Does Regence Cover Xarelto

Explore Regence's Xarelto coverage, reasons for denial, ways to secure approval, cost without insurance, and FAQs in this comprehensive guide.
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Coverage for Xarelto under Regence

 

  • Regence generally covers Xarelto, a blood thinner used to prevent blood clots and reduce the risk of stroke in certain conditions such as atrial fibrillation, deep vein thrombosis, and pulmonary embolism.
  •  

  • Coverage eligibility depends on the member's specific plan. Members should check their policy documents or contact Regence directly for confirmation of coverage.
  •  

  • Approval for Xarelto often requires prior authorization. This means a healthcare provider must demonstrate the necessity of Xarelto based on the patient's medical condition.
  •  

  • Regence may require patients to have tried and failed other anticoagulants before Xarelto is approved. Documentation from healthcare providers can help establish the need for Xarelto.

 

Basic Rules and Criteria

 

  • Members should utilize preferred pharmacies for convenience and potential cost savings.
  •  

  • Out-of-pocket costs depend on the plan's formulary tier & copay structure. Plans may vary in terms of tier placements.
  •  

  • Regular reviews of medication usage and its effectiveness might be needed for continued coverage.

 

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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.

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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.

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Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

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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 Regence

 

Verify Your Prescription Benefits

 

  • Log in to your Regence member account through their website. If you don't have an account, create one using your member ID.
  •  

  • Navigate to the "Benefits" or "Coverage" section to review your current prescription drug coverage, including whether Xarelto is listed under the formulary or requires special authorization.
  •  

  • If necessary, download or request a copy of your plan's formulary list to confirm Xarelto’s coverage tier and related co-payments or co-insurance details.

 

Consult Your Healthcare Provider

 

  • Discuss your need for Xarelto with your healthcare provider to ensure it is the best medication for your conditions and confirm it is the prescribed treatment.
  •  

  • Ask your doctor to provide any necessary documentation or rationale for using Xarelto as part of your treatment plan, which may be required for approval by Regence.

 

Initiate a Prior Authorization (If Required)

 

  • Check if Xarelto requires prior authorization under your Regence plan. This information can be found in your benefits section or by contacting Regence customer service.
  •  

  • If prior authorization is needed, request that your healthcare provider submit a prior authorization form on your behalf. The form should include medical justification for the medication.
  •  

  • Follow up with your provider to ensure the prior authorization is submitted and check the status of the request with Regence.

 

Explore Prescription Savings Programs

 

  • Investigate Regence’s pharmacy programs that might help reduce medication costs. These can include mail-order options, generic alternatives, or additional discounts.
  •  

  • Consider using the Xarelto Savings Program or other available manufacturer discount programs that can reduce out-of-pocket expenses if eligible.

 

Contact Regence Customer Service

 

  • Call Regence customer service directly to ask any questions about the specifics of your Xarelto coverage, including out-of-pocket costs or any steps for appeals if coverage is initially denied.
  •  

  • Prepare your policy information and any relevant documentation for a more seamless interaction and to expedite assistance.

 

Review and Appeal If Necessary

 

  • If you receive a denial for Xarelto coverage, review the reasoning provided by Regence carefully.
  •  

  • Consult with your healthcare provider to gather any additional documentation or information that could support an appeal for coverage.
  •  

  • Submit an appeal by following Regence’s appeal process, ensuring all required forms and supporting documentation are included.
  •  

  • Stay proactive and follow up with Regence regarding the status of your appeal to ensure the timely processing of your request.

 

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FAQs

Does Regence Cover Xarelto

Explore Regence's Xarelto coverage, reasons for denial, ways to secure approval, cost without insurance, and FAQs in this comprehensive guide.
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Is Xarelto Covered by Regence

 

Coverage for Xarelto under Regence

 

  • Regence generally covers Xarelto, a blood thinner used to prevent blood clots and reduce the risk of stroke in certain conditions such as atrial fibrillation, deep vein thrombosis, and pulmonary embolism.
  •  

  • Coverage eligibility depends on the member's specific plan. Members should check their policy documents or contact Regence directly for confirmation of coverage.
  •  

  • Approval for Xarelto often requires prior authorization. This means a healthcare provider must demonstrate the necessity of Xarelto based on the patient's medical condition.
  •  

  • Regence may require patients to have tried and failed other anticoagulants before Xarelto is approved. Documentation from healthcare providers can help establish the need for Xarelto.

 

Basic Rules and Criteria

 

  • Members should utilize preferred pharmacies for convenience and potential cost savings.
  •  

  • Out-of-pocket costs depend on the plan's formulary tier & copay structure. Plans may vary in terms of tier placements.
  •  

  • Regular reviews of medication usage and its effectiveness might be needed for continued coverage.

 

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Regence's Approved Criteria for Xarelto Coverage

 

Coverage Criteria for Xarelto under Regence Insurance

 

  • **Diagnosis Requirement:** The patient must have a documented diagnosis that aligns with the FDA-approved indications for Xarelto, including but not limited to non-valvular atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism (PE), and risk reduction in recurrence of DVT and PE.
  •  

  • **Age Requirement:** Coverage is typically provided for adult patients. However, pediatric use may be approved if it meets specific guidelines as established by regulatory authorities.
  •  

  • **Duration of Therapy:** The prescribed duration of Xarelto therapy must be consistent with clinical guidelines and the labeled indications and must be periodically re-evaluated for necessity and effectiveness.
  •  

  • **Dosage Evaluation:** The prescribed dosage must meet the standard dosing regimen as approved by the FDA. Adjustments for renal impairment should be in accordance with approved labeling instructions.
  •  

  • **Prior Authorization:** Prior authorization may be required, which involves a review of the therapy's medical necessity, consistency with labeled indications, and compliance with clinical guidelines.
  •  

  • **Therapeutic Alternatives:** In some cases, documentation may be required to justify the use of Xarelto over other therapeutic alternatives, especially if those alternatives are covered under the plan.
  •  

  • **Medical Records:** Submission of relevant medical records, including diagnosis and previous treatment history, may be required to establish medical necessity and support the coverage request.

 

Why Regence Might Deny Xarelto Coverage

 

Criteria for Denial of Xarelto Coverage by Regence

 

  • **Non-FDA Approved Conditions:** Regence may deny coverage if the prescribed use of Xarelto is not approved by the FDA. Off-label uses could be a potential reason for denial.
  •  

  • **Lack of Medical Necessity:** The coverage might be denied if there is insufficient justification provided for Xarelto being a medical necessity as per Regence's evaluation standards.
  •  

  • **Missing Authorization:** If the necessary prior authorization protocol is not followed or documentation is incomplete, Regence might refuse to cover Xarelto prescriptions.
  •  

  • **Alternative Therapies Available:** Coverage could be denied if there are other less expensive or generic alternatives available and they have not been first considered or tried.
  •  

  • **Inclusion in Exclusion List:** If Xarelto falls under a medication category specifically excluded in the health plan, it will not be covered by Regence.
  •  

  • **Non-Compliance with Plan Requirements:** Non-compliance with any specific requirements or stipulations laid out in the individual's health plan regarding anticoagulant therapies could lead to denial.

 

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How Much Does Xarelto Cost without Insurance?

 

Approximate Cost of Xarelto Without Insurance

 

  • The cost for Xarelto, a prescription anticoagulant medication, can vary depending on the dosage and quantity prescribed. On average, the cost of a 30-day supply of Xarelto 20 mg tablets, without insurance, can range from $450 to $540.
  •  

  • Prices may differ at various pharmacies, and patients might find lower prices through discount programs or pharmacy discount cards.
  •  

  • Shopping around and comparing prices at different pharmacies or checking with online retailers can sometimes yield better deals or discounts.
  •  

  • Additional savings may be available through pharmaceutical assistance programs, which are offered by the manufacturer for eligible patients who meet specific criteria.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Xarelto Coverage with Regence

 

Verify Your Prescription Benefits

 

  • Log in to your Regence member account through their website. If you don't have an account, create one using your member ID.
  •  

  • Navigate to the "Benefits" or "Coverage" section to review your current prescription drug coverage, including whether Xarelto is listed under the formulary or requires special authorization.
  •  

  • If necessary, download or request a copy of your plan's formulary list to confirm Xarelto’s coverage tier and related co-payments or co-insurance details.

 

Consult Your Healthcare Provider

 

  • Discuss your need for Xarelto with your healthcare provider to ensure it is the best medication for your conditions and confirm it is the prescribed treatment.
  •  

  • Ask your doctor to provide any necessary documentation or rationale for using Xarelto as part of your treatment plan, which may be required for approval by Regence.

 

Initiate a Prior Authorization (If Required)

 

  • Check if Xarelto requires prior authorization under your Regence plan. This information can be found in your benefits section or by contacting Regence customer service.
  •  

  • If prior authorization is needed, request that your healthcare provider submit a prior authorization form on your behalf. The form should include medical justification for the medication.
  •  

  • Follow up with your provider to ensure the prior authorization is submitted and check the status of the request with Regence.

 

Explore Prescription Savings Programs

 

  • Investigate Regence’s pharmacy programs that might help reduce medication costs. These can include mail-order options, generic alternatives, or additional discounts.
  •  

  • Consider using the Xarelto Savings Program or other available manufacturer discount programs that can reduce out-of-pocket expenses if eligible.

 

Contact Regence Customer Service

 

  • Call Regence customer service directly to ask any questions about the specifics of your Xarelto coverage, including out-of-pocket costs or any steps for appeals if coverage is initially denied.
  •  

  • Prepare your policy information and any relevant documentation for a more seamless interaction and to expedite assistance.

 

Review and Appeal If Necessary

 

  • If you receive a denial for Xarelto coverage, review the reasoning provided by Regence carefully.
  •  

  • Consult with your healthcare provider to gather any additional documentation or information that could support an appeal for coverage.
  •  

  • Submit an appeal by following Regence’s appeal process, ensuring all required forms and supporting documentation are included.
  •  

  • Stay proactive and follow up with Regence regarding the status of your appeal to ensure the timely processing of your request.

 

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

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Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

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Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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