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Does Independence Blue Cross Cover Xarelto

Explore Independence Blue Cross coverage for Xarelto, reasons for denial, steps to get coverage, costs without insurance, and FAQs in this comprehensive guide.
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Coverage for Xarelto by Independence Blue Cross

 

  • Independence Blue Cross typically covers Xarelto, a blood thinner used for preventing strokes and managing blood clot risk in conditions like atrial fibrillation and deep vein thrombosis.

    •  

  • Coverage often depends on your specific plan benefits, including any prescription drug tiers, formularies, and approval processes that might require prior authorization or step therapy.

    •  

  • Medically necessary prescriptions generally need a healthcare provider's prescription and may be subject to certain criteria, such as the severity of the condition or previous treatments tried.

    •  

  • Out-of-pocket costs and coverage details can vary; reviewing your specific policy documents or consulting with a customer service representative for detailed information on coverage rules is advisable.

 

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Clinical Support

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 Independence Blue Cross

 

Check Your Plan Details

 

  • Review your Independence Blue Cross health plan documents to see if Xarelto is covered under your policy. This information can typically be found in the formulary section of your plan.

    •  

  • If you have access to your health plan’s member portal, use it to search for medication coverage details regarding Xarelto.

 

Consult with Your Doctor

 

  • Discuss your need for Xarelto with your healthcare provider. Ensure they understand your situation and any prior attempts to get coverage.

    •  

  • Request a detailed prescription note from your doctor, specifying why Xarelto is necessary for your treatment. This documentation may be essential if a prior authorization is required.

 

Contact Independence Blue Cross

 

  • Call the customer service number on your insurance card to speak with a representative from Independence Blue Cross regarding coverage of Xarelto.

    •  

  • Inquire whether Xarelto requires pre-authorization or if there are any special requirements or forms that need to be completed by your healthcare provider.

 

Submit a Prior Authorization Request

 

  • If advised, work with your doctor to fill out and submit any necessary prior authorization forms provided by Independence Blue Cross.

    •  

  • Be prepared to provide detailed medical records or additional documentation that supports the necessity of Xarelto for your treatment.

 

Follow Up on the Request

 

  • Regularly check the status of your prior authorization request through the member portal or by contacting customer service. This will ensure that the request is being processed and to address any additional information needed promptly.

    •  

  • If the initial request is denied, request an explanation of the decision and ask about the appeals process, which can often lead to a reversal if new information or documentation is provided.

 

Explore Alternative Financial Assistance

 

  • If necessary, inquire about financial assistance programs that Independence Blue Cross or the manufacturer of Xarelto might offer. These programs can sometimes provide discounts or help cover the cost of medication.

    •  

  • Consider discussing with your healthcare provider other potential medication options covered by your plan that might be suitable for your treatment needs.

 

Re-Evaluate Your Coverage Periodically

 

  • Regularly review your insurance coverage, especially during renewal periods, to ensure continued coverage of Xarelto under your plan.

    •  

  • Stay informed on any changes in your policy or formulary that might affect medication coverage.

 

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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Independence Blue Cross Cover Xarelto

Explore Independence Blue Cross coverage for Xarelto, reasons for denial, steps to get coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Xarelto Covered by Independence Blue Cross

 

Coverage for Xarelto by Independence Blue Cross

 

  • Independence Blue Cross typically covers Xarelto, a blood thinner used for preventing strokes and managing blood clot risk in conditions like atrial fibrillation and deep vein thrombosis.

    •  

  • Coverage often depends on your specific plan benefits, including any prescription drug tiers, formularies, and approval processes that might require prior authorization or step therapy.

    •  

  • Medically necessary prescriptions generally need a healthcare provider's prescription and may be subject to certain criteria, such as the severity of the condition or previous treatments tried.

    •  

  • Out-of-pocket costs and coverage details can vary; reviewing your specific policy documents or consulting with a customer service representative for detailed information on coverage rules is advisable.

 

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Independence Blue Cross's Approved Criteria for Xarelto Coverage

 

Approved Criteria for Xarelto Coverage by Independence Blue Cross

 

  • **Indication for Use**: Xarelto is covered for members diagnosed with atrial fibrillation, venous thromboembolism, and deep vein thrombosis as indicated by a healthcare provider following established guidelines.

    •  

  • **Prescribing Physician**: The prescription must be written by a qualified healthcare professional, such as a cardiologist, hematologist, or other specialist deemed appropriate who is within the coverage network of Independence Blue Cross.

    •  

  • **Dosage and Administration**: The dosage must align with FDA-approved recommendations and the member should follow the administration instructions as prescribed by the healthcare provider to ensure compliance.

    •  

  • **Previous Treatments**: Documentation evidencing failure or contraindication of alternative therapies, such as warfarin, must be provided to establish the necessity for Xarelto as the best treatment option for the condition.

    •  

  • **Special Populations Coverage**: Xarelto may be covered in special populations including patients at high risk for thromboembolism post orthopedic surgery (e.g., hip or knee replacement) if prescribed accordingly.

    •  

  • **Monitoring and Risk Assessment**: The ongoing review of kidney function may be required if applicable, as well as regular assessment of bleeding risks, which should notably be recorded and reported as a baseline to continue coverage.

    •  

  • **Prior Authorization**: A prior authorization may be required to ensure that Xarelto is suitable and medically necessary. The prescription should be accompanied by relevant clinical documentation to facilitate this process.

 

Why Independence Blue Cross Might Deny Xarelto Coverage

 

Situations When Independence Blue Cross Does Not Cover Xarelto

 

  • **Off-Label Use:** Xarelto prescribed for conditions not approved by the FDA may not be covered.

    •  

  • **Lack of Medical Necessity:** If the use of Xarelto is deemed not to be medically necessary based on the patient's condition and available medical evidence, coverage may be denied.

    •  

  • **Non-Compliance with Step Therapy Protocols:** If there is a requirement to try a less expensive alternative medication before approving Xarelto, and the member has not followed this protocol, coverage can be denied.

    •  

  • **Pre-existing Conditions or Restrictions:** Treatments related to pre-existing conditions that do not meet specific criteria may not be covered.

    •  

  • **Inadequate Documentation:** Failure to provide the required documentation demonstrating the need and appropriateness of Xarelto can result in denial.

    •  

  • **Policy Exclusions:** If Xarelto falls under any of the specific exclusions in the insurance policy, coverage will not be provided.

 

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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.

 

Clinical Support

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 Independence Blue Cross

 

Check Your Plan Details

 

  • Review your Independence Blue Cross health plan documents to see if Xarelto is covered under your policy. This information can typically be found in the formulary section of your plan.

    •  

  • If you have access to your health plan’s member portal, use it to search for medication coverage details regarding Xarelto.

 

Consult with Your Doctor

 

  • Discuss your need for Xarelto with your healthcare provider. Ensure they understand your situation and any prior attempts to get coverage.

    •  

  • Request a detailed prescription note from your doctor, specifying why Xarelto is necessary for your treatment. This documentation may be essential if a prior authorization is required.

 

Contact Independence Blue Cross

 

  • Call the customer service number on your insurance card to speak with a representative from Independence Blue Cross regarding coverage of Xarelto.

    •  

  • Inquire whether Xarelto requires pre-authorization or if there are any special requirements or forms that need to be completed by your healthcare provider.

 

Submit a Prior Authorization Request

 

  • If advised, work with your doctor to fill out and submit any necessary prior authorization forms provided by Independence Blue Cross.

    •  

  • Be prepared to provide detailed medical records or additional documentation that supports the necessity of Xarelto for your treatment.

 

Follow Up on the Request

 

  • Regularly check the status of your prior authorization request through the member portal or by contacting customer service. This will ensure that the request is being processed and to address any additional information needed promptly.

    •  

  • If the initial request is denied, request an explanation of the decision and ask about the appeals process, which can often lead to a reversal if new information or documentation is provided.

 

Explore Alternative Financial Assistance

 

  • If necessary, inquire about financial assistance programs that Independence Blue Cross or the manufacturer of Xarelto might offer. These programs can sometimes provide discounts or help cover the cost of medication.

    •  

  • Consider discussing with your healthcare provider other potential medication options covered by your plan that might be suitable for your treatment needs.

 

Re-Evaluate Your Coverage Periodically

 

  • Regularly review your insurance coverage, especially during renewal periods, to ensure continued coverage of Xarelto under your plan.

    •  

  • Stay informed on any changes in your policy or formulary that might affect medication coverage.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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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.

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.

 

Have questions left?

‍

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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A weight management program tailored to you

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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