Does Highmark Cover Eliquis

Explore the ins and outs of Highmark's coverage for Eliquis, cost considerations, and strategies to secure coverage. Discover answers to common questions.
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Coverage for Eliquis

 

  • Highmark may cover Eliquis for treating conditions like atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Coverage is dependent on plan specifics and whether Eliquis is on the formulary, which varies by policy.
  •  

  • Prior authorization might be required, where a physician submits a request for approval based on medical necessity.

 

Criteria for Coverage

 

  • Patients usually need a prescription from a healthcare provider, affirming it's medically necessary.
  •  

  • Highmark may require documentation proving that alternatives like warfarin aren't suitable or effective for the patient.
  •  

  • Compliance with specific plan guidelines regarding third-tier medications can also affect coverage eligibility.

 

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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 Highmark

 

Verify Your Eligibility

 

  • Ensure you have a valid health insurance plan with Highmark. Eligibility for coverage depends on your specific plan details.
  •  

  • Check your plan’s formulary to verify if Eliquis is listed as a covered medication.
  •  

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about Eliquis being the most suitable option for your condition. Obtain a prescription.
  •  

  • Ask the healthcare provider to prepare any necessary documentation that Highmark might require, such as a prior authorization form.
  •  

 

Contact Highmark Customer Service

 

  • Reach out to Highmark’s customer service to clarify specific steps needed to get Eliquis covered under your plan.
  •  

  • Request detailed information on any documentation or steps required for approval.
  •  

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if Eliquis requires it under your Highmark plan.
  •  

  • Make sure all necessary information and supporting documents are included to avoid delays.
  •  

 

Verify Coverage Status

 

  • After submission, follow up with Highmark to confirm the status of your prior authorization request.
  •  

  • Check if Eliquis is approved for coverage, and note any conditions or limitations applied to the coverage.
  •  

 

Appeal a Denied Claim

 

  • If your request for coverage of Eliquis is denied, ask Highmark for the specific reason and the appeals process.
  •  

  • Submit an appeal with any additional supporting documentation or clarifications needed.
  •  

 

Explore Financial Assistance

 

  • If you encounter challenges with costs even after coverage, inquire about patient assistance programs or additional financial aid through Highmark or the manufacturer’s assistance programs.
  •  

  • Consider discussing options for generic versions or alternative medications with your healthcare provider if suitable.
  •  

 

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FAQs

Does Highmark Cover Eliquis

Explore the ins and outs of Highmark's coverage for Eliquis, cost considerations, and strategies to secure coverage. Discover answers to common questions.
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Is Eliquis Covered by Highmark

 

Coverage for Eliquis

 

  • Highmark may cover Eliquis for treating conditions like atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Coverage is dependent on plan specifics and whether Eliquis is on the formulary, which varies by policy.
  •  

  • Prior authorization might be required, where a physician submits a request for approval based on medical necessity.

 

Criteria for Coverage

 

  • Patients usually need a prescription from a healthcare provider, affirming it's medically necessary.
  •  

  • Highmark may require documentation proving that alternatives like warfarin aren't suitable or effective for the patient.
  •  

  • Compliance with specific plan guidelines regarding third-tier medications can also affect coverage eligibility.

 

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Highmark's Approved Criteria for Eliquis Coverage

 

Highmark's Eliquis Coverage Criteria

 

  • **Non-Valvular Atrial Fibrillation (NVAF):** Highmark covers Eliquis for the prevention of stroke and systemic embolism in patients diagnosed with non-valvular atrial fibrillation (NVAF). Proper documentation of the condition diagnosis is required.
  •  

  • **Venous Thromboembolism (VTE):** Eliquis is covered for treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for the reduction in the risk of recurrence of these conditions. Treatment should be initiated and managed by a qualified healthcare provider.
  •  

  • **Post-Surgical Coverage:** Patients who have undergone knee or hip replacement surgery are eligible for Eliquis coverage to reduce the risk of DVT and PE during the recovery period.
  •  

  • **Renal Impairment:** Coverage includes patients with renal impairment, provided the dosage adjustments are documented and monitored appropriately by the healthcare provider.
  •  

  • **Age-Specific Criteria:** Elderly patients, typically those over 80 years old, who meet medical criteria for NVAF or VTE are covered. Dose adjustments based on clinical evaluations are supported.
  •  

  • **Comorbid Conditions:** Patients with additional cardiovascular or clotting disorders that align with Eliquis's therapeutic use can also be covered. Healthcare providers must offer rationale and supporting diagnosis documentation.

 

Why Highmark Might Deny Eliquis Coverage

 

Situations Where Highmark Might Deny Eliquis Coverage

 

  • Prescription does not align with FDA-approved uses. If Eliquis is prescribed for conditions not approved by the FDA, Highmark may deny coverage.
  •  

  • Lack of prior authorization. If Highmark requires prior authorization for Eliquis and the prescriber fails to obtain it, coverage may be denied.
  •  

  • Inadequate documentation of medical necessity. Highmark might deny coverage if there is insufficient evidence showing that Eliquis is medically necessary for the patient.
  •  

  • Failure to try alternative medications first. If the patient has not tried less expensive or traditionally prescribed medications before Eliquis, coverage may be denied under step therapy protocols.
  •  

  • Out-of-network provider. If the prescription is written or filled by a provider not covered by Highmark's network, it may result in denial of coverage.
  •  

  • Policy exclusions. Coverage for Eliquis may be denied if it falls under a specific exclusion in the patient's insurance policy.
  •  

  • Prescription quantity limits. Highmark might not cover amounts of Eliquis that exceed established quantity limits, unless an exception is made.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 Highmark

 

Verify Your Eligibility

 

  • Ensure you have a valid health insurance plan with Highmark. Eligibility for coverage depends on your specific plan details.
  •  

  • Check your plan’s formulary to verify if Eliquis is listed as a covered medication.
  •  

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor about Eliquis being the most suitable option for your condition. Obtain a prescription.
  •  

  • Ask the healthcare provider to prepare any necessary documentation that Highmark might require, such as a prior authorization form.
  •  

 

Contact Highmark Customer Service

 

  • Reach out to Highmark’s customer service to clarify specific steps needed to get Eliquis covered under your plan.
  •  

  • Request detailed information on any documentation or steps required for approval.
  •  

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if Eliquis requires it under your Highmark plan.
  •  

  • Make sure all necessary information and supporting documents are included to avoid delays.
  •  

 

Verify Coverage Status

 

  • After submission, follow up with Highmark to confirm the status of your prior authorization request.
  •  

  • Check if Eliquis is approved for coverage, and note any conditions or limitations applied to the coverage.
  •  

 

Appeal a Denied Claim

 

  • If your request for coverage of Eliquis is denied, ask Highmark for the specific reason and the appeals process.
  •  

  • Submit an appeal with any additional supporting documentation or clarifications needed.
  •  

 

Explore Financial Assistance

 

  • If you encounter challenges with costs even after coverage, inquire about patient assistance programs or additional financial aid through Highmark or the manufacturer’s assistance programs.
  •  

  • Consider discussing options for generic versions or alternative medications with your healthcare provider if suitable.
  •  

 

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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.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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.

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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