Does Priority Health Cover Xarelto

Explore Xarelto coverage with Priority Health, reasons for denial, and steps for approval. Learn Xarelto's uninsured costs in this detailed guide.
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Does Priority Health Cover Xarelto?

 

  • Priority Health may provide coverage for Xarelto, primarily if prescribed for approved conditions such as preventing blood clots post-surgery, treating deep vein thrombosis (DVT), pulmonary embolism (PE), or reducing stroke risks due to atrial fibrillation.
  •  

  • Coverage is typically contingent upon meeting specific criteria, including prior authorization. Physicians need to document the medical necessity accurately.
  •  

  • Patients may need to undergo step therapy, initially trying other treatments before qualifying for Xarelto coverage.
  •  

  • It's important for beneficiaries to review their specific policy details regarding formulary and tier placement to understand copayment responsibilities.
  •  

  • Contacting Priority Health's customer service can provide information tailored to individual plan benefits and any steps required to ensure coverage.

 

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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 Priority Health

 

Check Xarelto Coverage with Priority Health

 

  • Start by visiting the Priority Health official website to understand their coverage options for prescription drugs, specifically Xarelto.
  •  

  • Access the formulary or drug list provided by Priority Health to see if Xarelto is included. This list will show you if the medication is covered and under what tier.
  •  

 

Contact Priority Health Customer Service

 

  • Reach out to Priority Health customer service for personalized assistance regarding your Xarelto coverage. You can find their contact details on their website.
  •  

  • Prepare to provide your insurance policy ID and any details about your medical necessity for Xarelto to get accurate information.
  •  

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of taking Xarelto. They can provide documentation or notes that may be required for coverage approval.
  •  

  • Ask your provider if there are any preferred alternatives to Xarelto that are more readily covered by your insurance plan.
  •  

 

File Any Required Documentation

 

  • Gather any medical records, prescriptions, or doctor's notes that Priority Health may require for covering Xarelto.
  •  

  • If a prior authorization form is required, work with your healthcare provider to complete and submit it to Priority Health.
  •  

 

Understand Cost Sharing and Co-payments

 

  • Review your plan details to know how much you will pay out-of-pocket for Xarelto. This may include co-payments or co-insurance obligations.
  •  

  • Consider the tier under which Xarelto is categorized to better understand your financial responsibilities.
  •  

 

Explore Financial Assistance Programs

 

  • Inquire with your healthcare provider or pharmacy about manufacturer coupons or patient assistance programs that can help reduce the cost of Xarelto.
  •  

  • Check online for any additional savings programs associated with Xarelto that may offer discounts or rebates.
  •  

 

Reassess Coverage Annually

 

  • Each year, review any changes to the Priority Health formulary or your specific insurance plan to ensure Xarelto remains covered.
  •  

  • If coverage changes, contact Priority Health or your employer's benefits administrator to understand your options.
  •  

 

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FAQs

Does Priority Health Cover Xarelto

Explore Xarelto coverage with Priority Health, reasons for denial, and steps for approval. Learn Xarelto's uninsured costs in this detailed guide.
Curex allergy drops unboxing

Is Xarelto Covered by Priority Health

 

Does Priority Health Cover Xarelto?

 

  • Priority Health may provide coverage for Xarelto, primarily if prescribed for approved conditions such as preventing blood clots post-surgery, treating deep vein thrombosis (DVT), pulmonary embolism (PE), or reducing stroke risks due to atrial fibrillation.
  •  

  • Coverage is typically contingent upon meeting specific criteria, including prior authorization. Physicians need to document the medical necessity accurately.
  •  

  • Patients may need to undergo step therapy, initially trying other treatments before qualifying for Xarelto coverage.
  •  

  • It's important for beneficiaries to review their specific policy details regarding formulary and tier placement to understand copayment responsibilities.
  •  

  • Contacting Priority Health's customer service can provide information tailored to individual plan benefits and any steps required to ensure coverage.

 

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Priority Health's Approved Criteria for Xarelto Coverage

 

Criteria for Xarelto Coverage

 

  • Xarelto is covered for patients who are diagnosed with non-valvular atrial fibrillation to reduce the risk of stroke and systemic embolism.
  •  

  • Candidates eligible for orthopedic surgery can receive coverage for Xarelto for the prevention of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), especially after knee or hip replacement surgery.
  •  

  • Xarelto is approved for the treatment of DVT and PE and is covered for the reduction in the risk of recurrence of these conditions.
  •  

  • Patients diagnosed with coronary artery disease (CAD) or peripheral artery disease (PAD) can receive Xarelto coverage to reduce the risk of major cardiovascular events, including cardiovascular death, myocardial infarction, and stroke.
  •  

  • Xarelto is covered for those with a history of acute coronary syndrome (ACS) when used in combination with aspirin to lower the risk of cardiovascular events.
  •  

  • Coverage is provided for pediatric patients aged 2 years and older for the treatment of venous thromboembolism (VTE), including DVT or PE, and reduction in the risk of recurrent VTE in pediatric patients.
  •  

Why Priority Health Might Deny Xarelto Coverage

 

Situations Where Priority Health Might Deny Xarelto Coverage

 

  • **Non-Compliance with Formulary Requirements**: Xarelto may not be covered if it is not listed on the formulary unless there's a valid exception.
  •  

  • **Lack of Prior Authorization**: Coverage could be denied if proper prior authorization procedures are not followed. This means failing to obtain necessary approvals before the medication is dispensed.
  •  

  • **Generic Alternatives Requirement**: If a generic alternative is available and preferred by the plan, Priority Health might require the use of the generic unless there is an exception due to medical necessity.
  •  

  • **Inadequate Medical Justification**: Xarelto may not be covered if there is insufficient medical documentation to justify its use over other available therapies.
  •  

  • **Off-Label Use**: Use of Xarelto for conditions not approved by the FDA may lead to a denial unless it is explicitly covered under specific plan terms.
  •  

  • **Exclusion from Specific Plan Benefits**: Certain plans may have exclusions that specifically rule out coverage for Xarelto based on the benefits offered or the nature of the plan.

 

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 Priority Health

 

Check Xarelto Coverage with Priority Health

 

  • Start by visiting the Priority Health official website to understand their coverage options for prescription drugs, specifically Xarelto.
  •  

  • Access the formulary or drug list provided by Priority Health to see if Xarelto is included. This list will show you if the medication is covered and under what tier.
  •  

 

Contact Priority Health Customer Service

 

  • Reach out to Priority Health customer service for personalized assistance regarding your Xarelto coverage. You can find their contact details on their website.
  •  

  • Prepare to provide your insurance policy ID and any details about your medical necessity for Xarelto to get accurate information.
  •  

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about the necessity of taking Xarelto. They can provide documentation or notes that may be required for coverage approval.
  •  

  • Ask your provider if there are any preferred alternatives to Xarelto that are more readily covered by your insurance plan.
  •  

 

File Any Required Documentation

 

  • Gather any medical records, prescriptions, or doctor's notes that Priority Health may require for covering Xarelto.
  •  

  • If a prior authorization form is required, work with your healthcare provider to complete and submit it to Priority Health.
  •  

 

Understand Cost Sharing and Co-payments

 

  • Review your plan details to know how much you will pay out-of-pocket for Xarelto. This may include co-payments or co-insurance obligations.
  •  

  • Consider the tier under which Xarelto is categorized to better understand your financial responsibilities.
  •  

 

Explore Financial Assistance Programs

 

  • Inquire with your healthcare provider or pharmacy about manufacturer coupons or patient assistance programs that can help reduce the cost of Xarelto.
  •  

  • Check online for any additional savings programs associated with Xarelto that may offer discounts or rebates.
  •  

 

Reassess Coverage Annually

 

  • Each year, review any changes to the Priority Health formulary or your specific insurance plan to ensure Xarelto remains covered.
  •  

  • If coverage changes, contact Priority Health or your employer's benefits administrator to understand your options.
  •  

 

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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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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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