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Does Priority Health Cover Farxiga

Explore if Priority Health covers Farxiga, reasons for denial, tips for securing coverage, costs without insurance, and FAQs.
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Does Priority Health Cover Farxiga?

 

  • Priority Health may cover Farxiga, a medication used to treat Type 2 diabetes, heart failure, and chronic kidney disease, based on specific plans and conditions.

    •  

  • Coverage criteria typically include a documented diagnosis aligned with FDA-approved indications.

    •  

  • Prior authorization might be required, meaning your healthcare provider needs to demonstrate the medical necessity of Farxiga before coverage is granted.

    •  

  • Patients may have to try other preferred formulary medications first, unless deemed inappropriate by their physician.

    •  

  • Cost-sharing requirements such as copayments or coinsurance may apply depending on your specific plan tier.

    •  

  • To confirm coverage, review your plan's drug formulary or contact Priority Health customer service directly.

 

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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 Farxiga Coverage with Priority Health

 

Verify Your Eligibility

 

  • Confirm your prescription for Farxiga, which is prescribed for conditions such as type 2 diabetes, heart failure, or chronic kidney disease.
  • Check if your specific medical condition falls within the approved list for Farxiga coverage by Priority Health.
  • Ensure you have active health insurance coverage with Priority Health.

 

Review Your Health Plan Benefits

 

  • Log into your Priority Health member account to review your health plan benefits.
  • Check if Farxiga is listed under the covered medications in your plan’s formulary.
  • Identify any special criteria or prior authorization requirements for coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss the necessity of Farxiga with your healthcare provider.
  • Request detailed medical documentation and justification for Farxiga to aid in getting it covered.
  • Ensure your provider understands the necessary steps for obtaining prior authorization if needed.

 

Submit a Prior Authorization Request

 

  • If required, have your healthcare provider submit a prior authorization request to Priority Health.
  • Ensure all necessary documentation, including medical records and justification for Farxiga, is included in the submission.
  • Follow up with your provider or Priority Health to confirm receipt and processing of the request.

 

Understand the Costs and Co-Payments

 

  • Find out about any co-payment or out-of-pocket costs associated with Farxiga under your plan.
  • Use the Priority Health cost estimator tool, if available, to calculate your expected expenses.
  • Inquire about financial assistance programs for high co-payments if needed.

 

Enroll in a Savings Program

 

  • Research available pharmaceutical savings programs or coupons for Farxiga.
  • Consider enrolling in the AstraZeneca Savings Program, which may reduce your out-of-pocket costs for Farxiga.
  • Combine these savings with your Priority Health coverage to minimize expenses.

 

Monitor Your Coverage Status

 

  • Regularly check with Priority Health and your pharmacy to ensure ongoing Farxiga coverage.
  • Be aware of any changes in your health plan that could affect coverage in the future.
  • Contact Priority Health customer service for assistance if any issues arise with coverage or claims.

 

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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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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Priority Health Cover Farxiga

Explore if Priority Health covers Farxiga, reasons for denial, tips for securing coverage, costs without insurance, and FAQs.
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Is Farxiga Covered by Priority Health

 

Does Priority Health Cover Farxiga?

 

  • Priority Health may cover Farxiga, a medication used to treat Type 2 diabetes, heart failure, and chronic kidney disease, based on specific plans and conditions.

    •  

  • Coverage criteria typically include a documented diagnosis aligned with FDA-approved indications.

    •  

  • Prior authorization might be required, meaning your healthcare provider needs to demonstrate the medical necessity of Farxiga before coverage is granted.

    •  

  • Patients may have to try other preferred formulary medications first, unless deemed inappropriate by their physician.

    •  

  • Cost-sharing requirements such as copayments or coinsurance may apply depending on your specific plan tier.

    •  

  • To confirm coverage, review your plan's drug formulary or contact Priority Health customer service directly.

 

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Priority Health's Approved Criteria for Farxiga Coverage

 

Eligibility for Farxiga Coverage

 

  • Patient must have a confirmed diagnosis of Type 2 Diabetes Mellitus.

    •  

  • Documentation of lifestyle modifications, such as diet and exercise, attempted to improve glycemic control.

    •  

  • Evidence that the patient is 18 years of age or older.

    •  

 

Requirements for Heart Failure

 

  • Documentation confirming diagnosis of heart failure with a reduced ejection fraction.

    •  

  • Demonstration that Farxiga is being used as an adjunct to standard heart failure therapies.

    •  

  • Patient must not have contraindications to the use of SGLT2 inhibitors.

    •  

 

Chronic Kidney Disease Criteria

 

  • Diagnosis of chronic kidney disease, stages 3 to 4, supported by lab results.

    •  

  • Confirmation that the patient is not on dialysis.

    •  

  • Indication for Farxiga must be consistent with improving renal outcomes and delaying progression of kidney disease.

    •  

 

Monitoring and Follow-up

 

  • Ongoing assessment of the patient's blood glucose levels and HbA1c to gauge effectiveness.

    •  

  • Regular monitoring of renal function through laboratory tests, as appropriate for the patient's condition.

    •  

  • Continuous review and documentation of patient adherence to prescribed treatment regimen.

    •  

 

Additional Considerations

 

  • Verification that patient education on the use and potential side effects of Farxiga has been provided.

    •  

  • Documentation of any previous adverse reactions to other diabetes medications, if applicable.

    •  

  • Review of any concurrent medications that may interact with Farxiga to avoid detrimental effects.

    •  

 

Why Priority Health Might Deny Farxiga Coverage

 

Why Priority Health Might Deny Farxiga Coverage

 

  • Non-Medical Necessity: Priority Health may deny coverage if Farxiga is not deemed medically necessary for the patient's condition. This could occur if other treatment options are considered more appropriate based on clinical guidelines.

    •  

  • Lack of Prior Authorization: If the patient or prescriber fails to obtain necessary prior authorization before starting Farxiga, the claim might be denied.

    •  

  • Off-Label Use: Farxiga might be denied if prescribed for conditions that are not within the FDA-approved indications or outside the peer-reviewed medical standards recognized by Priority Health.

    •  

  • Failure to Meet Step Therapy Requirements: If Farxiga is not the first-line treatment, and step therapy protocols require the use of other drugs first, coverage might be denied if these steps are not followed.

    •  

  • Non-Compliance with Plan Requirements: Coverage could be denied if the patient does not adhere to specific plan rules, such as using a designated network pharmacy or participating in required management programs.

    •  

  • Exceeded Dosage Limits: If the prescribed dosage exceeds established limits set by Priority Health, the medication may be denied for coverage.

    •  

  • Policy Exclusions: Farxiga might not be covered if it falls under specific exclusions in the patient's health plan policy, such as exclusions for certain conditions or protocols.

 

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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.

 

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 Farxiga Coverage with Priority Health

 

Verify Your Eligibility

 

  • Confirm your prescription for Farxiga, which is prescribed for conditions such as type 2 diabetes, heart failure, or chronic kidney disease.
  • Check if your specific medical condition falls within the approved list for Farxiga coverage by Priority Health.
  • Ensure you have active health insurance coverage with Priority Health.

 

Review Your Health Plan Benefits

 

  • Log into your Priority Health member account to review your health plan benefits.
  • Check if Farxiga is listed under the covered medications in your plan’s formulary.
  • Identify any special criteria or prior authorization requirements for coverage.

 

Consult with Your Healthcare Provider

 

  • Discuss the necessity of Farxiga with your healthcare provider.
  • Request detailed medical documentation and justification for Farxiga to aid in getting it covered.
  • Ensure your provider understands the necessary steps for obtaining prior authorization if needed.

 

Submit a Prior Authorization Request

 

  • If required, have your healthcare provider submit a prior authorization request to Priority Health.
  • Ensure all necessary documentation, including medical records and justification for Farxiga, is included in the submission.
  • Follow up with your provider or Priority Health to confirm receipt and processing of the request.

 

Understand the Costs and Co-Payments

 

  • Find out about any co-payment or out-of-pocket costs associated with Farxiga under your plan.
  • Use the Priority Health cost estimator tool, if available, to calculate your expected expenses.
  • Inquire about financial assistance programs for high co-payments if needed.

 

Enroll in a Savings Program

 

  • Research available pharmaceutical savings programs or coupons for Farxiga.
  • Consider enrolling in the AstraZeneca Savings Program, which may reduce your out-of-pocket costs for Farxiga.
  • Combine these savings with your Priority Health coverage to minimize expenses.

 

Monitor Your Coverage Status

 

  • Regularly check with Priority Health and your pharmacy to ensure ongoing Farxiga coverage.
  • Be aware of any changes in your health plan that could affect coverage in the future.
  • Contact Priority Health customer service for assistance if any issues arise with coverage or claims.

 

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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.

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.

    •  

Have questions left?

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“The Curex staff has been professional, efficient, and really focused on my individual needs.”
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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.
‍
Curex-affiliated medical practices are independently owned and operated by licensed physicians who provide services using the Curex telehealth platform.

Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.

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