Does Network Health Cover Xarelto

Explore Network Health's coverage for Xarelto, reasons for denial, cost without insurance, and FAQs. Learn how to secure Xarelto coverage effectively.
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Does Network Health Cover Xarelto?

 

  • Xarelto coverage under Network Health typically applies to medically necessary situations, such as reducing the risk of stroke and blood clots in patients with atrial fibrillation, treating deep vein thrombosis (DVT), and preventing blood clots after surgery.
  •  

  • Coverage may depend on the specific health plan, so verifying with Network Health is essential. Prior authorization might be required.
  •  

  • Patients often need to meet specific criteria like medical history and current health condition to be eligible for coverage.
  •  

  • Members should consult with their healthcare provider, who can present required documentation to justify the medical necessity of Xarelto.
  •  

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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.

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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 Network Health

 

Research Xarelto Coverage by Network Health

 

  • Visit the official Network Health website and navigate to the "Pharmacy" or "Prescription Coverage" section for information about medication coverage options.
  •  

  • Review the formulary document, as it lists the drugs covered, their corresponding tiers, and any specific requirements such as prior authorization.
  •  

  • Check the list to verify if Xarelto is covered under Network Health's formulary. Note that coverage details may vary between plans.

 

Contact Network Health Customer Service

 

  • Locate the contact details for Network Health's customer service, which are usually available on their website or on your insurance card.
  •  

  • Call the customer service number to inquire specifically about Xarelto coverage and any required steps. Ask them to provide detailed information, such as copay amounts and possible restrictions.
  •  

  • Request guidance on the process for securing prior authorization or any additional paperwork that might be needed to facilitate coverage.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor the need for Xarelto and if it's the best option for you compared to alternatives.
  •  

  • Ask your healthcare provider to send a prescription directly to your preferred pharmacy, emphasizing if prior authorization is required.
  •  

  • Request your healthcare provider to assist in submitting any necessary medical documentation that Network Health might need for coverage approval.

 

Choose a Participating Pharmacy

 

  • Determine which pharmacies are in-network with Network Health by checking their pharmacy locator tool or asking customer service.
  •  

  • Select a pharmacy that's convenient for you and confirm if they have Xarelto in stock or if it can be ordered readily.
  •  

  • Inquire if the pharmacy can assist with the prior authorization process, often needed for Xarelto, to ease the insurance paperwork.

 

Complete Prior Authorization Process

 

  • If prior authorization is necessary, ensure your doctor submits the required request and any supporting documents to Network Health in a timely manner.
  •  

  • Monitor the status of the prior authorization by contacting Network Health or checking with your doctor’s office to ensure all paperwork is processed smoothly.
  •  

  • Be proactive in providing any additional information if requested by your insurance or healthcare provider to prevent delays in coverage.

 

Verify Coverage and Fill Prescription

 

  • Once prior authorization is approved, verify with Network Health that Xarelto is covered and understand any specific terms or conditions tied to your coverage.
  •  

  • Proceed to have your prescription filled at the selected participating pharmacy and confirm the copayment or out-of-pocket cost, if any, upfront.
  •  

  • Maintain communication with your pharmacy to address any unexpected issues or delays in receiving your Xarelto medication through your Network Health plan.

 

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FAQs

Does Network Health Cover Xarelto

Explore Network Health's coverage for Xarelto, reasons for denial, cost without insurance, and FAQs. Learn how to secure Xarelto coverage effectively.
Curex allergy drops unboxing

Is Xarelto Covered by Network Health

 

Does Network Health Cover Xarelto?

 

  • Xarelto coverage under Network Health typically applies to medically necessary situations, such as reducing the risk of stroke and blood clots in patients with atrial fibrillation, treating deep vein thrombosis (DVT), and preventing blood clots after surgery.
  •  

  • Coverage may depend on the specific health plan, so verifying with Network Health is essential. Prior authorization might be required.
  •  

  • Patients often need to meet specific criteria like medical history and current health condition to be eligible for coverage.
  •  

  • Members should consult with their healthcare provider, who can present required documentation to justify the medical necessity of Xarelto.
  •  

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Network Health's Approved Criteria for Xarelto Coverage

 

Coverage Criteria for Xarelto

 

  • Xarelto (rivaroxaban) is covered for patients who require anticoagulation therapy for the prevention of stroke and systemic embolism in individuals diagnosed with non-valvular atrial fibrillation.
  •  

  • Patients undergoing hip or knee replacement surgery are eligible for coverage of Xarelto as it aids in the prevention of deep vein thrombosis (DVT), which could lead to pulmonary embolism (PE).
  •  

  • The medication is covered for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and for the reduction in the risk of recurrence of DVT and PE after initial treatment.
  •  

  • Xarelto is approved for use in patients diagnosed with coronary artery disease (CAD) or peripheral artery disease (PAD) to reduce the risk of major cardiovascular events, such as stroke, heart attack, and death.
  •  

  • Coverage includes patients with acute coronary syndrome (ACS) who are at risk of thrombotic events when co-administered with aspirin and/or clopidogrel or ticlopidine.

 

Why Network Health Might Deny Xarelto Coverage

 

Reasons Network Health Might Deny Xarelto Coverage

 

  • **Non-Formulary Drug**: Xarelto may be classified as a non-preferred or non-formulary drug within certain Network Health plan tiers, leading to denial if alternatives are available.
  •  

  • **Lack of Prior Authorization**: Coverage might be denied if prior authorization was not obtained before the prescription, as Xarelto may require such authorization for approval.
  •  

  • **No Medical Necessity**: If documentation does not sufficiently justify the medical necessity of Xarelto, Network Health may deny coverage on these grounds.
  •  

  • **Off-Label Use**: Coverage can be denied if Xarelto is prescribed for an off-label use not approved by regulatory agencies or unsupported by evidence-based guidelines.
  •  

  • **Step Therapy Requirements**: Network Health might require patients to try and fail a different medication first. Xarelto may not be covered if these step therapy protocols are not followed.
  •  

  • **Patient Ineligibility**: Coverage may be rejected if the patient does not meet specific age, condition, or diagnostic criteria set by Network Health's policy for Xarelto usage.
  •  

  • **Incomplete Documentation**: Denials could occur due to missing or incomplete clinical documentation, such as diagnosis, previous treatment outcomes, or justification for Xarelto use.

 

Together with our partners we have changed the lives of over 300,000 patients.

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 Network Health

 

Research Xarelto Coverage by Network Health

 

  • Visit the official Network Health website and navigate to the "Pharmacy" or "Prescription Coverage" section for information about medication coverage options.
  •  

  • Review the formulary document, as it lists the drugs covered, their corresponding tiers, and any specific requirements such as prior authorization.
  •  

  • Check the list to verify if Xarelto is covered under Network Health's formulary. Note that coverage details may vary between plans.

 

Contact Network Health Customer Service

 

  • Locate the contact details for Network Health's customer service, which are usually available on their website or on your insurance card.
  •  

  • Call the customer service number to inquire specifically about Xarelto coverage and any required steps. Ask them to provide detailed information, such as copay amounts and possible restrictions.
  •  

  • Request guidance on the process for securing prior authorization or any additional paperwork that might be needed to facilitate coverage.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor the need for Xarelto and if it's the best option for you compared to alternatives.
  •  

  • Ask your healthcare provider to send a prescription directly to your preferred pharmacy, emphasizing if prior authorization is required.
  •  

  • Request your healthcare provider to assist in submitting any necessary medical documentation that Network Health might need for coverage approval.

 

Choose a Participating Pharmacy

 

  • Determine which pharmacies are in-network with Network Health by checking their pharmacy locator tool or asking customer service.
  •  

  • Select a pharmacy that's convenient for you and confirm if they have Xarelto in stock or if it can be ordered readily.
  •  

  • Inquire if the pharmacy can assist with the prior authorization process, often needed for Xarelto, to ease the insurance paperwork.

 

Complete Prior Authorization Process

 

  • If prior authorization is necessary, ensure your doctor submits the required request and any supporting documents to Network Health in a timely manner.
  •  

  • Monitor the status of the prior authorization by contacting Network Health or checking with your doctor’s office to ensure all paperwork is processed smoothly.
  •  

  • Be proactive in providing any additional information if requested by your insurance or healthcare provider to prevent delays in coverage.

 

Verify Coverage and Fill Prescription

 

  • Once prior authorization is approved, verify with Network Health that Xarelto is covered and understand any specific terms or conditions tied to your coverage.
  •  

  • Proceed to have your prescription filled at the selected participating pharmacy and confirm the copayment or out-of-pocket cost, if any, upfront.
  •  

  • Maintain communication with your pharmacy to address any unexpected issues or delays in receiving your Xarelto medication through your Network Health plan.

 

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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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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.

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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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