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Does Priority Health Cover Eliquis

Explore Eliquis coverage by Priority Health, potential denial reasons, costs without insurance, and access tips in this comprehensive guide.
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Priority Health Coverage for Eliquis

 

  • Priority Health generally covers Eliquis if it's deemed medically necessary. It's commonly covered for conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism.

    •  

  • To get Eliquis covered, your healthcare provider must prescribe it and demonstrate its necessity based on your medical condition.

    •  

  • Prior authorization may be required, meaning your doctor needs to provide specific information to Priority Health to confirm the drug's necessity.

    •  

  • Coverage also depends on your specific health plan, so checking the formulary or contacting Priority Health directly for plan-specific details is crucial.

    •  

  • For optimal coverage, use in-network pharmacies and adhere to any step therapy protocols that might require trying other medications first.

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Clinical Support

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 Eliquis Coverage with Priority Health

 

Understand Your Coverage Options

 

  • Begin by reviewing your Priority Health plan documents or visiting their website to understand the specific coverage options available for medications like Eliquis. This can include checking your plan's formulary to see if Eliquis is listed as a covered drug.

    •  

  • If Eliquis is not covered, look for alternative medications that are listed, and note any potential requirements such as prior authorization or step therapy.

 

Consult with Your Doctor

 

  • Discuss with your healthcare provider about the necessity of Eliquis for your condition. Ensure they are aware of your Priority Health insurance coverage and any formulary restrictions or requirements that might apply.

    •  

  • Ask your doctor if any additional documentation or justification is needed to support the medical necessity of Eliquis for your treatment plan.

 

Contact Priority Health

 

  • Reach out to Priority Health customer service by phone or through your online account to get clarification on Eliquis coverage, potential costs, and any necessary steps you need to follow for approval.

    •  

  • Inquire about any specific forms or applications required for pre-authorization or to request coverage exceptions for Eliquis.

 

Complete Necessary Documentation

 

  • If prior authorization is necessary, work with your healthcare provider to complete and submit the required forms to Priority Health. Ensure all information is accurate and complete to avoid delays.

    •  

  • If applicable, provide additional documentation such as test results or a letter of medical necessity from your doctor to strengthen your request.

 

Follow Up on Your Request

 

  • After submitting your prior authorization request or coverage exception, monitor the status by maintaining communication with Priority Health. You can do this through your online account or by contacting their customer service.

    •  

  • If your request is approved, review any details or instructions provided regarding your Eliquis coverage, including co-pays, pharmacy requirements, or restrictions.

 

Explore Alternative Solutions

 

  • If your request for Eliquis coverage is denied, consult with your healthcare provider to discuss alternative medications that may be covered by your Priority Health plan.

    •  

  • Consider checking if you qualify for manufacturer savings programs or patient assistance programs that offer discounts or financial assistance for Eliquis.

 

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Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

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FAQs

Does Priority Health Cover Eliquis

Explore Eliquis coverage by Priority Health, potential denial reasons, costs without insurance, and access tips in this comprehensive guide.
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Is Eliquis Covered by Priority Health

 

Priority Health Coverage for Eliquis

 

  • Priority Health generally covers Eliquis if it's deemed medically necessary. It's commonly covered for conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism.

    •  

  • To get Eliquis covered, your healthcare provider must prescribe it and demonstrate its necessity based on your medical condition.

    •  

  • Prior authorization may be required, meaning your doctor needs to provide specific information to Priority Health to confirm the drug's necessity.

    •  

  • Coverage also depends on your specific health plan, so checking the formulary or contacting Priority Health directly for plan-specific details is crucial.

    •  

  • For optimal coverage, use in-network pharmacies and adhere to any step therapy protocols that might require trying other medications first.

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Priority Health's Approved Criteria for Eliquis Coverage

 

Eligibility Criteria for Eliquis Coverage

 

  • Eliquis coverage is extended to adult patients with a diagnosis of non-valvular atrial fibrillation who require stroke prevention.

    •  

  • Patients with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) who require anticoagulation may qualify for coverage.

    •  

  • Candidates must have undergone a thorough cardiovascular assessment confirming the necessity for anticoagulation therapy.

 

Medical Necessity Requirements

 

  • Individuals who have demonstrated clinical signs of reduced efficacy with other anticoagulant treatments may be eligible.

    •  

  • Patients with documented intolerance or contraindications to warfarin or other direct oral anticoagulants can be covered.

    •  

  • Patients recently undergoing hip or knee replacement surgery who require anticoagulation fall within the coverage criteria.

 

Prior Authorization Process

 

  • A comprehensive medical history and current medication list must be provided for consideration.

    •  

  • Submission of relevant laboratory results and imaging studies supporting the requirement for Eliquis is necessary.

    •  

  • All requests for coverage require prior authorization to ensure the appropriate therapeutic use of Eliquis.

 

Clinical Evaluation and Monitoring

 

  • Ongoing monitoring of renal function, as well as regular cardiovascular evaluations, must be planned and documented.

    •  

  • Assessment must be completed to ensure optimal dosage and safety based on patient-specific factors.

    •  

  • Documentation of periodic follow-ups indicating review of therapy effectiveness and adverse effect profile is required for continued coverage.

 

Why Priority Health Might Deny Eliquis Coverage

 

Reasons for Priority Health to Deny Eliquis Coverage

 

  • Lack of Medical Necessity: Coverage may be denied if there is insufficient documentation proving the medical necessity for Eliquis. Medical records and prescriptions should clearly justify the need for this specific medication over alternatives.

    •  

  • Non-Compliance with Prior Authorization: If prior authorization was required and not obtained before the purchase of Eliquis, Priority Health might deny coverage. Make sure to complete all necessary pre-approval steps.

    •  

  • Alternative Treatments Available: Coverage may be denied if there are equivalent, more cost-effective alternatives available that have not been tried. Priority Health could require attempting different medications first.

    •  

  • Off-Label Use: Using Eliquis for conditions not approved by relevant health authorities may result in denial of coverage. Ensure Eliquis is prescribed for approved conditions only.

    •  

  • Non-Formulary Medication: If Eliquis is not included on the health plan's formulary list, coverage might be denied. It's important to verify if Eliquis is part of the approved medication list under the specific health plan.

    •  

  • Lapse in Coverage: If there are disruptions or lapses in health insurance coverage, Priority Health may deny claims for Eliquis dispensed during the uncovered period.

    •  

  • Plan Limitations and Exclusions: Some specific health plans might have explicit exclusions for certain medications or limit the duration or quantity of drugs covered. Ensure understanding of any limitations within the specific plan.

 

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How Much Does Eliquis Cost without Insurance?

 

Approximate Cost of Eliquis without Insurance

 

  • The cost of Eliquis, a commonly prescribed blood thinner, can vary based on the pharmacy, location, and any available discounts or coupons. On average, without insurance, Eliquis can cost around $550 to $650 for a 30-day supply.

    •  

  • Some pharmacies or online platforms may offer discounts or generic options that can lower the cost, so it's advisable to shop around. Patients should also inquire about manufacturer coupons or assistance programs that might help reduce the price.

    •  

  • Price comparison tools and websites can be helpful in finding the best available prices for Eliquis in your area.

 

Clinical Support

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 Eliquis Coverage with Priority Health

 

Understand Your Coverage Options

 

  • Begin by reviewing your Priority Health plan documents or visiting their website to understand the specific coverage options available for medications like Eliquis. This can include checking your plan's formulary to see if Eliquis is listed as a covered drug.

    •  

  • If Eliquis is not covered, look for alternative medications that are listed, and note any potential requirements such as prior authorization or step therapy.

 

Consult with Your Doctor

 

  • Discuss with your healthcare provider about the necessity of Eliquis for your condition. Ensure they are aware of your Priority Health insurance coverage and any formulary restrictions or requirements that might apply.

    •  

  • Ask your doctor if any additional documentation or justification is needed to support the medical necessity of Eliquis for your treatment plan.

 

Contact Priority Health

 

  • Reach out to Priority Health customer service by phone or through your online account to get clarification on Eliquis coverage, potential costs, and any necessary steps you need to follow for approval.

    •  

  • Inquire about any specific forms or applications required for pre-authorization or to request coverage exceptions for Eliquis.

 

Complete Necessary Documentation

 

  • If prior authorization is necessary, work with your healthcare provider to complete and submit the required forms to Priority Health. Ensure all information is accurate and complete to avoid delays.

    •  

  • If applicable, provide additional documentation such as test results or a letter of medical necessity from your doctor to strengthen your request.

 

Follow Up on Your Request

 

  • After submitting your prior authorization request or coverage exception, monitor the status by maintaining communication with Priority Health. You can do this through your online account or by contacting their customer service.

    •  

  • If your request is approved, review any details or instructions provided regarding your Eliquis coverage, including co-pays, pharmacy requirements, or restrictions.

 

Explore Alternative Solutions

 

  • If your request for Eliquis coverage is denied, consult with your healthcare provider to discuss alternative medications that may be covered by your Priority Health plan.

    •  

  • Consider checking if you qualify for manufacturer savings programs or patient assistance programs that offer discounts or financial assistance for Eliquis.

 

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Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

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Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Eliquis FAQ

What are the side effects of Eliquis?

 

Common Side Effects of Eliquis

 

  • Mild bleeding or bruising due to its anticoagulant effect.
  • Nausea, which may occur as your body adjusts to the medication.
  • Skin rash or minor allergic reactions.
  • Fatigue or general weakness.

 

Serious Side Effects

 

  • Severe bleeding, including unusual bleeding from gums, nosebleeds, or heavier than usual menstrual bleeding.
  • Red, pink, or brown urine and black or bloody stools indicating internal bleeding.
  • Severe headache, dizziness, or fainting, which could indicate a bleed in the brain.
  • Signs of anemia, such as pale skin, weakness, or fatigue.

 

Consult Your Doctor

 

  • Always report any unusual symptoms to your healthcare provider promptly.
  • Seek emergency medical attention for significant bleeding or symptoms of a serious allergic reaction like difficulty breathing.

 

Is Eliquis a blood thinner?

 

Is Eliquis a Blood Thinner?

 

  • Yes, Eliquis (apixaban) is a blood thinner, also known as an anticoagulant.

    •  

  • It prevents blood clots by inhibiting Factor Xa, which is crucial in the clotting process.

    •  

  • Doctors prescribe Eliquis to reduce stroke risk in patients with atrial fibrillation and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).

    •  

  • Ensure regular monitoring and follow-ups with your healthcare provider while on Eliquis for safe management.

    •  

  • Contact a healthcare professional if you have concerns about bleeding risks or interactions with other medications.

 

Can you take Eliquis with alcohol?

 

Alcohol and Eliquis Interaction

 

  • Moderate alcohol consumption might be safe, but heavy drinking can increase bleeding risk.

    •  

  • Consult your healthcare provider to assess your specific condition and alcohol tolerance.

 

Potential Effects of Combining

 

  • Both Eliquis and alcohol affect blood clotting, raising potential for heightened bleeding.

    •  

  • Alcohol can augment Eliquis' effects, complicating the management of conditions like atrial fibrillation.

 

Recommendations for Use

 

  • If you drink, limit to one or two standard drinks occasionally and monitor for bruising or bleeding.

    •  

  • Report any unusual symptoms to your healthcare provider immediately.

 

Have questions left?

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A weight management program tailored to you

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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Curex provides allergy care plans for allergies, asthma, eczema and pet allergies.

Curex providers may prescribe sublingual allergy drops that contain the same ingredients as allergy shots but are more convenient & affordable.
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Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

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