Does Highmark Cover Xarelto

Find out if Highmark covers Xarelto, why coverage may be denied, and how to get it approved. Learn about Xarelto's cost without insurance and get answers to FAQs.
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Does Highmark Cover Xarelto?

 

  • Highmark typically covers Xarelto under its prescription drug plans, but specific coverage can vary based on the member's plan and state of residence.
  •  

  • Xarelto is often covered for conditions such as atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Coverage may require prior authorization, meaning that a healthcare provider must verify that the medication is medically necessary for the member.
  •  

  • Members may need to try alternative medications first, as Xarelto could be subject to step therapy protocols.
  •  

  • Copayments, coinsurance, and deductible requirements depend on the specific plan details.
  •  

  • For more personalized information, members should consult their plan documents or contact Highmark customer service directly.

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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 Highmark

 

Verify Your Current Plan for Coverage

 

  • Contact Highmark customer service to check if your current plan provides coverage for Xarelto.
  •  

  • Consult Highmark's online member portal where you can view your plan details and prescription coverage.
  •  

  • Review your plan's formulary, which is typically available on Highmark's website, to see if Xarelto is listed as a covered medication.

 

Speak with Your Healthcare Provider

 

  • Discuss with your healthcare provider why Xarelto is necessary for your treatment.
  •  

  • Ensure your provider understands the insurance requirements to potentially aid in getting coverage approval, including any necessary documentation.
  •  

  • Request that your healthcare provider write a detailed letter of medical necessity if required.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to initiate a prior authorization request. This may be necessary for medications like Xarelto that may not be first-line options according to your insurance.
  •  

  • Acquire the necessary forms from Highmark's website or customer service for prior authorization submission.
  •  

  • Ensure all required information is completed accurately, including provider details, medical justification, and any other required documentation.

 

Explore Generic and Alternative Options

 

  • If Xarelto is not covered, ask your healthcare provider about possible generic alternatives that may be more affordable or covered by Highmark.
  •  

  • Consider discussing lifestyle or treatment plan adjustments that could make alternative medications viable.
  •  

  • Check if the insurance plan offers lower copays for alternative medications on their formulary list.

 

Appeal Denials

 

  • If your prior authorization request is denied, promptly appeal the decision by following Highmark's grievance and appeals process.
  •  

  • Review the denial letter from Highmark carefully and identify the specific reasons for denial.
  •  

  • Obtain any additional information or documentation supporting your case from your healthcare provider and submit it as part of your appeal.

 

Consider a Highmark Prescription Drug Plan Review

 

  • If you face consistent issues with medication coverage, consider speaking with a Highmark representative to review your current plan features and options.
  •  

  • Explore the possibility of switching to a plan that better suits your prescription needs during the annual open enrollment period.
  •  

  • Utilize Highmark's online tools and resources to compare plans and see their formulary lists, ensuring your medications are covered.

 

Utilize Highmark Member Resources

 

  • Access Highmark's website or member services to find concierge-level support for prescription questions or appeals.
  •  

  • Engage with available patient advocacy services facilitated by Highmark to address complex insurance issues.
  •  

  • Look for available rebates, discounts, or patient assistance programs for Xarelto provided by pharmaceutical companies, as Highmark may list these resources.

 

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FAQs

Does Highmark Cover Xarelto

Find out if Highmark covers Xarelto, why coverage may be denied, and how to get it approved. Learn about Xarelto's cost without insurance and get answers to FAQs.
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Is Xarelto Covered by Highmark

 

Does Highmark Cover Xarelto?

 

  • Highmark typically covers Xarelto under its prescription drug plans, but specific coverage can vary based on the member's plan and state of residence.
  •  

  • Xarelto is often covered for conditions such as atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Coverage may require prior authorization, meaning that a healthcare provider must verify that the medication is medically necessary for the member.
  •  

  • Members may need to try alternative medications first, as Xarelto could be subject to step therapy protocols.
  •  

  • Copayments, coinsurance, and deductible requirements depend on the specific plan details.
  •  

  • For more personalized information, members should consult their plan documents or contact Highmark customer service directly.

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Highmark's Approved Criteria for Xarelto Coverage

 

Highmark's Approved Criteria for Xarelto Coverage

 

  • Xarelto is approved for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for reducing the risk of recurrence of DVT and PE in people who have been treated for these conditions for at least 6 months.
  •  

  • Xarelto may be covered for use in reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation.
  •  

  • Coverage is granted for Xarelto to be used as a prophylactic treatment following knee or hip replacement surgery.
  •  

  • In situations where Xarelto is prescribed to reduce the risk of major cardiovascular events in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD), coverage is provided.
  •  

  • Xarelto is approved for use in conjunction with aspirin to reduce the risk of major cardiovascular events such as heart attack or stroke in patients with CAD or PAD.
  •  

  • Coverage is available for pediatric patients with venous thromboembolism requiring anticoagulation treatment, especially when an injectable formulation is needed.
  •  

  • Xarelto may be covered for use in patients with a high risk of venous thromboembolism stemming from genetic factors or family history, subject to medical review.
  •  

 

Why Highmark Might Deny Xarelto Coverage

 

Exclusion Criteria for Xarelto Coverage by Highmark

 

  • Prescription is not for an FDA-approved use that is generally accepted by medical standards.
  •  

  • The claim does not meet the criteria outlined in Highmark's formulary policies or drug utilization review guidelines.
  •  

  • Xarelto is being prescribed for an off-label use that lacks sufficient evidence or support as determined by Highmark's evaluation protocols.
  •  

  • Lack of prior authorization where such approval is mandated by Highmark's prescription drug plan.
  •  

  • Attempt to refill prescription before the allowed duration specified in the plan's guidelines without justification or documented medical necessity.
  •  

  • Use of Xarelto in combination with other anticoagulants unless expressly permitted by Highmark's policy.
  •  

  • Prescriptions obtained from providers or pharmacies not within Highmark's network, especially in cases where network restrictions apply and no out-of-network coverage is available.

 

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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 Highmark

 

Verify Your Current Plan for Coverage

 

  • Contact Highmark customer service to check if your current plan provides coverage for Xarelto.
  •  

  • Consult Highmark's online member portal where you can view your plan details and prescription coverage.
  •  

  • Review your plan's formulary, which is typically available on Highmark's website, to see if Xarelto is listed as a covered medication.

 

Speak with Your Healthcare Provider

 

  • Discuss with your healthcare provider why Xarelto is necessary for your treatment.
  •  

  • Ensure your provider understands the insurance requirements to potentially aid in getting coverage approval, including any necessary documentation.
  •  

  • Request that your healthcare provider write a detailed letter of medical necessity if required.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to initiate a prior authorization request. This may be necessary for medications like Xarelto that may not be first-line options according to your insurance.
  •  

  • Acquire the necessary forms from Highmark's website or customer service for prior authorization submission.
  •  

  • Ensure all required information is completed accurately, including provider details, medical justification, and any other required documentation.

 

Explore Generic and Alternative Options

 

  • If Xarelto is not covered, ask your healthcare provider about possible generic alternatives that may be more affordable or covered by Highmark.
  •  

  • Consider discussing lifestyle or treatment plan adjustments that could make alternative medications viable.
  •  

  • Check if the insurance plan offers lower copays for alternative medications on their formulary list.

 

Appeal Denials

 

  • If your prior authorization request is denied, promptly appeal the decision by following Highmark's grievance and appeals process.
  •  

  • Review the denial letter from Highmark carefully and identify the specific reasons for denial.
  •  

  • Obtain any additional information or documentation supporting your case from your healthcare provider and submit it as part of your appeal.

 

Consider a Highmark Prescription Drug Plan Review

 

  • If you face consistent issues with medication coverage, consider speaking with a Highmark representative to review your current plan features and options.
  •  

  • Explore the possibility of switching to a plan that better suits your prescription needs during the annual open enrollment period.
  •  

  • Utilize Highmark's online tools and resources to compare plans and see their formulary lists, ensuring your medications are covered.

 

Utilize Highmark Member Resources

 

  • Access Highmark's website or member services to find concierge-level support for prescription questions or appeals.
  •  

  • Engage with available patient advocacy services facilitated by Highmark to address complex insurance issues.
  •  

  • Look for available rebates, discounts, or patient assistance programs for Xarelto provided by pharmaceutical companies, as Highmark may list these resources.

 

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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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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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