Does Molina Healthcare Cover Xarelto

Explore Molina Healthcare's Xarelto coverage, denial reasons, costs without insurance, and FAQs to ensure you get the prescription you need.
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Coverage Overview

 

  • Molina Healthcare may cover Xarelto based on medical necessity and plan specifics. Xarelto is generally prescribed for preventing blood clots in patients with atrial fibrillation, deep vein thrombosis, or after certain surgeries. Coverage can vary depending on state and policy.

 

Basic Rules and Criteria

 

  • Coverage eligibility often requires a physician's prescription and demonstration of medical necessity. The patient might need to provide documentation of conditions like atrial fibrillation or deep vein thrombosis that warrant Xarelto use.
  • Prior authorization might be necessary, which involves the provider submitting a request justifying why Xarelto is needed over other treatments.
  • Patients should check their specific Molina plan's formulary and consult with their healthcare provider to confirm coverage details and any out-of-pocket costs.

 

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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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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 Molina Healthcare

 

Contact Molina Healthcare Customer Service

 

  • Reach out to Molina Healthcare's customer service via phone or online member account to inquire about prescription drug coverage.
  • Ask specifically about the coverage for Xarelto and any pre-requisite criteria that need to be met.

 

Review Your Current Plan Benefits

 

  • Check your current Molina Healthcare plan details through your member portal or the physical plan document.
  • Look for the formulary section which lists covered drugs to confirm if Xarelto is included.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Xarelto for your treatment.
  • Request your provider to write a detailed prescription and a letter of medical necessity if needed by Molina Healthcare.

 

Understand Prior Authorization Requirements

 

  • Inquire if Xarelto requires prior authorization under your Molina Healthcare plan.
  • Gather the specific documentation or forms required for obtaining prior authorization.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete and submit any necessary prior authorization forms to Molina Healthcare.
  • Include any supporting documents such as the prescription and letter of medical necessity.

 

Follow Up on the Authorization Process

 

  • Contact Molina Healthcare regularly to check the status of your prior authorization request.
  • Address any additional information requests promptly to avoid delays.

 

Explore Financial Assistance Programs

 

  • If there are coverage or cost concerns, inquire about financial assistance programs that Molina Healthcare may offer.
  • Consider manufacturer discount programs or patient assistance services that may reduce out-of-pocket costs for Xarelto.

 

Review Alternative Options If Needed

 

  • If coverage is denied, discuss with your healthcare provider about alternative medications that suit your health needs and are covered by your plan.
  • File an appeal with Molina Healthcare if you believe Xarelto coverage was unjustly denied, providing all necessary documentation.

 

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FAQs

Does Molina Healthcare Cover Xarelto

Explore Molina Healthcare's Xarelto coverage, denial reasons, costs without insurance, and FAQs to ensure you get the prescription you need.
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Is Xarelto Covered by Molina Healthcare

 

Coverage Overview

 

  • Molina Healthcare may cover Xarelto based on medical necessity and plan specifics. Xarelto is generally prescribed for preventing blood clots in patients with atrial fibrillation, deep vein thrombosis, or after certain surgeries. Coverage can vary depending on state and policy.

 

Basic Rules and Criteria

 

  • Coverage eligibility often requires a physician's prescription and demonstration of medical necessity. The patient might need to provide documentation of conditions like atrial fibrillation or deep vein thrombosis that warrant Xarelto use.
  • Prior authorization might be necessary, which involves the provider submitting a request justifying why Xarelto is needed over other treatments.
  • Patients should check their specific Molina plan's formulary and consult with their healthcare provider to confirm coverage details and any out-of-pocket costs.

 

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Molina Healthcare's Approved Criteria for Xarelto Coverage

 

Criteria for Xarelto Coverage by Molina Healthcare

 

  • Xarelto is covered for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation.
  •  

  • It is approved for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients who meet the clinical guidelines.
  •  

  • Coverage includes the reduction in the risk of recurrence of DVT and PE in patients who have been previously treated.
  •  

  • Patients undergoing hip or knee replacement surgery are eligible for coverage of Xarelto to prevent DVT.
  •  

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

  • The prescription must come from a healthcare professional who is authorized and qualified to prescribe this medication within the scope of their practice.
  •  

  • An appropriate trial or contraindication to more cost-effective anticoagulation options when applicable is required for coverage.

 

Why Molina Healthcare Might Deny Xarelto Coverage

 

Reasons Molina Healthcare Might Deny Xarelto Coverage

 

  • **Non-Formulary Drug**: Xarelto may not be included on Molina Healthcare’s formulary list, which consists of approved and covered medications. If Xarelto is not part of this list, coverage may be denied.
  •  

  • **Prior Authorization Requirements**: Molina Healthcare may require prior authorization for Xarelto. If the provider does not obtain necessary approval beforehand, coverage can be denied.
  •  

  • **Lack of Medical Necessity**: If Xarelto is not deemed medically necessary by Molina Healthcare based on the patient's current health condition and medical history, coverage may be refused.
  •  

  • **Step Therapy Protocols**: Molina might mandate starting with alternative, lower-cost medications before progressing to Xarelto. If these protocols are not followed, coverage might be denied.
  •  

  • **Out-of-Network Prescriptions**: Prescriptions from providers who are not part of the Molina Healthcare network may not be covered for Xarelto unless there is an agreement or exceptional case documented.
  •  

  • **Dosage Limitations**: Coverage could be denied if the prescribed dosage of Xarelto exceeds what Molina Healthcare considers typical or safe based on approved guidelines.
  •  

  • **Plan Exclusions**: Specific health insurance plans under Molina Healthcare may have exclusions where Xarelto is explicitly not covered, depending on the policy details.

 

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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 Molina Healthcare

 

Contact Molina Healthcare Customer Service

 

  • Reach out to Molina Healthcare's customer service via phone or online member account to inquire about prescription drug coverage.
  • Ask specifically about the coverage for Xarelto and any pre-requisite criteria that need to be met.

 

Review Your Current Plan Benefits

 

  • Check your current Molina Healthcare plan details through your member portal or the physical plan document.
  • Look for the formulary section which lists covered drugs to confirm if Xarelto is included.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the medical necessity of Xarelto for your treatment.
  • Request your provider to write a detailed prescription and a letter of medical necessity if needed by Molina Healthcare.

 

Understand Prior Authorization Requirements

 

  • Inquire if Xarelto requires prior authorization under your Molina Healthcare plan.
  • Gather the specific documentation or forms required for obtaining prior authorization.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to complete and submit any necessary prior authorization forms to Molina Healthcare.
  • Include any supporting documents such as the prescription and letter of medical necessity.

 

Follow Up on the Authorization Process

 

  • Contact Molina Healthcare regularly to check the status of your prior authorization request.
  • Address any additional information requests promptly to avoid delays.

 

Explore Financial Assistance Programs

 

  • If there are coverage or cost concerns, inquire about financial assistance programs that Molina Healthcare may offer.
  • Consider manufacturer discount programs or patient assistance services that may reduce out-of-pocket costs for Xarelto.

 

Review Alternative Options If Needed

 

  • If coverage is denied, discuss with your healthcare provider about alternative medications that suit your health needs and are covered by your plan.
  • File an appeal with Molina Healthcare if you believe Xarelto coverage was unjustly denied, providing all necessary documentation.

 

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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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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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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