Does Network Health Cover Farxiga

Explore why Network Health may not cover Farxiga, how to obtain coverage, costs without insurance, and find answers to common questions.
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Network Health Coverage for Farxiga

 

  • Network Health provides coverage for Farxiga depending on the specific plan and tier of prescription medications. Coverage often includes situations of type 2 diabetes management, heart failure, and chronic kidney disease.
  •  

  • To have Farxiga covered, it must be prescribed by a healthcare provider. It is essential that the prescription meets medical necessity criteria as outlined by Network Health's formulary guidelines.
  •  

  • Members are required to follow prior authorization processes. This means the healthcare provider must submit a request for review and approval before the prescription is filled. Coverage may also depend on step therapy rules, which require trying alternative medications first.
  •  

  • Patients should check for any copayments, deductibles, or coinsurance that might apply to Farxiga, as these out-of-pocket costs vary based on the specific insurance plan and benefits package.

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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 Network Health

 

Get Started with Network Health

 

  • Visit the official Network Health website to choose a health plan that suits your needs. This process allows you to review various plans and determine which ones could offer prescription drug coverage for medications like Farxiga.
  •  

  • Check if you are currently enrolled in a Network Health plan. If not, you will need to sign up during the open enrollment period. If you're considering Farxiga, ensure the plan you’re interested in includes Prescription Drug Coverage.

 

Examine Prescription Drug Coverage

 

  • Navigate to the Prescription Drug Coverage section on the Network Health website. This will provide a list of medications covered under each plan, including any specific requirements like prior authorization or step therapy for Farxiga.
  •  

  • Review the formulary, a list of covered drugs, to confirm that Farxiga is included. You may want to verify the drug tier classification, as this will impact your out-of-pocket costs.

 

Consult the Customer Service

 

  • Contact Network Health customer service for assistance. You can ask specific questions about Farxiga coverage, any out-of-pocket expenses, and the exact process of how to get the medication covered under your plan.
  •  

  • Inquire about any membership perks that might lower prescription costs, such as pharmacy discounts or mail-order services.

 

Obtain a Prescription

 

  • Meet with your healthcare provider to discuss your need for Farxiga. Your healthcare provider can then provide a prescription and determine if any special steps, like prior authorization, are required by your plan.
  •  

  • If necessary, your healthcare provider can assist with completing any additional forms or paperwork required by Network Health to ensure coverage.

 

Fill Your Prescription

 

  • Use a Network Health preferred pharmacy to fill your prescription. Doing so can often maximize your benefits and reduce out-of-pocket costs.
  •  

  • Check if there is an option for mail-order pharmacy services that Network Health supports, which could provide additional convenience and possibly lower costs.

 

Address Coverage Issues

 

  • If your claim for Farxiga coverage is denied, review the denial notice for the reasons and clarification. You may need to gather supporting documents from your healthcare provider.
  •  

  • Work with Network Health’s customer service or your healthcare provider to appeal the denial if you believe the coverage should apply. They can provide guidance on how to proceed with an appeal.

 

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FAQs

Does Network Health Cover Farxiga

Explore why Network Health may not cover Farxiga, how to obtain coverage, costs without insurance, and find answers to common questions.
Curex allergy drops unboxing

Is Farxiga Covered by Network Health

 

Network Health Coverage for Farxiga

 

  • Network Health provides coverage for Farxiga depending on the specific plan and tier of prescription medications. Coverage often includes situations of type 2 diabetes management, heart failure, and chronic kidney disease.
  •  

  • To have Farxiga covered, it must be prescribed by a healthcare provider. It is essential that the prescription meets medical necessity criteria as outlined by Network Health's formulary guidelines.
  •  

  • Members are required to follow prior authorization processes. This means the healthcare provider must submit a request for review and approval before the prescription is filled. Coverage may also depend on step therapy rules, which require trying alternative medications first.
  •  

  • Patients should check for any copayments, deductibles, or coinsurance that might apply to Farxiga, as these out-of-pocket costs vary based on the specific insurance plan and benefits package.

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Network Health's Approved Criteria for Farxiga Coverage

 

Eligibility Criteria for Farxiga Coverage

 

  • The patient must have a confirmed diagnosis of Type 2 diabetes mellitus, chronic kidney disease, or heart failure, as documented by a healthcare provider.
  •  

  • Documentation must show that Farxiga is being prescribed as an adjunct therapy to diet and exercise for improving glycemic control or managing chronic conditions related to heart and kidney health.

 

Prescribing Information

 

  • Farxiga must be prescribed by a licensed clinician familiar with the patient's medical history and treatment objectives.
  •  

  • The prescription should align with FDA-approved indications and be consistent with established clinical guidelines.

 

Previous Medication Trials

 

  • Evidence must be provided that the patient has tried and not achieved desired outcomes with other anti-diabetic therapies if being used for glucose management.
  •  

  • For heart failure and kidney disease, documentation showing that Farxiga is an appropriate treatment choice based on clinical judgment and patient-specific factors is required.

 

Clinical Assessments and Monitoring Plan

 

  • A detailed clinical assessment including recent lab results, comorbid conditions, and medical history should support the need for Farxiga therapy.
  •  

  • The prescribing clinician must outline a plan for monitoring the patient’s progress, including regular follow-ups and assessments of efficacy and safety.

 

Patient Adherence and Education

 

  • The patient must be informed about the potential benefits and risks of Farxiga therapy and demonstrate understanding and willingness to adhere to the treatment regimen.
  •  

  • Providers should document the provision of educational resources and support to aid patient adherence.

 

Insurance Documentation Requirements

 

  • All claims for Farxiga coverage must include detailed documentation supporting medical necessity, prior authorization requests, and compliance with the outlined criteria.
  •  

  • Any supporting data or appeals must address specific criteria and patient-specific factors influencing the treatment plan.

 

Why Network Health Might Deny Farxiga Coverage

 

Situations When Network Health Might Deny Farxiga Coverage

 

  • **Farxiga is prescribed for off-label uses** - Coverage may be denied if the medication is being prescribed for conditions not approved by the FDA.
  •  

  • **Lack of prior authorization** - If prior authorization requirements are not fulfilled by the prescribing healthcare provider, coverage for Farxiga might be denied.
  •  

  • **Non-compliance with formulary guidelines** - Coverage may be denied if Farxiga is not included in the network's formulary list or if a more cost-effective alternative is available.
  •  

  • **Insufficient medical necessity documentation** - If there is inadequate documentation proving the medical necessity of prescribing Farxiga, the network may deny coverage.
  •  

  • **Failure to meet clinical criteria** - Without meeting specific clinical criteria set by the network, such as particular lab results or diagnosis confirmation, coverage may be refused.
  •  

  • **Duplicate therapy concerns** - If Farxiga is found to duplicate the effect of another medication that the patient is already taking, coverage might be denied.
  •  

  • **Age restrictions** - Coverage might be denied if Farxiga is prescribed to patients outside the approved age range without appropriate justification.
  •  

  • **Experimental or investigational use** - If Farxiga is used for experimental or investigational purposes, it may be ineligible for coverage.

 

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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 Network Health

 

Get Started with Network Health

 

  • Visit the official Network Health website to choose a health plan that suits your needs. This process allows you to review various plans and determine which ones could offer prescription drug coverage for medications like Farxiga.
  •  

  • Check if you are currently enrolled in a Network Health plan. If not, you will need to sign up during the open enrollment period. If you're considering Farxiga, ensure the plan you’re interested in includes Prescription Drug Coverage.

 

Examine Prescription Drug Coverage

 

  • Navigate to the Prescription Drug Coverage section on the Network Health website. This will provide a list of medications covered under each plan, including any specific requirements like prior authorization or step therapy for Farxiga.
  •  

  • Review the formulary, a list of covered drugs, to confirm that Farxiga is included. You may want to verify the drug tier classification, as this will impact your out-of-pocket costs.

 

Consult the Customer Service

 

  • Contact Network Health customer service for assistance. You can ask specific questions about Farxiga coverage, any out-of-pocket expenses, and the exact process of how to get the medication covered under your plan.
  •  

  • Inquire about any membership perks that might lower prescription costs, such as pharmacy discounts or mail-order services.

 

Obtain a Prescription

 

  • Meet with your healthcare provider to discuss your need for Farxiga. Your healthcare provider can then provide a prescription and determine if any special steps, like prior authorization, are required by your plan.
  •  

  • If necessary, your healthcare provider can assist with completing any additional forms or paperwork required by Network Health to ensure coverage.

 

Fill Your Prescription

 

  • Use a Network Health preferred pharmacy to fill your prescription. Doing so can often maximize your benefits and reduce out-of-pocket costs.
  •  

  • Check if there is an option for mail-order pharmacy services that Network Health supports, which could provide additional convenience and possibly lower costs.

 

Address Coverage Issues

 

  • If your claim for Farxiga coverage is denied, review the denial notice for the reasons and clarification. You may need to gather supporting documents from your healthcare provider.
  •  

  • Work with Network Health’s customer service or your healthcare provider to appeal the denial if you believe the coverage should apply. They can provide guidance on how to proceed with an appeal.

 

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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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Initial Dosage

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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