Does Scripps Health Cover Farxiga

Explore Farxiga coverage with Scripps Health, learn why it might be denied, find out costs without insurance, and get answers to common questions.
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Coverage for Farxiga under Scripps Health

 

  • Scripps Health may cover Farxiga, a medication for type 2 diabetes, under certain health plans. Coverage often depends on whether Farxiga is listed on the plan's formulary.
  •  

  • Prior authorization may be required. Your healthcare provider must demonstrate medical necessity for Farxiga over alternative treatments.
  •  

  • It is important to confirm coverage specifics, such as copayment and formulary status, by consulting your specific plan details or contacting Scripps Health customer service.

 

Criteria for Coverage

 

  • Diagnosed with type 2 diabetes and an appropriate candidate for Farxiga based on healthcare provider evaluation.
  •  

  • Documented prior attempts with alternative medications, if necessary, as part of the authorization process.
  •  

  • Meeting any additional criteria set forth by the specific health plan under Scripps Health for coverage of Farxiga.

 

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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.

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 Scripps Health

 

Understanding Farxiga and Coverage

 

  • Farxiga is a medication used for managing various health conditions like type 2 diabetes, heart failure, and chronic kidney disease. It's important to understand if your health plan under Scripps Health covers this medication.

 

Contact Scripps Health Insurance

 

  • Reach out to Scripps Health's insurance customer service via phone or online portal to inquire if Farxiga is included in your plan's formulary. Formulary is a list of covered drugs under an insurance policy.

 

Consult with Your Healthcare Provider

 

  • Speak with your healthcare provider affiliated with Scripps Health to ensure Farxiga is medically necessary for you. They can provide supporting documentation which can be helpful for insurance purposes.

 

Check the Specific Plan Details

 

  • Log into your Scripps Health online account and review your specific health plan details. Investigate your benefits and the prior authorization requirements for getting Farxiga covered.

 

Request Prior Authorization

 

  • If necessary, your healthcare provider can help you submit a prior authorization request to Scripps Health's pharmacy benefit manager, which might be required before you can receive coverage for Farxiga.

 

Explore Patient Assistance Programs

 

  • Contact the manufacturer of Farxiga or search for patient assistance programs that might help offset the cost if your insurance doesn't cover the full price. Some programs are designed to assist patients who need financial aid for medications.

 

Pharmacy Selection

 

  • Ensure you use a pharmacy that is in-network with Scripps Health. This will help in obtaining Farxiga at a reduced cost if your insurance covers it.

 

Follow Up with Claims

 

  • Regularly check your claims online through the Scripps Health portal or directly contact customer support to ensure Farxiga claims have been successfully processed and applied towards your benefits.

 

Keep Documentation Handy

 

  • Maintain copies of all correspondence related to your request for Farxiga coverage, including doctor notes, prior authorization forms, and any communication with the insurance provider for future reference.

 

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FAQs

Does Scripps Health Cover Farxiga

Explore Farxiga coverage with Scripps Health, learn why it might be denied, find out costs without insurance, and get answers to common questions.
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Is Farxiga Covered by Scripps Health

 

Coverage for Farxiga under Scripps Health

 

  • Scripps Health may cover Farxiga, a medication for type 2 diabetes, under certain health plans. Coverage often depends on whether Farxiga is listed on the plan's formulary.
  •  

  • Prior authorization may be required. Your healthcare provider must demonstrate medical necessity for Farxiga over alternative treatments.
  •  

  • It is important to confirm coverage specifics, such as copayment and formulary status, by consulting your specific plan details or contacting Scripps Health customer service.

 

Criteria for Coverage

 

  • Diagnosed with type 2 diabetes and an appropriate candidate for Farxiga based on healthcare provider evaluation.
  •  

  • Documented prior attempts with alternative medications, if necessary, as part of the authorization process.
  •  

  • Meeting any additional criteria set forth by the specific health plan under Scripps Health for coverage of Farxiga.

 

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Scripps Health's Approved Criteria for Farxiga Coverage

 

Coverage Criteria for Farxiga Under Scripps Health Insurance

 

  • **Diagnosis of Type 2 Diabetes Mellitus:** Patients must have a confirmed diagnosis of type 2 diabetes mellitus to be eligible for Farxiga coverage.
  •  

  • **Inadequate Control with Metformin:** Patients who have not achieved sufficient glycemic control on metformin or who are unable to tolerate metformin are eligible for coverage.
  •  

  • **Presence of Cardiovascular Disease:** Farxiga may be covered for patients with type 2 diabetes who also have established cardiovascular disease, to reduce the risk of hospitalization for heart failure.
  •  

  • **Reduced Kidney Function Consideration:** Patients with reduced renal function (eGFR above 45 mL/min/1.73 m²) may receive coverage if Farxiga is deemed appropriate by their healthcare provider.
  •  

  • **Heart Failure with Reduced Ejection Fraction (HFrEF):** Coverage may extend to those diagnosed with heart failure with reduced ejection fraction, regardless of the presence of type 2 diabetes.
  •  

  • **Trial and Failure of Preferred Alternatives:** Documentation of trial, failure, or intolerance to preferred alternative medications might be required.
  •  

  • **Prescriber Requirements:** Farxiga must be prescribed by or in consultation with a healthcare provider experienced in the treatment of diabetes or cardiovascular disease.

 

Why Scripps Health Might Deny Farxiga Coverage

 

Reasons for Denial of Farxiga Coverage by Scripps Health

 

  • **Non-Indicated Use**: Scripps Health may deny coverage if Farxiga is prescribed for uses not FDA-approved or outside of its established indications without proper documentation of medical necessity.
  •  

  • **Absence of Prior Authorization**: Coverage can be denied if prior authorization requirements are not met where Scripps Health requires approval before covering Farxiga.
  •  

  • **Incomplete Documentation**: Claims lacking adequate documentation or rationale to justify the medical necessity of Farxiga could result in denial.
  •  

  • **Step Therapy Requirements**: If Scripps mandates that other, less expensive medications be tried first, Farxiga may not be covered unless these protocols have been followed and documented.
  •  

  • **Exclusion From Plan**: Farxiga might be on a list of medications specifically excluded from coverage based on Scripps Health's formulary or specific plan provisions.
  •  

  • **Off-Formulary Prescription**: If Farxiga is not included on the Scripps Health formulary and no exception has been granted, coverage can be denied.
  •  

  • **Pre-Existing Condition Limitations**: Coverage for Farxiga might be denied if used to treat conditions considered pre-existing and not covered under the specific health plan terms.

 

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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.

 

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 Scripps Health

 

Understanding Farxiga and Coverage

 

  • Farxiga is a medication used for managing various health conditions like type 2 diabetes, heart failure, and chronic kidney disease. It's important to understand if your health plan under Scripps Health covers this medication.

 

Contact Scripps Health Insurance

 

  • Reach out to Scripps Health's insurance customer service via phone or online portal to inquire if Farxiga is included in your plan's formulary. Formulary is a list of covered drugs under an insurance policy.

 

Consult with Your Healthcare Provider

 

  • Speak with your healthcare provider affiliated with Scripps Health to ensure Farxiga is medically necessary for you. They can provide supporting documentation which can be helpful for insurance purposes.

 

Check the Specific Plan Details

 

  • Log into your Scripps Health online account and review your specific health plan details. Investigate your benefits and the prior authorization requirements for getting Farxiga covered.

 

Request Prior Authorization

 

  • If necessary, your healthcare provider can help you submit a prior authorization request to Scripps Health's pharmacy benefit manager, which might be required before you can receive coverage for Farxiga.

 

Explore Patient Assistance Programs

 

  • Contact the manufacturer of Farxiga or search for patient assistance programs that might help offset the cost if your insurance doesn't cover the full price. Some programs are designed to assist patients who need financial aid for medications.

 

Pharmacy Selection

 

  • Ensure you use a pharmacy that is in-network with Scripps Health. This will help in obtaining Farxiga at a reduced cost if your insurance covers it.

 

Follow Up with Claims

 

  • Regularly check your claims online through the Scripps Health portal or directly contact customer support to ensure Farxiga claims have been successfully processed and applied towards your benefits.

 

Keep Documentation Handy

 

  • Maintain copies of all correspondence related to your request for Farxiga coverage, including doctor notes, prior authorization forms, and any communication with the insurance provider for future reference.

 

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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.
  •  

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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.

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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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