Does Horizon Blue Cross Blue Shield of New Jersey Cover Xarelto

Explore Xarelto coverage with Horizon BCBS NJ, reasons for denial, steps for approval, and costs without insurance. Get the answers you need in our Xarelto FAQ.
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Xarelto Coverage by Horizon BCBSNJ

 

  • Xarelto is typically covered when prescribed for conditions such as atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism (PE), where it serves as an anticoagulant to prevent blood clots.
  •  

  • Coverage is generally subject to Horizon BCBSNJ’s formulary, prior authorization, and medical necessity criteria. Reviewing the specific plan details is essential to confirm if prior authorization is required.
  •  

  • Patients often need to demonstrate they have tried other, more traditional anticoagulants unless there's a medical reason they cannot use those.
  •  

  • Consulting the Horizon BCBSNJ member portal or contacting customer service will provide tailored and accurate coverage details based on the specific health plan.

 

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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 Horizon Blue Cross Blue Shield of New Jersey

 

Verify Your Plan Coverage

 

  • Check your Horizon Blue Cross Blue Shield of New Jersey (HBCBSNJ) insurance plan documentation or online portal to see if Xarelto is listed on the formulary. This will help you understand if it's covered or if there are any restrictions.
  •  

  • Contact HBCBSNJ customer service for confirmation on Xarelto coverage, including any conditions or tiers that may impact your coverage or costs.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Xarelto for your condition. Your healthcare provider should justify the prescription based on your health needs.
  •  

  • If there are alternative medications available, your doctor might provide reasons why Xarelto is preferred.

 

Obtain a Prescription

 

  • Get a prescription for Xarelto from your healthcare provider once its necessity is established. Ensure the prescription is detailed and includes relevant information about dosage and frequency.

 

Submit a Preauthorization Request

 

  • Work with your healthcare provider to submit a preauthorization request to HBCBSNJ if your plan requires it. This process involves obtaining approval from your insurer before your prescription is filled, confirming that the treatment is medically necessary.
  •  

  • Include any required documentation, such as medical records or supporting letters from your provider.

 

Check for Tiered Pricing

 

  • Determine if Xarelto is on a tiered pricing system within your plan. Higher-tier drugs typically have higher copayments, and you may need to explore alternative medications if cost is an issue.

 

Explore Patient Assistance Programs

 

  • If coverage challenges persist, investigate any patient assistance programs provided by the manufacturer of Xarelto. These programs can assist with co-payments or provide the medication at a reduced cost.
  •  

  • Gather the required financial and medical eligibility documents to apply for these programs.

 

Reassess Annually

 

  • Review your insurance plan details annually during the open enrollment period. Coverage, formularies, and costs may change from year to year.
  •  

  • If Xarelto is not covered or is too costly, discuss alternative medication strategies with your healthcare provider.

 

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FAQs

Does Horizon Blue Cross Blue Shield of New Jersey Cover Xarelto

Explore Xarelto coverage with Horizon BCBS NJ, reasons for denial, steps for approval, and costs without insurance. Get the answers you need in our Xarelto FAQ.
Curex allergy drops unboxing

Is Xarelto Covered by Horizon Blue Cross Blue Shield of New Jersey

 

Xarelto Coverage by Horizon BCBSNJ

 

  • Xarelto is typically covered when prescribed for conditions such as atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism (PE), where it serves as an anticoagulant to prevent blood clots.
  •  

  • Coverage is generally subject to Horizon BCBSNJ’s formulary, prior authorization, and medical necessity criteria. Reviewing the specific plan details is essential to confirm if prior authorization is required.
  •  

  • Patients often need to demonstrate they have tried other, more traditional anticoagulants unless there's a medical reason they cannot use those.
  •  

  • Consulting the Horizon BCBSNJ member portal or contacting customer service will provide tailored and accurate coverage details based on the specific health plan.

 

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Horizon Blue Cross Blue Shield of New Jersey's Approved Criteria for Xarelto Coverage

 

Eligibility Criteria for Xarelto Coverage

 

  • Members must have a confirmed diagnosis of atrial fibrillation (AF), deep vein thrombosis (DVT), pulmonary embolism (PE), or have a high risk of stroke or systemic embolism.
  •  

  • Xarelto is considered for coverage when used as an anticoagulant therapy. Patients must have a documented history of intolerance or contraindication to other anticoagulants such as warfarin.
  •  

  • The healthcare provider must submit information verifying that Xarelto is prescribed according to FDA-approved indications for use.

 

Prior Authorization Requirements

 

  • A prior authorization from Horizon Blue Cross Blue Shield of New Jersey is necessary. The healthcare provider must submit clinical documentation supporting the medical necessity of Xarelto.
  •  

  • Documentation should include the patient’s diagnosis, previous treatments, lab results demonstrating coagulation status, and an evaluation of risk factors for clotting or bleeding complications.

 

Renewal of Coverage

 

  • For renewal of Xarelto coverage, the healthcare provider must submit updated clinical documentation demonstrating ongoing medical necessity and effectiveness of the treatment regimen.
  •  

  • Additional documentation may be requested to confirm that the member is adhering to the prescribed treatment plan and any necessary ancillary care (e.g., regular monitoring of kidney function).

 

Prescription and Dosage Requirements

 

  • Xarelto prescriptions must comply with the FDA-approved dosage and formulations. Any deviations must be justified with supporting clinical documentation.
  •  

  • Members must be under the regular care of a healthcare provider managing their anticoagulant therapy, who ensures correct dosage adjustments based on clinical response and patient factors.

 

Why Horizon Blue Cross Blue Shield of New Jersey Might Deny Xarelto Coverage

 

Possible Reasons for Xarelto Coverage Denial by Horizon Blue Cross Blue Shield of New Jersey

 

  • The patient does not meet the specific clinical criteria outlined in the policy for Xarelto, which could involve a lack of appropriate diagnosis or failure to demonstrate medical necessity.
  •  

  • Prescription of Xarelto is for an off-label use that is not supported by the plan's coverage guidelines or lacks sufficient evidence of effectiveness and safety.
  •  

  • The patient has been prescribed Xarelto for a condition for which there are less expensive, equally effective, alternative medications available and covered under the insurance plan.
  •  

  • There is missing or insufficient documentation provided to justify the use of Xarelto as part of the prescribed treatment plan.
  •  

  • The patient has not tried other standard or recommended therapies prior to using Xarelto, which might be a requirement by the insurance plan before approving coverage for higher-cost medications.
  •  

  • Xarelto is being requested for a form of administration or dosage that is not approved by the FDA or not listed in the formulary guidelines supported by Horizon Blue Cross Blue Shield of New Jersey.

 

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

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 Horizon Blue Cross Blue Shield of New Jersey

 

Verify Your Plan Coverage

 

  • Check your Horizon Blue Cross Blue Shield of New Jersey (HBCBSNJ) insurance plan documentation or online portal to see if Xarelto is listed on the formulary. This will help you understand if it's covered or if there are any restrictions.
  •  

  • Contact HBCBSNJ customer service for confirmation on Xarelto coverage, including any conditions or tiers that may impact your coverage or costs.

 

Consult Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Xarelto for your condition. Your healthcare provider should justify the prescription based on your health needs.
  •  

  • If there are alternative medications available, your doctor might provide reasons why Xarelto is preferred.

 

Obtain a Prescription

 

  • Get a prescription for Xarelto from your healthcare provider once its necessity is established. Ensure the prescription is detailed and includes relevant information about dosage and frequency.

 

Submit a Preauthorization Request

 

  • Work with your healthcare provider to submit a preauthorization request to HBCBSNJ if your plan requires it. This process involves obtaining approval from your insurer before your prescription is filled, confirming that the treatment is medically necessary.
  •  

  • Include any required documentation, such as medical records or supporting letters from your provider.

 

Check for Tiered Pricing

 

  • Determine if Xarelto is on a tiered pricing system within your plan. Higher-tier drugs typically have higher copayments, and you may need to explore alternative medications if cost is an issue.

 

Explore Patient Assistance Programs

 

  • If coverage challenges persist, investigate any patient assistance programs provided by the manufacturer of Xarelto. These programs can assist with co-payments or provide the medication at a reduced cost.
  •  

  • Gather the required financial and medical eligibility documents to apply for these programs.

 

Reassess Annually

 

  • Review your insurance plan details annually during the open enrollment period. Coverage, formularies, and costs may change from year to year.
  •  

  • If Xarelto is not covered or is too costly, discuss alternative medication strategies with your healthcare provider.

 

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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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Initial Dosage

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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