Does Regence Cover Eliquis

Explore Regence coverage for Eliquis. Learn reasons for denial, steps to secure coverage, costs without insurance, and get answers with our FAQ.
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Coverage for Eliquis under Regence

 

  • Regence typically covers Eliquis for conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism as it is often prescribed for clot prevention and treatment.
  •  

  • Coverage is subject to plan-specific terms and may vary based on individual policy details, so it's important to verify your own plan's formulary.

 

Basic Rules and Criteria

 

  • Pre-authorization may be required to confirm that Eliquis is medically necessary for your condition.
  •  

  • Regence usually needs evidence that you've tried other anticoagulants and didn't achieve the desired outcome, or that you're at higher risk of complications with alternatives.
  •  

  • Checking whether Eliquis is in a preferred tier of your formulary can affect co-pay and out-of-pocket costs.

 

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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 Eliquis Coverage with Regence

 

Evaluate Your Current Regence Plan

 

  • Log in to your Regence member account online to review your current coverage or consult your plan documentation to understand your pharmacy benefits.
  • Check if Eliquis is listed on the formulary, which is the list of medications covered under your plan. If unsure, contact Regence customer service for confirmation.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Eliquis for your condition. Ensure they provide ample documentation or a prescription that outlines why Eliquis is the best treatment option for you.
  • Ask your doctor if they can provide a detailed justification or prior authorization request if Eliquis requires special approval by Regence.

 

Verify Pharmacy Benefits

 

  • Contact Regence to confirm details about your pharmacy benefits. Ask specifically about coverage for Eliquis, co-pays, and any requirements for prior authorization or step therapy.
  • Check if using a preferred pharmacy or mail-order service could offer lower copays or better coverage for your prescription.

 

Submit a Prior Authorization Request

 

  • If required, work with your doctor to submit a prior authorization request to Regence. This involves providing clinical details and justifying the need for Eliquis.
  • Ensure all necessary forms and documentation are accurately completed to avoid processing delays.

 

Understand Potential Costs

 

  • Ask Regence for an estimate of your out-of-pocket costs for Eliquis including deductible, copay, or coinsurance responsibilities based on your specific plan.
  • Consider supporting programs such as pharmaceutical manufacturer assistance or patient assistance programs to help offset costs.

 

Appeal Denied Coverage (if applicable)

 

  • If coverage for Eliquis is initially denied, review the specific reasons provided by Regence and gather additional supporting documents, if needed.
  • Work with your healthcare provider to file an appeal. Provide any additional evidence or arguments to support the necessity of Eliquis for your treatment.

 

Review the Process Regularly

 

  • Regularly check-in with your pharmacy and plan to ensure continued coverage of Eliquis as formulary structures and coverage policies can update annually.
  • Stay informed about any changes to your health plan during open enrollment or plan renewals to maintain or adjust Eliquis coverage as needed.

 

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FAQs

Does Regence Cover Eliquis

Explore Regence coverage for Eliquis. Learn reasons for denial, steps to secure coverage, costs without insurance, and get answers with our FAQ.
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Is Eliquis Covered by Regence

 

Coverage for Eliquis under Regence

 

  • Regence typically covers Eliquis for conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism as it is often prescribed for clot prevention and treatment.
  •  

  • Coverage is subject to plan-specific terms and may vary based on individual policy details, so it's important to verify your own plan's formulary.

 

Basic Rules and Criteria

 

  • Pre-authorization may be required to confirm that Eliquis is medically necessary for your condition.
  •  

  • Regence usually needs evidence that you've tried other anticoagulants and didn't achieve the desired outcome, or that you're at higher risk of complications with alternatives.
  •  

  • Checking whether Eliquis is in a preferred tier of your formulary can affect co-pay and out-of-pocket costs.

 

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Regence's Approved Criteria for Eliquis Coverage

 

Criteria for Eliquis Coverage by Regence

 

  • Eliquis is covered for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation.
  •  

  • Coverage is provided for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and PE.
  •  

  • Regence covers Eliquis for patients who require prophylaxis of DVT, which could lead to PE, especially following hip or knee replacement surgery.
  •  

  • Patients with specific contraindications to warfarin or intolerance to direct oral anticoagulants (DOACs) may be eligible for coverage under special consideration.
  •  

  • Documentation from prescribers may be required to demonstrate the necessity of Eliquis over other anticoagulant options based on clinical history and patient-specific factors.

 

Supporting Documentation Requirements

 

  • Physician's notes detailing the indication, previous therapies attempted, and the rationale for choosing Eliquis.
  •  

  • Laboratory results supporting the diagnosis of conditions warranting anticoagulation therapy where applicable.
  •  

  • A comprehensive treatment plan that includes the duration of therapy expected and follow-up protocols for patient monitoring.

 

Why Regence Might Deny Eliquis Coverage

 

Reasons for Denial of Eliquis Coverage by Regence

 

  • Eliquis is prescribed for a non-FDA-approved indication or off-label use that hasn't been supported with adequate clinical evidence.
  •  

  • The patient does not meet the specific age, gender, or condition criteria set by Regence for Eliquis coverage.
  •  

  • The prescribing physician has not provided sufficient medical justification or documentation supporting the necessity of Eliquis over other treatments.
  •  

  • There is a lack of participation in or failure to meet outcomes related to step therapy, which may require trying and failing other lower-cost therapies before Eliquis.
  •  

  • Eliquis is not included in the patient's current formulary as a preferred drug, possibly due to formulary updates or the introduction of new, more cost-effective alternatives.
  •  

  • The patient has a current health plan with Regence that restricts Eliquis coverage due to its therapeutic classification as a non-preferred or specialty drug.
  •  

  • The dosing regimen prescribed is not within the approved limits or guidelines, making the prescribed usage inconsistent with the plan's approved dosage criteria.
  •  

  • Drug interaction or contraindication alerts with current medications the patient is taking, which can lead to potentially harmful results when combined with Eliquis.

 

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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.

 

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 Regence

 

Evaluate Your Current Regence Plan

 

  • Log in to your Regence member account online to review your current coverage or consult your plan documentation to understand your pharmacy benefits.
  • Check if Eliquis is listed on the formulary, which is the list of medications covered under your plan. If unsure, contact Regence customer service for confirmation.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the medical necessity of Eliquis for your condition. Ensure they provide ample documentation or a prescription that outlines why Eliquis is the best treatment option for you.
  • Ask your doctor if they can provide a detailed justification or prior authorization request if Eliquis requires special approval by Regence.

 

Verify Pharmacy Benefits

 

  • Contact Regence to confirm details about your pharmacy benefits. Ask specifically about coverage for Eliquis, co-pays, and any requirements for prior authorization or step therapy.
  • Check if using a preferred pharmacy or mail-order service could offer lower copays or better coverage for your prescription.

 

Submit a Prior Authorization Request

 

  • If required, work with your doctor to submit a prior authorization request to Regence. This involves providing clinical details and justifying the need for Eliquis.
  • Ensure all necessary forms and documentation are accurately completed to avoid processing delays.

 

Understand Potential Costs

 

  • Ask Regence for an estimate of your out-of-pocket costs for Eliquis including deductible, copay, or coinsurance responsibilities based on your specific plan.
  • Consider supporting programs such as pharmaceutical manufacturer assistance or patient assistance programs to help offset costs.

 

Appeal Denied Coverage (if applicable)

 

  • If coverage for Eliquis is initially denied, review the specific reasons provided by Regence and gather additional supporting documents, if needed.
  • Work with your healthcare provider to file an appeal. Provide any additional evidence or arguments to support the necessity of Eliquis for your treatment.

 

Review the Process Regularly

 

  • Regularly check-in with your pharmacy and plan to ensure continued coverage of Eliquis as formulary structures and coverage policies can update annually.
  • Stay informed about any changes to your health plan during open enrollment or plan renewals to maintain or adjust Eliquis coverage as needed.

 

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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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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.

 

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Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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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