Does SummaCare Cover Eliquis

Explore Eliquis coverage with SummaCare, reasons for denial, tips to secure coverage, out-of-pocket costs, and answers to frequently asked questions.
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SummaCare Coverage for Eliquis

 

  • Eliquis is covered under SummaCare's prescription drug plans. Coverage specifics can depend on your particular plan tier and formulary.
  •  

  • To get Eliquis covered, it's generally required that it be prescribed for FDA-approved uses such as reducing the risk of stroke and embolism in patients with non-valvular atrial fibrillation, treating deep vein thrombosis (DVT), or pulmonary embolism (PE).
  •  

  • Prior authorization may be needed. Your doctor might have to provide documentation showing that Eliquis is medically necessary and that alternatives are not suitable.
  •  

  • Copays and out-of-pocket costs will vary depending on your plan. Review your Summary of Benefits or contact SummaCare customer service for specific details.
  •  

  • Ensure your provider is within the SummaCare network to avoid additional charges.

 

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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 Eliquis Coverage with SummaCare

 

Understand Your Prescription Coverage Needs

 

  • Contact your healthcare provider to confirm that Eliquis is the appropriate medication for you and obtain a valid prescription.
  • Assess your current SummaCare plan to determine if it offers any coverage for prescription medications, particularly Eliquis.

 

Review SummaCare Plan Details

 

  • Examine your SummaCare policy documents or member portal to see if Eliquis is listed in the formulary (the list of covered drugs).
  • If Eliquis is not listed, investigate the plan's drug exclusion policies to understand why it may not be covered.

 

Contact SummaCare Customer Service

 

  • Call the SummaCare customer service hotline to directly inquire about Eliquis coverage options and any potential costs or restrictions.
  • Ask if there are any specific steps you need to complete, such as prior authorization, to have Eliquis covered by your plan.

 

Work with Your Physician

 

  • If prior authorization is required, coordinate with your physician to submit the necessary documentation to SummaCare.
  • Ensure your doctor provides any clinical information required by SummaCare to support the necessity of Eliquis.

 

Explore Assistance Programs

 

  • Investigate if there are any manufacturer assistance programs or generic alternatives if Eliquis is not covered.
  • Consider reaching out to patient assistance foundations that can provide support for prescription costs.

 

Confirm Coverage and Costs

 

  • Once authorization is obtained, verify with SummaCare that Eliquis is now covered under your plan, and understand any co-pays or out-of-pocket expenses.
  • Ensure your pharmacy is in-network with SummaCare to avoid unexpected costs when filling your prescription.

 

File an Appeal if Necessary

 

  • If coverage for Eliquis is denied, prepare to file an appeal with SummaCare by gathering necessary documentation and support from your healthcare provider.
  • Understand the appeal process timeline and remain in contact with SummaCare representatives throughout the appeal.

 

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FAQs

Does SummaCare Cover Eliquis

Explore Eliquis coverage with SummaCare, reasons for denial, tips to secure coverage, out-of-pocket costs, and answers to frequently asked questions.
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Is Eliquis Covered by SummaCare

 

SummaCare Coverage for Eliquis

 

  • Eliquis is covered under SummaCare's prescription drug plans. Coverage specifics can depend on your particular plan tier and formulary.
  •  

  • To get Eliquis covered, it's generally required that it be prescribed for FDA-approved uses such as reducing the risk of stroke and embolism in patients with non-valvular atrial fibrillation, treating deep vein thrombosis (DVT), or pulmonary embolism (PE).
  •  

  • Prior authorization may be needed. Your doctor might have to provide documentation showing that Eliquis is medically necessary and that alternatives are not suitable.
  •  

  • Copays and out-of-pocket costs will vary depending on your plan. Review your Summary of Benefits or contact SummaCare customer service for specific details.
  •  

  • Ensure your provider is within the SummaCare network to avoid additional charges.

 

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SummaCare's Approved Criteria for Eliquis Coverage

 

Criteria for Eliquis Coverage by SummaCare

 

  • **FDA-Approved Indications:** Eliquis is covered for patients with non-valvular atrial fibrillation to reduce the risk of stroke and systemic embolism.
  •  

  • **Treatment of Deep Vein Thrombosis (DVT):** SummaCare provides coverage for Eliquis when prescribed for the treatment of DVT in patients.
  •  

  • **Pulmonary Embolism (PE):** Coverage is applicable for the treatment of pulmonary embolism, ensuring that Eliquis is a prescribed option for patients with this condition.
  •  

  • **DVT and PE Recurrence Prevention:** Patients who have experienced a DVT or PE and require long-term treatment to prevent recurrence may be eligible for coverage of Eliquis under SummaCare insurance.
  •  

  • **Post-hip or Knee Replacement Surgery:** SummaCare covers Eliquis for patients requiring post-operative thromboprophylaxis to reduce the risk of blood clots after knee or hip replacement surgery.
  •  

  • **Renal and Hepatic Function Considerations:** Coverage may be provided with consideration of renal and hepatic function, particularly if Eliquis is deemed appropriate despite functional impairments.
  •  

 

Patient Requirements

 

  • **Physician's Prescription:** A verifiable prescription from a licensed physician indicating the necessity of Eliquis for the FDA-approved indications is required.
  •  

  • **Documentation Verification:** Proper documentation supporting the diagnosis and treatment plan should be submitted to ensure compliance with SummaCare's criteria.
  •  

  • **Continuous Evaluation:** Regular assessment and re-evaluation of the patient’s condition and treatment effectiveness must be documented for continuous coverage.
  •  

  • **Age and Dosage Considerations:** Coverage decisions may take into account patient age and recommended dosage, aligning with clinical guidelines and safety recommendations.
  •  

 

Why SummaCare Might Deny Eliquis Coverage

 

Reasons SummaCare Might Deny Eliquis Coverage

 

  • Eliquis is being prescribed for an off-label use that is not approved by the FDA and not covered under the plan's formulary guidelines.
  •  

  • The patient has not met the required step therapy criteria where less expensive or alternative medications must be tried first before Eliquis is covered.
  •  

  • The use of Eliquis does not align with SummaCare's medical policies or guidelines, which may include factors like age or concurrent health conditions.
  •  

  • The prescriber has not provided sufficient documentation or justification for using Eliquis over other preferred medications on the formulary.
  •  

  • The patient does not meet the eligibility tests or lab results required by SummaCare for Eliquis coverage, such as specific blood clotting disorders or criteria.
  •  

  • Coverage is excluded because Eliquis is used beyond the limits of daily doses or duration specified in the SummaCare policy.
  •  

  • The prescription is from a provider or pharmacy that is out of SummaCare's network, violating plan terms.
  •  

 

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How Much Does Eliquis Cost without Insurance?

 

Approximate Cost of Eliquis without Insurance

 

  • The cost of Eliquis, a commonly prescribed blood thinner, can vary based on the pharmacy, location, and any available discounts or coupons. On average, without insurance, Eliquis can cost around $550 to $650 for a 30-day supply.
  •  

  • Some pharmacies or online platforms may offer discounts or generic options that can lower the cost, so it's advisable to shop around. Patients should also inquire about manufacturer coupons or assistance programs that might help reduce the price.
  •  

  • Price comparison tools and websites can be helpful in finding the best available prices for Eliquis in your area.

 

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 Eliquis Coverage with SummaCare

 

Understand Your Prescription Coverage Needs

 

  • Contact your healthcare provider to confirm that Eliquis is the appropriate medication for you and obtain a valid prescription.
  • Assess your current SummaCare plan to determine if it offers any coverage for prescription medications, particularly Eliquis.

 

Review SummaCare Plan Details

 

  • Examine your SummaCare policy documents or member portal to see if Eliquis is listed in the formulary (the list of covered drugs).
  • If Eliquis is not listed, investigate the plan's drug exclusion policies to understand why it may not be covered.

 

Contact SummaCare Customer Service

 

  • Call the SummaCare customer service hotline to directly inquire about Eliquis coverage options and any potential costs or restrictions.
  • Ask if there are any specific steps you need to complete, such as prior authorization, to have Eliquis covered by your plan.

 

Work with Your Physician

 

  • If prior authorization is required, coordinate with your physician to submit the necessary documentation to SummaCare.
  • Ensure your doctor provides any clinical information required by SummaCare to support the necessity of Eliquis.

 

Explore Assistance Programs

 

  • Investigate if there are any manufacturer assistance programs or generic alternatives if Eliquis is not covered.
  • Consider reaching out to patient assistance foundations that can provide support for prescription costs.

 

Confirm Coverage and Costs

 

  • Once authorization is obtained, verify with SummaCare that Eliquis is now covered under your plan, and understand any co-pays or out-of-pocket expenses.
  • Ensure your pharmacy is in-network with SummaCare to avoid unexpected costs when filling your prescription.

 

File an Appeal if Necessary

 

  • If coverage for Eliquis is denied, prepare to file an appeal with SummaCare by gathering necessary documentation and support from your healthcare provider.
  • Understand the appeal process timeline and remain in contact with SummaCare representatives throughout the appeal.

 

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Eliquis FAQ

What are the side effects of Eliquis?

 

Common Side Effects of Eliquis

 

  • Mild bleeding or bruising due to its anticoagulant effect.
  • Nausea, which may occur as your body adjusts to the medication.
  • Skin rash or minor allergic reactions.
  • Fatigue or general weakness.

 

Serious Side Effects

 

  • Severe bleeding, including unusual bleeding from gums, nosebleeds, or heavier than usual menstrual bleeding.
  • Red, pink, or brown urine and black or bloody stools indicating internal bleeding.
  • Severe headache, dizziness, or fainting, which could indicate a bleed in the brain.
  • Signs of anemia, such as pale skin, weakness, or fatigue.

 

Consult Your Doctor

 

  • Always report any unusual symptoms to your healthcare provider promptly.
  • Seek emergency medical attention for significant bleeding or symptoms of a serious allergic reaction like difficulty breathing.

 

Is Eliquis a blood thinner?

 

Is Eliquis a Blood Thinner?

 

  • Yes, Eliquis (apixaban) is a blood thinner, also known as an anticoagulant.
  •  

  • It prevents blood clots by inhibiting Factor Xa, which is crucial in the clotting process.
  •  

  • Doctors prescribe Eliquis to reduce stroke risk in patients with atrial fibrillation and to treat or prevent deep vein thrombosis (DVT) and pulmonary embolism (PE).
  •  

  • Ensure regular monitoring and follow-ups with your healthcare provider while on Eliquis for safe management.
  •  

  • Contact a healthcare professional if you have concerns about bleeding risks or interactions with other medications.

 

Can you take Eliquis with alcohol?

 

Alcohol and Eliquis Interaction

 

  • Moderate alcohol consumption might be safe, but heavy drinking can increase bleeding risk.
  •  

  • Consult your healthcare provider to assess your specific condition and alcohol tolerance.

 

Potential Effects of Combining

 

  • Both Eliquis and alcohol affect blood clotting, raising potential for heightened bleeding.
  •  

  • Alcohol can augment Eliquis' effects, complicating the management of conditions like atrial fibrillation.

 

Recommendations for Use

 

  • If you drink, limit to one or two standard drinks occasionally and monitor for bruising or bleeding.
  •  

  • Report any unusual symptoms to your healthcare provider immediately.

 

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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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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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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