Does Medica Cover Eliquis

Discover why Medica may deny Eliquis, how to secure coverage, its cost without insurance, and answers to common questions in our detailed guide.
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Coverage for Eliquis with Medica

 

  • Medica often covers Eliquis, a medication used for preventing blood clots, primarily if deemed medically necessary.
  •  

  • Coverage generally applies in situations such as atrial fibrillation, treatment of deep vein thrombosis (DVT), and pulmonary embolism, among other related conditions.
  •  

  • Eligibility for coverage typically requires a healthcare provider's prescription, confirming the medication's necessity over alternatives.
  •  

  • Patients may need to undergo prior authorization, which involves submitting documentation from a healthcare provider proving the need for Eliquis based on the patient's specific medical condition.
  •  

  • Cost-sharing components like copayments or deductibles may apply, varying based on the specific Medica plan.
  •  

  • It's advisable for patients to contact Medica directly or review their specific policy to understand detailed terms and conditions related to Eliquis coverage.

 

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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.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Eliquis Coverage with Medica

 

Contact Medica Customer Service

 

  • Before beginning the process, reach out to Medica's customer service to inquire about prescription coverage for Eliquis. The contact number can typically be found on the back of your Medica insurance card.
  •  

  • Confirm whether Eliquis is included in your specific health plan's formulary list. This step will help you understand if it's regularly covered or if there are alternatives.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Eliquis. Ensure your doctor believes it's medically necessary for your condition.
  •  

  • If required, ask your doctor to provide supporting documentation or a letter of medical necessity to help with the approval process.

 

Review Your Prescription Drug Benefits

 

  • Log in to your Medica member account online to check your current prescription drug benefits. Look for detailed information about coverage for medications like Eliquis.
  •  

  • Understand the tiers and requirements you need to meet, such as prior authorization or step therapy.

 

Submit a Prior Authorization Request

 

  • If Eliquis requires prior authorization, request your doctor to submit the necessary forms and documentation to Medica. This process is crucial for approval and coverage of your medication.
  •  

  • Follow up with your doctor's office to ensure that the documentation has been properly sent and received by Medica.

 

Explore Prescription Assistance Programs

 

  • If Medica does not fully cover Eliquis, or if you're facing significant out-of-pocket expenses, look into prescription assistance programs offered by the manufacturer of Eliquis, Bristol-Myers Squibb.
  •  

  • These programs might provide Eliquis at a reduced cost or sometimes even for free, depending on your income and insurance status.

 

Appeal a Denied Request

 

  • If your request for coverage is denied, don't be discouraged. Check the explanation of benefits (EOB) for details regarding the denial.
  •  

  • Prepare an appeal by gathering necessary documentation and any additional supporting evidence from your healthcare provider to make your case effectively.
  •  

  • Submit your appeal to Medica as instructed, and follow up regularly to check its status.

 

Follow Up and Stay Informed

 

  • Maintain regular communication with Medica to ensure that you are updated regarding the status of your request or appeal.
  •  

  • Keep your healthcare provider in the loop so they can assist you throughout the process and provide any additional information if required.

 

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FAQs

Does Medica Cover Eliquis

Discover why Medica may deny Eliquis, how to secure coverage, its cost without insurance, and answers to common questions in our detailed guide.
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Is Eliquis Covered by Medica

 

Coverage for Eliquis with Medica

 

  • Medica often covers Eliquis, a medication used for preventing blood clots, primarily if deemed medically necessary.
  •  

  • Coverage generally applies in situations such as atrial fibrillation, treatment of deep vein thrombosis (DVT), and pulmonary embolism, among other related conditions.
  •  

  • Eligibility for coverage typically requires a healthcare provider's prescription, confirming the medication's necessity over alternatives.
  •  

  • Patients may need to undergo prior authorization, which involves submitting documentation from a healthcare provider proving the need for Eliquis based on the patient's specific medical condition.
  •  

  • Cost-sharing components like copayments or deductibles may apply, varying based on the specific Medica plan.
  •  

  • It's advisable for patients to contact Medica directly or review their specific policy to understand detailed terms and conditions related to Eliquis coverage.

 

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Medica's Approved Criteria for Eliquis Coverage

 

Eligibility Criteria for Eliquis Coverage

 

  • Medica provides coverage for Eliquis to patients diagnosed with Atrial Fibrillation (AF) who require anticoagulant therapy to reduce the risk of stroke and systemic embolism, particularly when warfarin therapy is unsuitable.
  •  

  • Eliquis is covered for patients who have developed or are at high risk of developing Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) and for whom alternative therapies are contraindicated or have caused adverse effects.

 

Medical History Consideration

 

  • Patients with a documented history of intolerance or contraindication to other anticoagulants are prioritized for Eliquis coverage.
  •  

  • The individual's medical records must demonstrate a need for anticoagulation therapy based on a thorough evaluation by a healthcare professional.

 

Physician Prescription Requirement

 

  • Eliquis coverage requires a prescription from a licensed healthcare provider who specializes in cardiovascular or hematological treatments, ensuring an assessment of the patient's condition and treatment necessity.
  •  

  • The prescribing physician must provide a detailed medical necessity statement supporting the use of Eliquis instead of other anticoagulants.

 

FDA-Approved Use

 

  • Eliquis must be prescribed for FDA-approved indications, such as stroke prevention in atrial fibrillation, treatment of DVT, and treatment of PE.
  •  

  • Off-label uses are not eligible for coverage unless there is substantial clinical evidence provided by the healthcare provider that justifies such use.

 

Combination Therapy Consideration

 

  • If Eliquis is to be used in conjunction with other medications, the therapeutic benefit and rationale should be clearly documented to receive coverage eligibility approval.
  •  

  • The combination therapy should be clinically justified, particularly if additive anticoagulation might be required and is backed by recent clinical studies or guidelines.

 

Reevaluation Period

 

  • Ongoing coverage of Eliquis requires periodic re-evaluation to assess the continued need for therapy, potential change of condition, and any new developments in medical health that might influence treatment.
  •  

  • The reevaluation ensures that patients are receiving the best possible treatment tailored to their evolving medical condition.

 

Why Medica Might Deny Eliquis Coverage

 

Reasons Medica Might Deny Eliquis Coverage

 

  • **Non-Formulary Status**: Eliquis is not included in the specific formulary or drug list provided by Medica. If considered non-essential, Medica may deny coverage.
  •  

  • **Prior Authorization Requirement**: If Medica's policy requires prior authorization and it hasn't been obtained, coverage for Eliquis might be denied.
  •  

  • **Step Therapy Policies**: Medica may require trial and failure of a preferred medication before Eliquis is covered. Failure to document such steps can result in denial.
  •  

  • **Quantity Limits**: Requests exceeding the standard or maximum allowed dosing without documented need or approval may lead to denial.
  •  

  • **Off-Label Use**: Coverage might be denied if Eliquis is prescribed for a condition not approved by the FDA or outside Medica's coverage policies.
  •  

  • **Incomplete Documentation**: Insufficient or missing documentation from the prescribing healthcare provider can result in a denial of coverage.
  •  

  • **Exclusion Criteria in Policy**: Specific patient attributes or conditions outlined in the Medica policy as exclusions can result in denied coverage.
  •  

  • **Non-Network Pharmacy**: If the prescription is filled at a pharmacy not included in Medica's network, Eliquis might not be covered.
  •  

 

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How Much Does Eliquis Cost without Insurance?

 

Approximate Cost of Eliquis without Insurance

 

  • The cost of Eliquis, a commonly prescribed blood thinner, can vary based on the pharmacy, location, and any available discounts or coupons. On average, without insurance, Eliquis can cost around $550 to $650 for a 30-day supply.
  •  

  • Some pharmacies or online platforms may offer discounts or generic options that can lower the cost, so it's advisable to shop around. Patients should also inquire about manufacturer coupons or assistance programs that might help reduce the price.
  •  

  • Price comparison tools and websites can be helpful in finding the best available prices for Eliquis in your area.

 

Our team is here to help!

Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Eliquis Coverage with Medica

 

Contact Medica Customer Service

 

  • Before beginning the process, reach out to Medica's customer service to inquire about prescription coverage for Eliquis. The contact number can typically be found on the back of your Medica insurance card.
  •  

  • Confirm whether Eliquis is included in your specific health plan's formulary list. This step will help you understand if it's regularly covered or if there are alternatives.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Eliquis. Ensure your doctor believes it's medically necessary for your condition.
  •  

  • If required, ask your doctor to provide supporting documentation or a letter of medical necessity to help with the approval process.

 

Review Your Prescription Drug Benefits

 

  • Log in to your Medica member account online to check your current prescription drug benefits. Look for detailed information about coverage for medications like Eliquis.
  •  

  • Understand the tiers and requirements you need to meet, such as prior authorization or step therapy.

 

Submit a Prior Authorization Request

 

  • If Eliquis requires prior authorization, request your doctor to submit the necessary forms and documentation to Medica. This process is crucial for approval and coverage of your medication.
  •  

  • Follow up with your doctor's office to ensure that the documentation has been properly sent and received by Medica.

 

Explore Prescription Assistance Programs

 

  • If Medica does not fully cover Eliquis, or if you're facing significant out-of-pocket expenses, look into prescription assistance programs offered by the manufacturer of Eliquis, Bristol-Myers Squibb.
  •  

  • These programs might provide Eliquis at a reduced cost or sometimes even for free, depending on your income and insurance status.

 

Appeal a Denied Request

 

  • If your request for coverage is denied, don't be discouraged. Check the explanation of benefits (EOB) for details regarding the denial.
  •  

  • Prepare an appeal by gathering necessary documentation and any additional supporting evidence from your healthcare provider to make your case effectively.
  •  

  • Submit your appeal to Medica as instructed, and follow up regularly to check its status.

 

Follow Up and Stay Informed

 

  • Maintain regular communication with Medica to ensure that you are updated regarding the status of your request or appeal.
  •  

  • Keep your healthcare provider in the loop so they can assist you throughout the process and provide any additional information if required.

 

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Eliquis FAQ

What are the side effects of Eliquis?

 

Common Side Effects of Eliquis

 

  • Mild bleeding or bruising due to its anticoagulant effect.
  • Nausea, which may occur as your body adjusts to the medication.
  • Skin rash or minor allergic reactions.
  • Fatigue or general weakness.

 

Serious Side Effects

 

  • Severe bleeding, including unusual bleeding from gums, nosebleeds, or heavier than usual menstrual bleeding.
  • Red, pink, or brown urine and black or bloody stools indicating internal bleeding.
  • Severe headache, dizziness, or fainting, which could indicate a bleed in the brain.
  • Signs of anemia, such as pale skin, weakness, or fatigue.

 

Consult Your Doctor

 

  • Always report any unusual symptoms to your healthcare provider promptly.
  • Seek emergency medical attention for significant bleeding or symptoms of a serious allergic reaction like difficulty breathing.

 

Is Eliquis a blood thinner?

 

Is Eliquis a Blood Thinner?

 

  • Yes, Eliquis (apixaban) is a blood thinner, also known as an anticoagulant.
  •  

  • It prevents blood clots by inhibiting Factor Xa, which is crucial in the clotting process.
  •  

  • Doctors prescribe Eliquis to reduce stroke risk in patients with atrial fibrillation and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
  •  

  • Ensure regular monitoring and follow-ups with your healthcare provider while on Eliquis for safe management.
  •  

  • Contact a healthcare professional if you have concerns about bleeding risks or interactions with other medications.

 

Can you take Eliquis with alcohol?

 

Alcohol and Eliquis Interaction

 

  • Moderate alcohol consumption might be safe, but heavy drinking can increase bleeding risk.
  •  

  • Consult your healthcare provider to assess your specific condition and alcohol tolerance.

 

Potential Effects of Combining

 

  • Both Eliquis and alcohol affect blood clotting, raising potential for heightened bleeding.
  •  

  • Alcohol can augment Eliquis' effects, complicating the management of conditions like atrial fibrillation.

 

Recommendations for Use

 

  • If you drink, limit to one or two standard drinks occasionally and monitor for bruising or bleeding.
  •  

  • Report any unusual symptoms to your healthcare provider immediately.

 

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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.

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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.

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Will I be prescribed semaglutide if I sign up?

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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.

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Can I pay with an FSA or HSA card?

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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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