coverage remains an issue, investigate manufacturer assistance programs for Xarelto, which may provide discounts or copay assistance.
  •  

  • Consult with your healthcare provider about alternative medications covered by Health Net that may offer similar therapeutic benefits.

 

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FAQs

Does Health Net Cover Xarelto

Learn if Health Net covers Xarelto, understand potential denial reasons, explore coverage options, costs without insurance, and get answers to common questions.
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Is Xarelto Covered by Health Net

 

Coverage of Xarelto by Health Net

 

  • Health Net may cover Xarelto, a prescription blood thinner, as part of its formulary. Coverage varies based on specific health plans and policy types.
  •  

  • Common coverage scenarios include preventing strokes in patients with nonvalvular atrial fibrillation, treating deep vein thrombosis (DVT), and pulmonary embolism (PE), as well as reduction of recurrence in these conditions.
  •  

  • To obtain coverage, you typically need a prescription from a healthcare provider. Prior authorization by Health Net is often required to assess necessity and ensure it's the appropriate medication over alternatives.
  •  

  • Coverage may involve copayments or coinsurance, which varies based on your plan's tier levels and benefits structure. Verify with Health Net or your pharmacy benefits for plan-specific details.
  •  

  • Patients may need to demonstrate medical necessity if Health Net's standard formulary protocols do not automatically include Xarelto for their condition.

 

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Health Net's Approved Criteria for Xarelto Coverage

 

Eligibility Criteria for Xarelto Coverage

 

  • Xarelto must be prescribed by a licensed healthcare provider who specializes in the treatment of the condition being managed with this medication.
  •  

  • The individual must have one of the following diagnosed conditions for Xarelto to be covered: non-valvular atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), or for the reduction in the risk of recurrence of DVT or PE.
  •  

  • There must be documented medical necessity indicating that Xarelto is the most appropriate medication for the individual’s condition, supported by clinical evidence.
  •  

  • If Xarelto is being prescribed for prophylaxis of DVT in patients undergoing knee or hip replacement surgery, the individual must be scheduled for such surgery and have documentation to support this procedure.
  •  

 

Prior Authorization Requirements

 

  • A prior authorization form must be completed and submitted by the prescriber. This form should include detailed medical history, diagnosis, and rationale for Xarelto use.
  •  

  • There must be evidence that other anticoagulants have been considered or tried, and that Xarelto offers a benefit over those treatments, which needs to be documented.
  •  

  • The healthcare provider may need to provide lab results, imaging studies, or other diagnostic results that support the diagnosis and necessity for Xarelto therapy.
  •  

 

Continuous Evaluation and Monitoring

 

  • The healthcare provider must regularly monitor the patient’s status and response to Xarelto, with follow-up appointments documented to ensure ongoing medical necessity.
  •  

  • Patients must adhere to regular check-ups, and any adverse reactions or changes in condition must be reported and addressed in their medical record.
  •  

  • Ongoing coverage for Xarelto may require periodic reviews via updated documentation to assess the efficacy and safety of continued use.
  •  

 

Age and Dosage Specifications

 

  • Xarelto is covered for individuals within the adult age range prescribed according to the manufacturer's guidelines, typically for those aged 18 and older.
  •  

  • The prescribed dosage must align with FDA-approved dosing schedules for the specific condition being treated, with exceptions considered upon clinical justification.
  •  

 

Why Health Net Might Deny Xarelto Coverage

 

Reasons Health Net Might Deny Xarelto Coverage

 

  • If the member's condition does not meet the specific clinical criteria required for Xarelto, such as failing to demonstrate medical necessity according to Health Net's guidelines.
  •  

  • When there is the presence of an alternative, more cost-effective medication that Health Net considers as a first-line treatment option before approving Xarelto.
  •  

  • If the prescription falls outside the FDA-approved usage parameters, Health Net may deny coverage for off-label use unless prior authorization or special approval is obtained.
  •  

  • In cases where the member's plan excludes coverage for certain drugs under their specific formulary or benefit design, Xarelto may not be covered.
  •  

  • If there is insufficient documentation provided by the prescribing physician to support the need for Xarelto, including necessary medical records or test results.
  •  

  • When the member's previous non-compliance with prescription medications is documented, this may influence the decision to approve long-term medications like Xarelto.
  •  

  • If the member does not adhere to Health Net's step therapy protocols, which might require trying other medications before Xarelto is covered.
  •  

 

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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 Health Net

 

Gather Necessary Information

 

  • Collect your personal Health Net member ID and policy details, which will be essential when contacting Health Net.
  •  

  • Obtain a prescription for Xarelto from your healthcare provider, noting any specific dosage and duration of treatment.

 

Check Health Net's Formulary

 

  • Visit the Health Net website to access their drug formulary. This list will help you determine whether Xarelto is covered under your current plan.
  •  

  • If available online, download or view the current formulary document and search for "Xarelto" to verify its coverage status.

 

Contact Health Net Customer Service

 

  • Call the customer service number found on the back of your Health Net insurance card to inquire about Xarelto coverage details.
  •  

  • Ask for specific information such as tier level, copay amounts, and any restrictions or prior authorizations needed.

 

Understand Prior Authorization Requirements

 

  • If Xarelto requires prior authorization, request the necessary forms from Health Net or download them from their website if available.
  •  

  • Coordinate with your healthcare provider to complete the prior authorization process, ensuring all forms and documentation are accurately filled out.

 

Submit a Claim for Xarelto

 

  • After obtaining prior authorization (if needed), submit a claim through your healthcare provider or pharmacy using your Health Net member information.
  •  

  • Ensure that all necessary documentation, such as prescriptions and prior authorization approval, is attached to avoid claim denial.

 

Review and Appeal if Needed

 

  • Once your claim for Xarelto is processed, review the explanation of benefits (EOB) provided by Health Net to confirm coverage details and out-of-pocket costs.
  •  

  • If coverage is denied or not adequate, inquire about the appeals process through Health Net’s customer service, and provide additional documentation if required.

 

Consider Medication Alternative Assistance Programs

 

  • If coverage remains an issue, investigate manufacturer assistance programs for Xarelto, which may provide discounts or copay assistance.
  •  

  • Consult with your healthcare provider about alternative medications covered by Health Net that may offer similar therapeutic benefits.

 

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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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Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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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