Does Oscar Health Cover Xarelto

Explore Xarelto coverage by Oscar Health, reasons for denial, tips to secure it, cost without insurance, and answers to common questions.
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Oscar Health Coverage for Xarelto

 

  • Oscar Health may cover Xarelto, a prescription medication used to prevent blood clots. Coverage often depends on the patient’s plan and medical necessity.
  •  

  • To get Xarelto covered, a doctor typically needs to provide documentation indicating it's medically necessary. This often involves demonstrating that Xarelto is required for conditions like atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism.
  •  

  • Patients may be required to try another medication before Xarelto is approved, a process known as “step therapy.” Check if Xarelto is on Oscar Health's formulary list, which includes medications covered by their insurance plans.
  •  

  • Policyholders should verify if a prior authorization is needed, where the insurer approves the prescription before filling it.
  •  

  • Discuss potential out-of-pocket costs with the insurer, as they can vary based on the specific plan and tier level of the medication.

 

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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 Xarelto Coverage with Oscar Health

 

Research Prescription Coverage

 

  • Start by reviewing Oscar Health's formulary to check if Xarelto is covered under your current plan. You can access this document through your Oscar Health member portal or by contacting member services.
  •  

  • Identify the tier classification of Xarelto in your plan’s formulary, as this will affect the cost and coverage requirements such as prior authorization or step therapy.
  •  

  • Understand any applicable co-pays, co-insurance, or deductible requirements associated with accessing medications like Xarelto.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Xarelto and explore any medical documentation needed for insurance coverage.
  •  

  • Ask your doctor to provide a detailed prescription that includes sufficient medical justification if Oscar Health requires prior authorization for Xarelto.
  •  

  • Request your healthcare provider's assistance in communicating with Oscar Health should any additional documentation be necessary.

 

Contact Oscar Health

 

  • Reach out to Oscar Health's customer service to verify coverage details and necessary procedures for obtaining Xarelto under your insurance plan.
  •  

  • Inquire about the prior authorization process if required, and ask for any forms or documentation that may need your completion.
  •  

  • Verify whether there are preferred pharmacies for fulfilling prescriptions under your plan, which might impact your out-of-pocket costs.

 

Submit Prior Authorization

 

  • If prior authorization is necessary, work with your doctor to fill out and submit the correct forms to Oscar Health. This often involves detailing the medical necessity of Xarelto.
  •  

  • Ensure that forms are complete and signed by both you and your healthcare provider. Submit any additional documentation that Oscar Health may require.
  •  

  • Track the status of your prior authorization by keeping in touch with Oscar Health until a decision is finalized.

 

Fill Your Prescription

 

  • Upon receiving approval from Oscar Health, visit an in-network pharmacy to fill your prescription for Xarelto.
  •  

  • Provide any necessary documentation or proof of insurance to the pharmacy to apply your Oscar Health benefits.
  •  

  • Review the filled prescription to ensure it matches what your doctor prescribed, and verify the cost against your expected out-of-pocket expenses.

 

Appeal if Denied

 

  • If your request for coverage is denied, carefully review the denial letter to understand the specific reasons Oscar Health provided.
  •  

  • Work with your doctor to gather additional necessary documentation and submit an appeal to Oscar Health for reconsideration of your Xarelto prescription.
  •  

  • Follow up both telephonically and in writing to ensure your appeal is being reviewed and addressed in a timely manner.
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FAQs

Does Oscar Health Cover Xarelto

Explore Xarelto coverage by Oscar Health, reasons for denial, tips to secure it, cost without insurance, and answers to common questions.
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Is Xarelto Covered by Oscar Health

 

Oscar Health Coverage for Xarelto

 

  • Oscar Health may cover Xarelto, a prescription medication used to prevent blood clots. Coverage often depends on the patient’s plan and medical necessity.
  •  

  • To get Xarelto covered, a doctor typically needs to provide documentation indicating it's medically necessary. This often involves demonstrating that Xarelto is required for conditions like atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism.
  •  

  • Patients may be required to try another medication before Xarelto is approved, a process known as “step therapy.” Check if Xarelto is on Oscar Health's formulary list, which includes medications covered by their insurance plans.
  •  

  • Policyholders should verify if a prior authorization is needed, where the insurer approves the prescription before filling it.
  •  

  • Discuss potential out-of-pocket costs with the insurer, as they can vary based on the specific plan and tier level of the medication.

 

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Oscar Health's Approved Criteria for Xarelto Coverage

 

Oscar Health's Approved Criteria for Xarelto Coverage

 

  • **Indication for Use**: Coverage is provided for Xarelto when prescribed for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation.
  •  

  • **Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)**: Approved for patients requiring prophylaxis of DVT, which may lead to PE, following hip or knee replacement surgery.
  •  

  • **Risk of Recurrence**: Coverage is available for patients receiving Xarelto to reduce the risk of recurrence of DVT and PE in those who have experienced such conditions previously.
  •  

  • **Acute Treatment**: Patients who require the acute treatment of DVT and PE are eligible when treatment is initiated in conjunction with warfarin transition.
  •  

  • **Cardiovascular Risk Reduction**: Coverage extends to those at risk for major cardiovascular events, such as myocardial infarction or stroke, especially when Xarelto is part of a broader management plan.
  •  

  • **Prescriber Qualification**: The prescriber must be a licensed healthcare professional with experience in managing conditions treated by Xarelto.
  •  

  • **Age Consideration**: Patients must be within the approved age range based on FDA guidelines, typically covering adult treatment.
  •  

  • **Documentation of Medical Necessity**: Providers must supply documentation that demonstrates the medical necessity of Xarelto, aligning with Oscar Health's clinical guidelines.

 

Pharmacy and Dosage Specifications

 

  • **Formulary Availability**: Xarelto must be available in Oscar Health's drug formulary, and prescribed dosages must adhere to approved guideline recommendations.
  •  

  • **Preferred Medication Status**: Prescriptions of Xarelto should conform with preferred medication status based on current formulary agreements unless otherwise justified.
  •  

  • **Dosage Adjustments and Compliance**: Patients may need to show adherence to prescribed dosage levels and any required adjustments for continued coverage.

 

Special Authorization Requirements

 

  • **Prior Authorization**: Certain cases may necessitate prior authorization to verify appropriate clinical usage and alignment with Oscar Health policies.
  •  

  • **Clinical Review Process**: Availability of a clinical review process to assess complex cases or requests for exceptions to standard coverage criteria.

 

Continuous Coverage Considerations

 

  • **Regular Monitoring and Evaluation**: Patients may be subject to periodic evaluations to ensure continued eligibility based on their response to treatment and ongoing health status.
  •  

  • **Renewal of Coverage**: Renewals for Xarelto coverage often require updated prescriptions and affirmation of ongoing medical need.

 

Why Oscar Health Might Deny Xarelto Coverage

 

Criteria for Xarelto Non-Coverage by Oscar Health

 

  • **Non-Formulary Drug**: Xarelto may not be covered if it is not included in Oscar Health's drug formulary, which is a list of medications approved for coverage under their plans.
  •  

  • **Lack of Prior Authorization**: If prior authorization is required but not obtained before prescribing Xarelto, coverage can be denied. This involves getting approval from Oscar Health before the prescription is filled.
  •  

  • **Off-Label Usage**: Xarelto prescribed for conditions not approved by the FDA or not listed as covered uses by Oscar Health may result in denial of coverage.
  •  

  • **Non-compliance with Step Therapy**: If step therapy protocols are in place and not followed—meaning other medications should be tried first before Xarelto—coverage might be denied.
  •  

  • **Duplicate Therapy**: Situations where Xarelto is prescribed alongside similar anticoagulants without a clear medical justification might lead to denial.
  •  

  • **Plan Exclusions**: Xarelto might fall under exclusions specific to the member’s plan, such as certain types of drugs not being covered.
  •  

  • **Failure to Meet Medical Necessity Criteria**: If Xarelto does not meet the established criteria for medical necessity based on Oscar Health's policies, coverage can be denied.
  •  

 

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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 Oscar Health

 

Research Prescription Coverage

 

  • Start by reviewing Oscar Health's formulary to check if Xarelto is covered under your current plan. You can access this document through your Oscar Health member portal or by contacting member services.
  •  

  • Identify the tier classification of Xarelto in your plan’s formulary, as this will affect the cost and coverage requirements such as prior authorization or step therapy.
  •  

  • Understand any applicable co-pays, co-insurance, or deductible requirements associated with accessing medications like Xarelto.

 

Consult with Your Healthcare Provider

 

  • Schedule an appointment with your doctor to discuss your need for Xarelto and explore any medical documentation needed for insurance coverage.
  •  

  • Ask your doctor to provide a detailed prescription that includes sufficient medical justification if Oscar Health requires prior authorization for Xarelto.
  •  

  • Request your healthcare provider's assistance in communicating with Oscar Health should any additional documentation be necessary.

 

Contact Oscar Health

 

  • Reach out to Oscar Health's customer service to verify coverage details and necessary procedures for obtaining Xarelto under your insurance plan.
  •  

  • Inquire about the prior authorization process if required, and ask for any forms or documentation that may need your completion.
  •  

  • Verify whether there are preferred pharmacies for fulfilling prescriptions under your plan, which might impact your out-of-pocket costs.

 

Submit Prior Authorization

 

  • If prior authorization is necessary, work with your doctor to fill out and submit the correct forms to Oscar Health. This often involves detailing the medical necessity of Xarelto.
  •  

  • Ensure that forms are complete and signed by both you and your healthcare provider. Submit any additional documentation that Oscar Health may require.
  •  

  • Track the status of your prior authorization by keeping in touch with Oscar Health until a decision is finalized.

 

Fill Your Prescription

 

  • Upon receiving approval from Oscar Health, visit an in-network pharmacy to fill your prescription for Xarelto.
  •  

  • Provide any necessary documentation or proof of insurance to the pharmacy to apply your Oscar Health benefits.
  •  

  • Review the filled prescription to ensure it matches what your doctor prescribed, and verify the cost against your expected out-of-pocket expenses.

 

Appeal if Denied

 

  • If your request for coverage is denied, carefully review the denial letter to understand the specific reasons Oscar Health provided.
  •  

  • Work with your doctor to gather additional necessary documentation and submit an appeal to Oscar Health for reconsideration of your Xarelto prescription.
  •  

  • Follow up both telephonically and in writing to ensure your appeal is being reviewed and addressed in a timely manner.

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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.

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.

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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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