Does Molina Healthcare Cover Farxiga

Explore Farxiga coverage options with Molina Healthcare and discover ways to reduce costs without insurance. Get answers to FAQs and find out why coverage may be denied.
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Does Molina Healthcare Cover Farxiga?

 

  • Molina Healthcare may cover Farxiga (dapagliflozin), a prescription medication for managing type 2 diabetes, heart failure, or chronic kidney disease, depending on your specific plan and eligibility.
  •  

  • Coverage could involve prior authorization, where Molina reviews medical necessity based on your health condition and history.
  •  

  • Ensure your prescriptions are filled at a pharmacy within Molina's network to maximize coverage benefits.
  •  

  • Check formulary status since Farxiga is typically covered under tier-specific rules impacting co-pays and out-of-pocket costs.
  •  

  • Consult your healthcare provider to assess if Farxiga is medically necessary and discuss potential alternatives if coverage is denied.
  •  

  • Contact Molina Healthcare directly to verify coverage specifics, including any step therapy protocols, additional paperwork, and updates to your plan.

 

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Dr. Neeta Ogden, MD

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

Dr. Ravi Patel, VP Telemedicine

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

Jill Hamburg, PA - C

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

Dr. Chet Tharpe, Medical Director

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

Kayla Mardaga, NP

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

How to Get Farxiga Coverage with Molina Healthcare

 

Verify Farxiga Coverage

 

  • Visit Molina Healthcare's website or contact their customer service to check if Farxiga is included in their formulary, which is the list of covered prescription medications.
  •  

  • Review any specific criteria or restrictions that might apply to Farxiga coverage, such as prior authorization, step therapy, or quantity limits.

 

Enroll with Molina Healthcare

 

  • If not already enrolled, sign up for a Molina Healthcare plan that offers prescription drug coverage. This can typically be done through their website or by calling their enrollment services.
  •  

  • Review different plan options to ensure the selected plan provides pharmaceutical benefits that suit your needs, including the coverage of medications like Farxiga.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Farxiga with your healthcare provider. They can help provide any necessary documentation or medical justification required by Molina Healthcare.
  •  

  • Your provider can initiate any required prior authorization process by submitting necessary forms and medical information to Molina Healthcare.

 

Follow the Prior Authorization Process

 

  • Once your healthcare provider submits the necessary paperwork, follow up with Molina Healthcare to ensure all steps of the prior authorization process are completed.
  •  

  • You may need to provide additional information or complete additional paperwork. Stay in contact with both your healthcare provider and Molina to ensure all requirements are met.

 

Understand Copayments and Out-of-Pocket Costs

 

  • Review your plan details to understand the copayments or out-of-pocket costs associated with prescribing Farxiga.
  •  

  • For those facing high out-of-pocket costs, inquire about any available financial assistance programs or discounts through Molina Healthcare or the medication's manufacturer.

 

Fill Your Prescription

 

  • Once coverage is confirmed and any necessary authorizations are in place, fill your Farxiga prescription at a network pharmacy approved by Molina Healthcare.
  •  

  • Ensure to present your insurance information at the pharmacy to apply coverage and determine the final copayment or coinsurance required.

 

Monitor and Review Coverage Annually

 

  • Each year, review your Molina Healthcare plan during the open enrollment period to ensure that it continues to meet your pharmaceutical needs, including Farxiga coverage.
  •  

  • Be proactive in checking for any changes to the formulary, coverage policies, or out-of-pocket expenses related to your prescription medications.

 

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FAQs

Does Molina Healthcare Cover Farxiga

Explore Farxiga coverage options with Molina Healthcare and discover ways to reduce costs without insurance. Get answers to FAQs and find out why coverage may be denied.
Curex allergy drops unboxing

Is Farxiga Covered by Molina Healthcare

 

Does Molina Healthcare Cover Farxiga?

 

  • Molina Healthcare may cover Farxiga (dapagliflozin), a prescription medication for managing type 2 diabetes, heart failure, or chronic kidney disease, depending on your specific plan and eligibility.
  •  

  • Coverage could involve prior authorization, where Molina reviews medical necessity based on your health condition and history.
  •  

  • Ensure your prescriptions are filled at a pharmacy within Molina's network to maximize coverage benefits.
  •  

  • Check formulary status since Farxiga is typically covered under tier-specific rules impacting co-pays and out-of-pocket costs.
  •  

  • Consult your healthcare provider to assess if Farxiga is medically necessary and discuss potential alternatives if coverage is denied.
  •  

  • Contact Molina Healthcare directly to verify coverage specifics, including any step therapy protocols, additional paperwork, and updates to your plan.

 

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Molina Healthcare's Approved Criteria for Farxiga Coverage

 

Criteria for Farxiga Coverage with Molina Healthcare

 

  • Farxiga (dapagliflozin) is approved for adults with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycemic control.
  •  

  • Coverage is provided for patients with evidence of cardiovascular disease where Farxiga is prescribed to reduce the risk of cardiovascular death and hospitalization for heart failure.
  •  

  • For individuals with chronic kidney disease (CKD), Farxiga is approved to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure.
  •  

  • For heart failure, Farxiga is covered for reducing the risk of cardiovascular death and hospitalization in adults with heart failure with reduced ejection fraction.
  •  

  • Prior authorization is required to confirm the patient meets these criteria. Prescribing healthcare professionals must provide relevant medical records that indicate the presence of qualifying conditions, aligning with the specified guidelines.
  •  

  • Continuation of therapy with Farxiga requires regular reassessment of efficacy and the presence of benefiting conditions as per updated healthcare assessments.

 

Why Molina Healthcare Might Deny Farxiga Coverage

 

Reasons Molina Healthcare Might Deny Farxiga Coverage

 

  • Farxiga is not listed on the formulary for specific plans. It might be excluded if there are preferable alternatives considered more cost-effective.
  •  

  • Lack of necessary prior authorization or failure to meet specific criteria set by Molina Healthcare, such as documented trial and failure of generic alternatives or documented medical necessity.
  •  

  • Prescribed for off-label uses not approved by the FDA or not covered under specific policy guidelines of Molina Healthcare.
  •  

  • The patient does not meet the clinical criteria established in the plan's medical policy for Farxiga usage.
  •  

  • The prescription is from a provider or pharmacy that is out of Molina Healthcare's network, unless it's an emergency or prior authorized exception.
  •  

  • Exceeding dosage limits as defined by Molina Healthcare's medical or pharmacy policy.
  •  

  • The member's plan does not include prescription drug coverage for the type of medication that Farxiga represents.

 

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How Much Does Farxiga Cost without Insurance?

 

Estimated Cost of Farxiga Without Insurance

 

  • Farxiga, a medication used primarily for the management of type 2 diabetes and certain forms of heart failure, can be quite costly without insurance coverage.
  •  

  • The cash price for Farxiga typically ranges between $500 and $550 for a 30-day supply, depending on the pharmacy and location.
  •  

  • Some pharmacies may offer discount programs or cards that can slightly lower this cost, but significant savings are usually only available through insurance coverage.
  •  

  • Always consider checking with multiple pharmacies or online services where discounts might be more prevalent.

 

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 Farxiga Coverage with Molina Healthcare

 

Verify Farxiga Coverage

 

  • Visit Molina Healthcare's website or contact their customer service to check if Farxiga is included in their formulary, which is the list of covered prescription medications.
  •  

  • Review any specific criteria or restrictions that might apply to Farxiga coverage, such as prior authorization, step therapy, or quantity limits.

 

Enroll with Molina Healthcare

 

  • If not already enrolled, sign up for a Molina Healthcare plan that offers prescription drug coverage. This can typically be done through their website or by calling their enrollment services.
  •  

  • Review different plan options to ensure the selected plan provides pharmaceutical benefits that suit your needs, including the coverage of medications like Farxiga.

 

Consult with Your Healthcare Provider

 

  • Discuss your need for Farxiga with your healthcare provider. They can help provide any necessary documentation or medical justification required by Molina Healthcare.
  •  

  • Your provider can initiate any required prior authorization process by submitting necessary forms and medical information to Molina Healthcare.

 

Follow the Prior Authorization Process

 

  • Once your healthcare provider submits the necessary paperwork, follow up with Molina Healthcare to ensure all steps of the prior authorization process are completed.
  •  

  • You may need to provide additional information or complete additional paperwork. Stay in contact with both your healthcare provider and Molina to ensure all requirements are met.

 

Understand Copayments and Out-of-Pocket Costs

 

  • Review your plan details to understand the copayments or out-of-pocket costs associated with prescribing Farxiga.
  •  

  • For those facing high out-of-pocket costs, inquire about any available financial assistance programs or discounts through Molina Healthcare or the medication's manufacturer.

 

Fill Your Prescription

 

  • Once coverage is confirmed and any necessary authorizations are in place, fill your Farxiga prescription at a network pharmacy approved by Molina Healthcare.
  •  

  • Ensure to present your insurance information at the pharmacy to apply coverage and determine the final copayment or coinsurance required.

 

Monitor and Review Coverage Annually

 

  • Each year, review your Molina Healthcare plan during the open enrollment period to ensure that it continues to meet your pharmaceutical needs, including Farxiga coverage.
  •  

  • Be proactive in checking for any changes to the formulary, coverage policies, or out-of-pocket expenses related to your prescription medications.

 

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Farxiga FAQ

What are the side effects of Farxiga?

 

Common Side Effects of Farxiga

 

  • Increased urination due to its diuretic effect, which may lead to dehydration. Maintain adequate hydration.
  • Potential urinary tract infections or yeast infections in genital areas, due to changes in the urinary environment.

 

Metabolic Effects

 

  • Weight loss can occur, linked to its mechanism of expelling glucose via urine.
  • Electrolyte imbalances, such as elevated potassium levels in blood, may appear in some cases.

 

Serious Reactions

 

  • Ketoacidosis risk: Watch for symptoms like nausea, vomiting, or abdominal pain.
  • Rarely, serious infections like Fournier's gangrene can develop. Seek immediate attention if you notice pain, redness, or swelling in genital or anal areas.

 

Can Farxiga help with weight loss?

 

Can Farxiga Aid Weight Loss?

 

  • Farxiga (dapagliflozin) is primarily a medication for managing type 2 diabetes and heart failure. It helps control blood sugar by promoting the excretion of glucose through urine.
  •  

  • Though not prescribed primarily for weight loss, some patients experience weight reduction as a secondary benefit.
  •  

  • Weight loss occurs because Farxiga facilitates the removal of excess calories in the form of glucose. However, the effect is usually modest and not guaranteed for everyone.
  •  

  • Consult a healthcare professional to understand if Farxiga is suitable for your condition and weight management goals.

 

Is Farxiga used for heart failure treatment?

 

Farxiga for Heart Failure

 

  • Farxiga (dapagliflozin) is primarily a SGLT2 inhibitor, initially developed to treat type 2 diabetes by helping the kidneys excrete glucose.
  •  

  • Recent studies have shown Farxiga's efficacy in heart failure management, particularly heart failure with reduced ejection fraction (HFrEF), by reducing hospitalizations and improving cardiovascular outcomes.
  •  

  • The medication works by decreasing fluid overload and blood pressure, lessening the heart's workload.
  •  

  • Farxiga is approved for heart failure treatment regardless of diabetes status, broadening its use in cardiology.
  •  

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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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