Does Sharp Health Plan Cover Farxiga

Explore if Sharp Health Plan covers Farxiga, reasons for denial, how to secure coverage, costs without insurance, and FAQs. Discover essential insights here.
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Does Sharp Health Plan Cover Farxiga?

 

  • Sharp Health Plan may cover Farxiga, a medication used for managing type 2 diabetes, heart failure, and chronic kidney disease, depending on your specific plan and medical necessity.
  •  

  • To get Farxiga covered, you often need a prior authorization. This involves your healthcare provider demonstrating the necessity of the medication for your condition.
  •  

  • Coverage may require that you have tried other medications before approving Farxiga. These are called step therapy protocols.
  •  

  • It’s essential to review your specific Sharp Health Plan’s formulary or contact customer service to confirm coverage details, as plans and policies can vary.
  •  

  • Out-of-pocket costs may also be influenced by your plan’s specific deductible and copay/coinsurance terms.

 

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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.

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 Sharp Health Plan

 

Research Farxiga Coverage

 

  • Visit the Sharp Health Plan official website to access the most recent formulary, which lists all covered drugs.
  •  

  • Search for Farxiga in the formulary or drug list to verify its coverage and any potential restrictions or requirements.
  •  

  • If Farxiga is not covered, review alternative medications or therapy options listed in the formulary that may address similar health conditions.

 

Contact Sharp Health Plan Customer Service

 

  • Call the Sharp Health Plan customer service number provided on the back of your insurance card for verification of coverage details.
  •  

  • Prepare to provide your member ID, details about your prescription, and any questions regarding coverage and cost to the representative.
  •  

  • Inquire about specific coverage requirements such as prior authorization or step therapy that may apply to Farxiga.

 

Consult with Your Healthcare Provider

 

  • Discuss your medication needs and the potential to switch to Farxiga with your healthcare provider.
  •  

  • Request that your healthcare provider submits any necessary documentation or prior authorization forms to Sharp Health Plan on your behalf.
  •  

  • Ensure your healthcare provider is aware of any formulary alternatives or generic options if Sharp Health Plan does not cover Farxiga directly.

 

Submit a Coverage Request

 

  • If Farxiga requires prior authorization, work with your healthcare provider to complete and submit the necessary forms to Sharp Health Plan.
  •  

  • Attach any supporting documents such as medical records or notes from your healthcare provider that justify the need for Farxiga over other medications.
  •  

  • Follow up with Sharp Health Plan to confirm receipt and review status of your coverage request for Farxiga.

 

Review the Explanation of Benefits

 

  • Upon receiving notice from Sharp Health Plan, review the Explanation of Benefits (EOB) for details on how Farxiga is covered.
  •  

  • Pay special attention to any out-of-pocket costs, co-pays, or deductibles associated with the prescription.
  •  

  • If the coverage is denied, refer to the EOB for instructions on how to appeal the decision and seek further clarification if needed.

 

Appeal if Necessary

 

  • If Sharp Health Plan denies coverage for Farxiga, review the reasons outlined in the EOB carefully.
  •  

  • Gather additional documentation and support from your healthcare provider to strengthen your appeal case.
  •  

  • Submit the appeal according to the instructions provided by Sharp Health Plan, ensuring all deadlines and requirements are met.

 

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FAQs

Does Sharp Health Plan Cover Farxiga

Explore if Sharp Health Plan covers Farxiga, reasons for denial, how to secure coverage, costs without insurance, and FAQs. Discover essential insights here.
Curex allergy drops unboxing

Is Farxiga Covered by Sharp Health Plan

 

Does Sharp Health Plan Cover Farxiga?

 

  • Sharp Health Plan may cover Farxiga, a medication used for managing type 2 diabetes, heart failure, and chronic kidney disease, depending on your specific plan and medical necessity.
  •  

  • To get Farxiga covered, you often need a prior authorization. This involves your healthcare provider demonstrating the necessity of the medication for your condition.
  •  

  • Coverage may require that you have tried other medications before approving Farxiga. These are called step therapy protocols.
  •  

  • It’s essential to review your specific Sharp Health Plan’s formulary or contact customer service to confirm coverage details, as plans and policies can vary.
  •  

  • Out-of-pocket costs may also be influenced by your plan’s specific deductible and copay/coinsurance terms.

 

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Sharp Health Plan's Approved Criteria for Farxiga Coverage

 

Overview of Farxiga Coverage Criteria

 

  • Farxiga (dapagliflozin) is generally covered for members diagnosed with Type 2 Diabetes Mellitus when it is medically necessary and prescribed by a healthcare provider.
  •  

  • It may also be considered for individuals with chronic kidney disease or heart failure with reduced ejection fraction, as part of their comprehensive treatment plan.

 

Criteria for Type 2 Diabetes Mellitus

 

  • The member should have a diagnosis of Type 2 Diabetes Mellitus.
  •  

  • Farxiga must be prescribed as part of a treatment plan that includes diet and exercise.
  •  

  • Documentation of the medical necessity from the healthcare provider is required.

 

Criteria for Chronic Kidney Disease

 

  • Members must have a diagnosis of chronic kidney disease that has been confirmed by laboratory tests.
  •  

  • Farxiga should be prescribed to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure.
  •  

  • A specialist consult or recommendation may be required to confirm the appropriateness of Farxiga for this condition.

 

Criteria for Heart Failure

 

  • Members diagnosed with heart failure with reduced ejection fraction may be eligible for coverage.
  •  

  • Farxiga should be part of a comprehensive heart failure management plan including other medications, lifestyle changes, and monitoring.
  •  

  • The prescribing healthcare provider should document the potential benefits of Farxiga for this condition.

 

Why Sharp Health Plan Might Deny Farxiga Coverage

 

Reasons for Denial of Farxiga Coverage by Sharp Health Plan

 

  • **Non-Approved Indication**: Farxiga may be denied if it is prescribed for an off-label use that is not approved by Sharp Health Plan's formulary guidelines.
  •  

  • **Lack of Prior Authorization**: Coverage might be denied if prior authorization, when required, has not been obtained before the dispensing of Farxiga.
  •  

  • **Failure to Meet Step Therapy Requirements**: Sharp Health Plan might not cover Farxiga if the patient has not tried and failed alternative medications first, as required by step therapy protocols.
  •  

  • **Absence of Medical Necessity**: If Sharp Health Plan determines that the use of Farxiga is not medically necessary based on their clinical guidelines, coverage may be denied.
  •  

  • **Eligibility Issues**: Coverage could be denied if the patient is not eligible under the specific terms of their insurance plan, such as specific age or gender limitations.
  •  

  • **Exclusion from Policy Coverage**: Farxiga might be on a list of medications excluded from coverage under certain policy levels or types.
  •  

  • **Not Meeting Dosage Restrictions**: If prescribed dosages exceed the limits set by the health plan, coverage could be denied.
  •  

Together with our partners we have changed the lives of over 300,000 patients.

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 Sharp Health Plan

 

Research Farxiga Coverage

 

  • Visit the Sharp Health Plan official website to access the most recent formulary, which lists all covered drugs.
  •  

  • Search for Farxiga in the formulary or drug list to verify its coverage and any potential restrictions or requirements.
  •  

  • If Farxiga is not covered, review alternative medications or therapy options listed in the formulary that may address similar health conditions.

 

Contact Sharp Health Plan Customer Service

 

  • Call the Sharp Health Plan customer service number provided on the back of your insurance card for verification of coverage details.
  •  

  • Prepare to provide your member ID, details about your prescription, and any questions regarding coverage and cost to the representative.
  •  

  • Inquire about specific coverage requirements such as prior authorization or step therapy that may apply to Farxiga.

 

Consult with Your Healthcare Provider

 

  • Discuss your medication needs and the potential to switch to Farxiga with your healthcare provider.
  •  

  • Request that your healthcare provider submits any necessary documentation or prior authorization forms to Sharp Health Plan on your behalf.
  •  

  • Ensure your healthcare provider is aware of any formulary alternatives or generic options if Sharp Health Plan does not cover Farxiga directly.

 

Submit a Coverage Request

 

  • If Farxiga requires prior authorization, work with your healthcare provider to complete and submit the necessary forms to Sharp Health Plan.
  •  

  • Attach any supporting documents such as medical records or notes from your healthcare provider that justify the need for Farxiga over other medications.
  •  

  • Follow up with Sharp Health Plan to confirm receipt and review status of your coverage request for Farxiga.

 

Review the Explanation of Benefits

 

  • Upon receiving notice from Sharp Health Plan, review the Explanation of Benefits (EOB) for details on how Farxiga is covered.
  •  

  • Pay special attention to any out-of-pocket costs, co-pays, or deductibles associated with the prescription.
  •  

  • If the coverage is denied, refer to the EOB for instructions on how to appeal the decision and seek further clarification if needed.

 

Appeal if Necessary

 

  • If Sharp Health Plan denies coverage for Farxiga, review the reasons outlined in the EOB carefully.
  •  

  • Gather additional documentation and support from your healthcare provider to strengthen your appeal case.
  •  

  • Submit the appeal according to the instructions provided by Sharp Health Plan, ensuring all deadlines and requirements are met.

 

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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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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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