Does MDwise Cover Xarelto

Discover if MDwise covers Xarelto, reasons for denial, steps for obtaining coverage, costs without insurance, and answers to common questions.
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Does MDwise Cover Xarelto?

 

  • MDwise may cover Xarelto depending on the specific health plan, medical necessity, and adherence to their formulary guidelines.
  •  

  • Coverage for Xarelto typically includes situations like preventing blood clots in patients with atrial fibrillation, treatment of deep vein thrombosis, pulmonary embolism, and risk reduction of these conditions.
  •  

  • To get Xarelto covered, prior authorization might be required, meaning the prescribing doctor must justify the medical need based on the patient's condition which aligns with MDwise's criteria.
  •  

  • Patients might need to try alternative medications listed in the formulary first unless they have a documented adverse reaction or lack of efficacy with those alternatives.
  •  

  • Always ensure documentation is up-to-date and align prescriptions with MDwise preferred drug lists and clinical guidelines for smooth processing.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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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 MDwise

 

Research MDwise Coverage

 

  • Visit the MDwise official website to review their health plan options. Make sure Xarelto is covered under the specific plan you are interested in.
  •  

  • Consult the Summary of Benefits and Coverage (SBC) document for each plan. It gives detailed insights on what medications are covered.
  •  

  • Contact MDwise Member Services for confirmation of Xarelto coverage details if needed. They can provide up-to-date and specific coverage information.

 

Choose a Suitable Plan

 

  • Decide on a plan that best covers Xarelto as per your healthcare needs and budget considerations.
  •  

  • If needed, consult with a healthcare advisor to ensure you choose the most suitable plan for your specific health circumstances and medication needs.

 

Enroll in the MDwise Plan

 

  • Fill out the enrollment application available on the MDwise website. You may need personal information such as social security number, income details, and residency proof.
  •  

  • Submit the application before any deadlines for new enrollees to ensure coverage in a timely manner.

 

Consult Your Healthcare Provider

 

  • Inform your doctor that you have transitioned to an MDwise plan. Ensure they are part of MDwise's network, as it can affect prescription coverage.
  •  

  • Ask your healthcare provider to send any necessary documentation to MDwise to facilitate Xarelto coverage.

 

Utilize MDwise Pharmacy Benefits

 

  • Once your plan starts, obtain Xarelto from a pharmacy that participates in the MDwise network to get the coverage benefits.
  •  

  • Make sure your prescription is filled using the MDwise network pharmacies for reduced costs and ensure coverage applies properly.

 

Verify Coverage and Costs

 

  • Check your coverage documents or the MDwise member portal to verify the cost of Xarelto under your plan.
  •  

  • Review your Explanation of Benefits (EOB) statements to ensure Xarelto claims are processed correctly.

 

Stay Informed

 

  • Regularly check the MDwise website for updates related to your plan, especially concerning medication coverage changes.
  •  

  • Keep in touch with MDwise customer support for assistance with any discrepancies or questions about your benefits.

 

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FAQs

Does MDwise Cover Xarelto

Discover if MDwise covers Xarelto, reasons for denial, steps for obtaining coverage, costs without insurance, and answers to common questions.
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Is Xarelto Covered by MDwise

 

Does MDwise Cover Xarelto?

 

  • MDwise may cover Xarelto depending on the specific health plan, medical necessity, and adherence to their formulary guidelines.
  •  

  • Coverage for Xarelto typically includes situations like preventing blood clots in patients with atrial fibrillation, treatment of deep vein thrombosis, pulmonary embolism, and risk reduction of these conditions.
  •  

  • To get Xarelto covered, prior authorization might be required, meaning the prescribing doctor must justify the medical need based on the patient's condition which aligns with MDwise's criteria.
  •  

  • Patients might need to try alternative medications listed in the formulary first unless they have a documented adverse reaction or lack of efficacy with those alternatives.
  •  

  • Always ensure documentation is up-to-date and align prescriptions with MDwise preferred drug lists and clinical guidelines for smooth processing.

 

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MDwise's Approved Criteria for Xarelto Coverage

 

Xarelto Coverage Criteria by MDwise

 

  • Xarelto is covered for patients diagnosed with atrial fibrillation, specifically for reducing the risk of stroke and systemic embolism in individuals who have non-valvular atrial fibrillation.
  •  

  • MDwise approves Xarelto for patients who require anticoagulation for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE), as well as for reducing the risk of recurrence of these conditions.
  •  

  • Coverage is extended to patients who require a prophylactic measure against DVT which may lead to PE in patients undergoing knee or hip replacement surgery.
  •  

  • The medication is approved for use in patients diagnosed with coronary artery disease (CAD) or peripheral artery disease (PAD) to reduce the risk of major cardiovascular events.
  •  

  • For patients with established chronic conditions requiring long-term anticoagulation due to mechanical heart valves or ongoing thromboembolic disease, MDwise provides coverage for Xarelto.
  •  

  • MDwise covers Xarelto when prescribed for patients who have experienced an acute coronary syndrome, with approval contingent on the drug being part of a comprehensive treatment plan to prevent further cardiovascular events.

 

Why MDwise Might Deny Xarelto Coverage

 

Reasons for Xarelto Coverage Denial by MDwise

 

  • The prescription does not meet the prior authorization requirements as outlined by MDwise.
  •  

  • Xarelto is not considered medically necessary based on the patient's diagnosis or treatment plan.
  •  

  • There is availability of a less expensive alternative medication that MDwise covers.
  •  

  • Incomplete or missing documentation required for verifying the medical necessity of Xarelto.
  •  

  • The patient's health plan does not include coverage for brand-name drugs when generic equivalents are available.
  •  

  • Xarelto is being prescribed for an off-label use that is not approved by MDwise.
  •  

  • Failure to follow step therapy protocols, which may include trying other medications before Xarelto is approved.
  •  

  • Patient's enrollment status with MDwise is inactive or coverage has lapsed.

 

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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 MDwise

 

Research MDwise Coverage

 

  • Visit the MDwise official website to review their health plan options. Make sure Xarelto is covered under the specific plan you are interested in.
  •  

  • Consult the Summary of Benefits and Coverage (SBC) document for each plan. It gives detailed insights on what medications are covered.
  •  

  • Contact MDwise Member Services for confirmation of Xarelto coverage details if needed. They can provide up-to-date and specific coverage information.

 

Choose a Suitable Plan

 

  • Decide on a plan that best covers Xarelto as per your healthcare needs and budget considerations.
  •  

  • If needed, consult with a healthcare advisor to ensure you choose the most suitable plan for your specific health circumstances and medication needs.

 

Enroll in the MDwise Plan

 

  • Fill out the enrollment application available on the MDwise website. You may need personal information such as social security number, income details, and residency proof.
  •  

  • Submit the application before any deadlines for new enrollees to ensure coverage in a timely manner.

 

Consult Your Healthcare Provider

 

  • Inform your doctor that you have transitioned to an MDwise plan. Ensure they are part of MDwise's network, as it can affect prescription coverage.
  •  

  • Ask your healthcare provider to send any necessary documentation to MDwise to facilitate Xarelto coverage.

 

Utilize MDwise Pharmacy Benefits

 

  • Once your plan starts, obtain Xarelto from a pharmacy that participates in the MDwise network to get the coverage benefits.
  •  

  • Make sure your prescription is filled using the MDwise network pharmacies for reduced costs and ensure coverage applies properly.

 

Verify Coverage and Costs

 

  • Check your coverage documents or the MDwise member portal to verify the cost of Xarelto under your plan.
  •  

  • Review your Explanation of Benefits (EOB) statements to ensure Xarelto claims are processed correctly.

 

Stay Informed

 

  • Regularly check the MDwise website for updates related to your plan, especially concerning medication coverage changes.
  •  

  • Keep in touch with MDwise customer support for assistance with any discrepancies or questions about your benefits.

 

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Xarelto FAQ

What are the common side effects of Xarelto?

 

Common Side Effects of Xarelto

 

  • Bleeding is the most common, including nasal, gum, or gastrointestinal bleeding. Be vigilant for any signs of unusual bleeding and seek medical attention if necessary.
  •  

  • Gastrointestinal issues such as nausea and stomach pain may occur. Taking Xarelto with food can help alleviate these symptoms.
  •  

  • Dizziness and fatigue can affect some individuals, especially when first starting the medication. Ensure you maintain hydration and rest as needed.
  •  

  • In rare cases, allergic reactions may manifest as rash or itching. If this occurs, consult your healthcare provider promptly.

 

Is Xarelto a blood thinner?

 

Is Xarelto a Blood Thinner?

 

  • **Xarelto (rivaroxaban)** is indeed a blood thinner, specifically an anticoagulant, which is crucial for preventing blood clots that can lead to conditions like stroke or deep vein thrombosis (DVT).
  •  

  • It works by inhibiting **factor Xa**, an essential component in the coagulation cascade, reducing the ability of blood to form clots.
  •  

  • As a **direct oral anticoagulant (DOAC)**, it provides several advantages over traditional blood thinners like warfarin, such as having fewer dietary restrictions and not requiring regular blood monitoring.
  •  

  • It's important to take it as prescribed by a healthcare provider, considering potential drug interactions and contraindications.

 

Can you drink alcohol while taking Xarelto?

 

Drinking Alcohol with Xarelto

 

  • Xarelto, a blood thinner, may increase bleeding risk, and alcohol can amplify this risk.
  •  

  • Both substances affect liver function, potentially impacting medication metabolism and effectiveness.
  •  

  • Consuming alcohol while on Xarelto may enhance side effects like dizziness, increasing injury risk.
  •  

  • It’s crucial to consult your healthcare provider to discuss allowable alcohol intake based on your health status and dosage.
  •  

 

General Recommendations

 

  • Moderation is key – if approved, limit alcohol consumption as per medical advice.
  •  

  • Avoid binge drinking, which drastically heightens risk of adverse reactions.
  •  

  • Inform your medical team about recreational activities involving alcohol.

 

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Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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