Does Medica Cover Xarelto

Explore Medica's Xarelto coverage, reasons for denial, getting coverage, costs without insurance, and FAQs in this comprehensive guide.
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Does Medica Cover Xarelto?

 

  • **Coverage Situations:** Medica may cover Xarelto for conditions like atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism. Coverage is often subject to specific medical necessity criteria, which may include diagnosis verification and previous history with similar medications.
  •  

  • **Basic Rules and Criteria:** To get Xarelto covered, physicians usually must provide documentation supporting the clinical necessity, and the prescribing must adhere to Medica's formulary guidelines. Prior authorization could be required, ensuring the patient's treatment aligns with Medica’s coverage policy.
  •  

  • **Additional Considerations:** Patients might be required to try and document ineffectiveness or adverse reactions to alternative anticoagulants covered by Medica before approving Xarelto.

 

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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 Medica

 

Check Your Medica Insurance Plan

 

  • Review your Medica insurance policy documents carefully to understand what types of medication coverage are included.
  •  

  • Log into your Medica member portal to check if Xarelto is listed on the formulary (a list of medications covered by the plan).
  •  

  • If Xarelto is not listed, verify whether you need a prior authorization or if there are specific exceptions for coverage.

 

Contact Medica Customer Service

 

  • Reach out to Medica’s customer service for assistance. The number should be located on your insurance card or the Medica website.
  •  

  • Ask for information about Xarelto coverage, including any required documentation or specific steps to receive coverage.

 

Consult with Your Health Care Provider

 

  • Discuss the need for Xarelto with your healthcare provider; ensure that it is the most appropriate treatment for your condition.
  •  

  • Request a prescription for Xarelto that aligns with your discussed treatment plan.
  •  

  • Ask your provider to write a letter of medical necessity if Medica requires prior authorization.

 

Submit a Prior Authorization Request

 

  • If required, fill out any Medica-specific forms for medication prior authorization. These forms can typically be found on the Medica website or obtained through Medica directly.
  •  

  • Submit the completed forms along with the letter of medical necessity from your healthcare provider to Medica for review.
  •  

  • Monitor the progress by regularly checking your member portal or contacting Medica customer service.

 

Appeal If Necessary

 

  • If your initial request for Xarelto coverage is denied, review the reason for denial provided by Medica.
  •  

  • Prepare and submit an appeal following the guidelines provided by Medica. This may involve offering additional documentation or further clarification from your healthcare provider.
  •  

  • Continue to follow up on the status of your appeal by remaining in contact with Medica representatives.
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FAQs

Does Medica Cover Xarelto

Explore Medica's Xarelto coverage, reasons for denial, getting coverage, costs without insurance, and FAQs in this comprehensive guide.
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Is Xarelto Covered by Medica

 

Does Medica Cover Xarelto?

 

  • **Coverage Situations:** Medica may cover Xarelto for conditions like atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism. Coverage is often subject to specific medical necessity criteria, which may include diagnosis verification and previous history with similar medications.
  •  

  • **Basic Rules and Criteria:** To get Xarelto covered, physicians usually must provide documentation supporting the clinical necessity, and the prescribing must adhere to Medica's formulary guidelines. Prior authorization could be required, ensuring the patient's treatment aligns with Medica’s coverage policy.
  •  

  • **Additional Considerations:** Patients might be required to try and document ineffectiveness or adverse reactions to alternative anticoagulants covered by Medica before approving Xarelto.

 

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Medica's Approved Criteria for Xarelto Coverage

 

Criteria for Xarelto Coverage by Medica

 

  • Xarelto is covered for adults who have been diagnosed with non-valvular atrial fibrillation, specifically to reduce the risk of stroke and systemic embolism.
  •  

  • Coverage is included for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in those who have been diagnosed with these conditions.
  •  

  • Patients who require prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery, are eligible for Xarelto coverage.
  •  

  • Medica covers Xarelto for patients who need long-term, continued risk reduction of recurrent DVT and PE following the initial 6 months of treatment.
  •  

  • Xarelto is approved for use in patients requiring prophylaxis of venous thromboembolism (VTE) in acutely ill medical patients who are at risk for thromboembolic complications due to moderate or severe restricted mobility and other risk factors.
  •  

  • Coverage is extended to patients with coronary artery disease (CAD) or peripheral artery disease (PAD) for the reduction of the risk of major cardiovascular events such as stroke, myocardial infarction, and cardiovascular death.

 

Why Medica Might Deny Xarelto Coverage

 

Potential Coverage Denial Situations for Xarelto by Medica

 

  • Non-Formulary Status: If Xarelto is not listed on Medica’s drug formulary, coverage may be denied. This means Medica does not include Xarelto as part of their preferred drug list.
  •  

  • Lack of Medical Necessity: If a physician’s request for Xarelto is not justified with sufficient medical documentation showing it is necessary for the patient’s condition, Medica may deny coverage.
  •  

  • Prior Authorization Issues: If prior authorization is required and not obtained before prescribing Xarelto, Medica may deny coverage. Necessary approval processes must be completed to avoid denial.
  •  

  • Step Therapy Requirements: Medica might require patients to try and fail cheaper or generic alternatives before approving coverage for Xarelto. If these conditions are not met, Xarelto coverage may be denied.
  •  

  • Off-Label Use: Coverage might be denied if Xarelto is prescribed for a use that is not FDA-approved, or if it doesn’t meet the specific criteria set by Medica for off-label uses.
  •  

  • Lack of Membership Compliance: If the individual does not comply with Medica’s member requirements or if there is a lapse in membership status, coverage could be denied.
  •  

  • Exceeded Quantity Limits: Medica may have specific quantity limits for Xarelto. Exceeding the set limits without valid justification might result in denial of coverage.

 

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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 Medica

 

Check Your Medica Insurance Plan

 

  • Review your Medica insurance policy documents carefully to understand what types of medication coverage are included.
  •  

  • Log into your Medica member portal to check if Xarelto is listed on the formulary (a list of medications covered by the plan).
  •  

  • If Xarelto is not listed, verify whether you need a prior authorization or if there are specific exceptions for coverage.

 

Contact Medica Customer Service

 

  • Reach out to Medica’s customer service for assistance. The number should be located on your insurance card or the Medica website.
  •  

  • Ask for information about Xarelto coverage, including any required documentation or specific steps to receive coverage.

 

Consult with Your Health Care Provider

 

  • Discuss the need for Xarelto with your healthcare provider; ensure that it is the most appropriate treatment for your condition.
  •  

  • Request a prescription for Xarelto that aligns with your discussed treatment plan.
  •  

  • Ask your provider to write a letter of medical necessity if Medica requires prior authorization.

 

Submit a Prior Authorization Request

 

  • If required, fill out any Medica-specific forms for medication prior authorization. These forms can typically be found on the Medica website or obtained through Medica directly.
  •  

  • Submit the completed forms along with the letter of medical necessity from your healthcare provider to Medica for review.
  •  

  • Monitor the progress by regularly checking your member portal or contacting Medica customer service.

 

Appeal If Necessary

 

  • If your initial request for Xarelto coverage is denied, review the reason for denial provided by Medica.
  •  

  • Prepare and submit an appeal following the guidelines provided by Medica. This may involve offering additional documentation or further clarification from your healthcare provider.
  •  

  • Continue to follow up on the status of your appeal by remaining in contact with Medica representatives.

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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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