Does SelectHealth Cover Plavix

Explore SelectHealth's Plavix coverage, reasons for denial, tips to secure coverage, costs without insurance, and answers to common Plavix questions.
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Plavix Coverage by SelectHealth

 

  • SelectHealth may cover Plavix based on medical necessity, often for conditions such as heart attack prevention, stroke prevention, or treatment after certain types of heart surgeries.
  •  

  • Coverage criteria typically include a physician's prescription and a demonstration of the drug's necessity over alternatives.
  •  

  • Patients may need prior authorization, confirming the use meets SelectHealth's guidelines.
  •  

  • Costs and coverage levels can vary depending on the specific health plan and its formulary. Higher-tier plans might cover a larger portion of the medication's cost.
  •  

  • Policyholders should consult their specific plan details or contact SelectHealth directly for precise coverage information concerning Plavix.

 

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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 Plavix Coverage with SelectHealth

 

Initiate Contact with SelectHealth

 

  • Visit the SelectHealth website to locate their contact information, or refer to your SelectHealth insurance card for member services phone numbers.
  •  

  • Call the member services department to inquire about coverage details for Plavix, speaking to a representative who can guide you through the process.

 

Understand Your Plan Details

 

  • Log in to your SelectHealth member account online to review your specific health insurance plan details.
  •  

  • Check if Plavix is listed on your plan's formulary, which includes all medications covered by your policy.

 

Confirm Coverage Requirements

 

  • Ask your healthcare provider if pre-authorization is needed for Plavix under your SelectHealth plan. Pre-authorization may be required to confirm medical necessity.
  •  

  • Determine if there are any quantity limits or specific conditions under which Plavix is covered by your plan.

 

Explore Copayment Assistance Programs

 

  • Contact SelectHealth member services to discuss any available prescription drug coverage tiers and potential copayment amounts for Plavix.
  •  

  • Inquire about financial assistance programs or discounts that may apply to your prescription, either through SelectHealth or external programs.

 

Prepare Necessary Documentation

 

  • Gather any required documentation from your healthcare provider, such as prescriptions or letters of medical necessity.
  •  

  • Ensure you have completed any necessary forms that SelectHealth may require to process your prescription coverage for Plavix.

 

Submit Claims and Follow Up

 

  • Submit any required claims forms or paperwork through the appropriate channels, as outlined by SelectHealth.
  •  

  • Monitor the status of your claim, and be proactive in following up with SelectHealth to ensure there are no delays in processing your request for Plavix coverage.

 

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FAQs

Does SelectHealth Cover Plavix

Explore SelectHealth's Plavix coverage, reasons for denial, tips to secure coverage, costs without insurance, and answers to common Plavix questions.
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Is Plavix Covered by SelectHealth

 

Plavix Coverage by SelectHealth

 

  • SelectHealth may cover Plavix based on medical necessity, often for conditions such as heart attack prevention, stroke prevention, or treatment after certain types of heart surgeries.
  •  

  • Coverage criteria typically include a physician's prescription and a demonstration of the drug's necessity over alternatives.
  •  

  • Patients may need prior authorization, confirming the use meets SelectHealth's guidelines.
  •  

  • Costs and coverage levels can vary depending on the specific health plan and its formulary. Higher-tier plans might cover a larger portion of the medication's cost.
  •  

  • Policyholders should consult their specific plan details or contact SelectHealth directly for precise coverage information concerning Plavix.

 

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SelectHealth's Approved Criteria for Plavix Coverage

 

SelectHealth Approved Criteria for Plavix Coverage

 

  • Plavix (clopidogrel) therapy is approved for members who have experienced an acute coronary syndrome, including those with myocardial infarction or unstable angina. Prescription must be supported by hospitalization records or cardiologist reports indicating the occurrence.
  •  

  • Coverage is extended to members requiring antiplatelet therapy following recent percutaneous coronary intervention (PCI), with documentation evidencing stent placement.
  •  

  • Members diagnosed with peripheral arterial disease (PAD) who have a documented need for Plavix to improve circulation and reduce the risk of vascular events are eligible for coverage.
  •  

  • Patients with a history of ischemic stroke, or transient ischemic attack (TIA), may qualify for Plavix coverage upon submission of neurologist assessments or hospital discharge summaries.
  •  

  • For patients with a known allergy or contraindication to aspirin, Plavix may be covered as an alternative antiplatelet therapy, provided documentation from a healthcare professional confirms such status.
  •  

  • Evidence of genetic testing indicating the need for Plavix over other antiplatelet drugs due to enzyme metabolism variances (such as CYP2C19 polymorphism) may substantiate coverage.

 

Why SelectHealth Might Deny Plavix Coverage

 

Reasons SelectHealth Might Deny Plavix Coverage

 

  • Plavix is prescribed for a non-FDA approved use, also known as an off-label use, which may not be considered medically necessary by SelectHealth.
  •  

  • Insufficient clinical documentation provided to justify the need for Plavix, leading to a determination that it is not medically necessary.
  •  

  • Patient's medical history or condition does not align with SelectHealth’s criteria for Plavix coverage, possibly due to existing alternative therapies being sufficient.
  •  

  • Lack of prior authorization if it is required by SelectHealth’s prescription policy for Plavix, resulting in coverage denial.
  •  

  • Prescription is not filled at a pharmacy within the SelectHealth network, potentially excluding it from coverage.
  •  

  • The prescription does not meet specific dosage or duration guidelines as established by SelectHealth's formulary policies.
  •  

 

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How Much Does Plavix Cost without Insurance?

 

Approximate Cost of Plavix Without Insurance

 

  • The cost of Plavix, or its generic version clopidogrel, can vary widely depending on the pharmacy and geographical location.
  •  

  • Brand-name Plavix typically costs between $150 to $300 for a 30-day supply at retail prices.
  •  

  • The generic clopidogrel is significantly cheaper, often ranging from $5 to $50 for a 30-day supply when purchased without insurance.
  •  

  • Pricing may fluctuate based on factors such as dosage strength, promotions, or pharmacy discount programs.
  •  

  • Online or mail-order pharmacies might offer additional savings, in comparison to local pharmacies.

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 Plavix Coverage with SelectHealth

 

Initiate Contact with SelectHealth

 

  • Visit the SelectHealth website to locate their contact information, or refer to your SelectHealth insurance card for member services phone numbers.
  •  

  • Call the member services department to inquire about coverage details for Plavix, speaking to a representative who can guide you through the process.

 

Understand Your Plan Details

 

  • Log in to your SelectHealth member account online to review your specific health insurance plan details.
  •  

  • Check if Plavix is listed on your plan's formulary, which includes all medications covered by your policy.

 

Confirm Coverage Requirements

 

  • Ask your healthcare provider if pre-authorization is needed for Plavix under your SelectHealth plan. Pre-authorization may be required to confirm medical necessity.
  •  

  • Determine if there are any quantity limits or specific conditions under which Plavix is covered by your plan.

 

Explore Copayment Assistance Programs

 

  • Contact SelectHealth member services to discuss any available prescription drug coverage tiers and potential copayment amounts for Plavix.
  •  

  • Inquire about financial assistance programs or discounts that may apply to your prescription, either through SelectHealth or external programs.

 

Prepare Necessary Documentation

 

  • Gather any required documentation from your healthcare provider, such as prescriptions or letters of medical necessity.
  •  

  • Ensure you have completed any necessary forms that SelectHealth may require to process your prescription coverage for Plavix.

 

Submit Claims and Follow Up

 

  • Submit any required claims forms or paperwork through the appropriate channels, as outlined by SelectHealth.
  •  

  • Monitor the status of your claim, and be proactive in following up with SelectHealth to ensure there are no delays in processing your request for Plavix coverage.

 

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Plavix FAQ

1. What is Plavix used for?

 

Uses of Plavix

 

  • Plavix, known generically as clopidogrel, is primarily used as an antiplatelet medication.
  •  

  • It helps prevent blood clots, reducing the risk of stroke and heart attack in individuals with cardiovascular conditions.
  •  

  • Often prescribed post-heart attack or stroke, it is also beneficial for patients with peripheral artery disease.
  •  

    Mechanism of Action

     

    • Plavix inhibits platelet aggregation by irreversibly binding to the P2Y12 receptor on platelets.
    •  

    • This action prevents the platelets from clumping together, reducing clot formation in blood vessels.

     

    Considerations

     

    • Plavix is typically taken orally, once a day, with or without food.
    •  

    • Regular monitoring and consultation with a healthcare provider are recommended to ensure its effectiveness and manage potential side effects.

     

2. What are the side effects of Plavix?

 

Common Side Effects of Plavix

 

  • Bleeding symptoms, such as nosebleeds or bleeding gums, are among the most frequent side effects.
  • Some individuals may experience bruising more easily than usual.

 

Less Common Side Effects

 

  • Severe allergic reactions can occur, including skin rash or itching.
  • It's possible to develop gastrointestinal issues like indigestion or abdominal pain.

 

Rare but Serious Side Effects

 

  • In rare instances, patients might experience thrombotic thrombocytopenic purpura—a serious condition affecting blood clotting.
  • Liver function abnormalities, represented by symptoms like jaundice, can also occur.

 

Precautionary Measures

 

  • Always consult a healthcare provider for symptoms that appear unexpectedly.
  • Report any unusual bleeding or symptoms to a doctor promptly.

 

3. Can I take Plavix with aspirin?

 

Combining Plavix and Aspirin

 

  • **Plavix (clopidogrel)** and **aspirin** are both antiplatelet medications. They reduce the risk of clots, lowering the chance of heart attacks or strokes.
  •  

  • This combination can enhance antiplatelet effects but raises bleeding risk.

 

Consult with Your Doctor

 

  • Your healthcare provider will evaluate your risk factors and decide if this combination benefits you.
  •  

  • Contact your doctor if unexplained bruising, prolonged bleeding, or unusual weakness occurs.

 

Special Circumstances

 

  • In certain conditions like acute coronary syndrome or after stent placement, combined use is common but should always be under medical supervision.

 

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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.

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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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