Does Sharp Health Plan Cover Xarelto

Discover why Sharp Health Plan may deny Xarelto, tips for securing coverage, costs without insurance, and common questions answered in this comprehensive guide.
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Xarelto Coverage by Sharp Health Plan

 

  • Sharp Health Plan generally provides coverage for Xarelto, a medication used to prevent blood clots and reduce the risk of stroke.
  •  

  • Coverage typically applies to specific medical conditions such as atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Patients must receive a prescription from an in-network healthcare provider to ensure the highest level of coverage.
  •  

  • Preauthorization may be required for Xarelto, so it's crucial to check with Sharp Health Plan beforehand.
  •  

  • Copayments, coinsurance, or deductibles might apply, depending on the specific plan details.
  •  

  • It is important to verify whether Xarelto is listed on the formulary of the specific plan, as this can affect availability and pricing.
  •  

  • Patients should communicate with their healthcare provider and Sharp Health Plan to understand any specific criteria or restrictions regarding 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.

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 Sharp Health Plan

 

Research Sharp Health Plan's Formulary

 

  • Access Sharp Health Plan's website and locate their formulary, which is a list of covered drugs.
  •  

  • Search the formulary to check if Xarelto is included as a covered medication.

 

Contact Sharp Health Plan's Member Services

 

  • Gather necessary information, such as your member ID and details about your prescription needs.
  •  

  • Call Member Services using the number provided on your insurance ID card or on the website.
  •  

  • Ask a representative about the coverage for Xarelto, including any copayments or restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Xarelto.
  •  

  • Confirm that Xarelto is the preferred choice for your condition and that your provider agrees to prescribe it.

 

Check for Prior Authorization Requirements

 

  • Inquire if Xarelto requires prior authorization, a step to verify medical necessity before the plan covers it.
  •  

  • If required, work with your healthcare provider to submit a prior authorization request to Sharp Health Plan.

 

Review Your Insurance Plan Details

 

  • Log into your Sharp Health Plan account or review your benefits booklet to understand your prescription drug coverage details.
  •  

  • Identify the tier or category in which Xarelto falls, as it may impact the cost sharing for the medication.

 

Submit a Claim for Reimbursement

 

  • If you have already purchased Xarelto out of pocket, file a claim for reimbursement with Sharp Health Plan.
  •  

  • Complete the necessary claim forms and include receipts as required by your plan.

 

Explore Financial Assistance Programs

 

  • If Xarelto is not fully covered or is too costly, inquire about patient assistance programs or manufacturer coupons.
  •  

  • Contact the manufacturer of Xarelto to learn about available savings programs that might offer support.

 

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FAQs

Does Sharp Health Plan Cover Xarelto

Discover why Sharp Health Plan may deny Xarelto, tips for securing coverage, costs without insurance, and common questions answered in this comprehensive guide.
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Is Xarelto Covered by Sharp Health Plan

 

Xarelto Coverage by Sharp Health Plan

 

  • Sharp Health Plan generally provides coverage for Xarelto, a medication used to prevent blood clots and reduce the risk of stroke.
  •  

  • Coverage typically applies to specific medical conditions such as atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE).
  •  

  • Patients must receive a prescription from an in-network healthcare provider to ensure the highest level of coverage.
  •  

  • Preauthorization may be required for Xarelto, so it's crucial to check with Sharp Health Plan beforehand.
  •  

  • Copayments, coinsurance, or deductibles might apply, depending on the specific plan details.
  •  

  • It is important to verify whether Xarelto is listed on the formulary of the specific plan, as this can affect availability and pricing.
  •  

  • Patients should communicate with their healthcare provider and Sharp Health Plan to understand any specific criteria or restrictions regarding coverage.

 

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Sharp Health Plan's Approved Criteria for Xarelto Coverage

 

Eligibility Criteria for Xarelto Coverage

 

  • Xarelto may be covered for adult patients diagnosed with non-valvular atrial fibrillation for the reduction of stroke risk and systemic embolism.
  •  

  • Coverage is available for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) in adults.
  •  

  • Xarelto is approved for use in the prevention of recurrent DVT and PE following an initial six months of anticoagulant therapy.
  •  

  • Patients undergoing knee or hip replacement surgery may receive coverage for Xarelto to prevent DVT and PE post-operative complications.
  •  

  • Coverage extends to patients with coronary artery disease (CAD) and peripheral artery disease (PAD) to reduce the risk of major cardiovascular events as per medical guidelines.
  •  

 

Required Documentation

 

  • Physician documentation indicating the medical necessity of Xarelto for the above-covered conditions.
  •  

  • Confirmatory diagnostic test results or medical history consistent with the approved criteria.
  •  

  • Detailed treatment plan including previous therapies and rationale for choosing Xarelto.
  •  

 

Age and Dosage Considerations

 

  • Coverage applies to adult patients aged 18 and older, as per approved indications.
  •  

  • Dosage and administration should adhere to FDA-approved labeling guidelines unless otherwise specified by the prescribing physician due to unique patient needs.
  •  

 

Why Sharp Health Plan Might Deny Xarelto Coverage

 

Situations When Sharp Health Plan Does Not Cover Xarelto

 

  • **Alternative Covered Conditions**: If the condition for which Xarelto is prescribed can be effectively treated with a more cost-effective alternative medication that is covered under the plan, Xarelto coverage might be denied.
  •  

  • **Non-Formulary Medication**: Xarelto may be considered a non-formulary medication under the plan. If it does not appear on the formulary list of preferred drugs, coverage may not be provided.
  •  

  • **Lack of Prior Authorization**: If the plan requires prior authorization for Xarelto and the necessary approval has not been obtained before the prescription is filled, coverage is likely to be denied.
  •  

  • **Non-FDA Approved Use**: If Xarelto is prescribed for an off-label use that has not been approved by the FDA, the health plan may deny coverage due to lack of evidence supporting its effectiveness and safety for that specific condition.
  •  

  • **Coverage Limitations and Exclusions**: The health plan may have specific exclusions or limitations for certain medications, including Xarelto, which may result in denied coverage if these criteria are not met.
  •  

  • **Tier Restrictions**: If Xarelto is classified in a higher prescription drug tier than what is covered by the plan, additional costs or lack of coverage might be experienced.
  •  

  • **Non-Compliance with Plan Requirements**: If the prescribing practices do not comply with the plan’s requirements, such as not following step therapy protocols, coverage for Xarelto might be denied.

 

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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 Sharp Health Plan

 

Research Sharp Health Plan's Formulary

 

  • Access Sharp Health Plan's website and locate their formulary, which is a list of covered drugs.
  •  

  • Search the formulary to check if Xarelto is included as a covered medication.

 

Contact Sharp Health Plan's Member Services

 

  • Gather necessary information, such as your member ID and details about your prescription needs.
  •  

  • Call Member Services using the number provided on your insurance ID card or on the website.
  •  

  • Ask a representative about the coverage for Xarelto, including any copayments or restrictions.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider about your need for Xarelto.
  •  

  • Confirm that Xarelto is the preferred choice for your condition and that your provider agrees to prescribe it.

 

Check for Prior Authorization Requirements

 

  • Inquire if Xarelto requires prior authorization, a step to verify medical necessity before the plan covers it.
  •  

  • If required, work with your healthcare provider to submit a prior authorization request to Sharp Health Plan.

 

Review Your Insurance Plan Details

 

  • Log into your Sharp Health Plan account or review your benefits booklet to understand your prescription drug coverage details.
  •  

  • Identify the tier or category in which Xarelto falls, as it may impact the cost sharing for the medication.

 

Submit a Claim for Reimbursement

 

  • If you have already purchased Xarelto out of pocket, file a claim for reimbursement with Sharp Health Plan.
  •  

  • Complete the necessary claim forms and include receipts as required by your plan.

 

Explore Financial Assistance Programs

 

  • If Xarelto is not fully covered or is too costly, inquire about patient assistance programs or manufacturer coupons.
  •  

  • Contact the manufacturer of Xarelto to learn about available savings programs that might offer support.

 

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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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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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