Does Tufts Health Plan Cover Eliquis

Explore Eliquis coverage with Tufts Health Plan, reasons for denial, steps for approval, costs without insurance, and FAQs in this detailed guide.
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Coverage for Eliquis

 

  • Tufts Health Plan generally covers Eliquis, a medication used to prevent blood clots, specifically for conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism.
  •  

  • Coverage often depends on the specific plan and the patient's medical necessity as evaluated by their healthcare provider.

 

Criteria for Coverage

 

  • Prescriptions must be filled by an in-network pharmacy.
  •  

  • A prior authorization might be required, meaning the prescribing doctor must provide information to justify the necessity of Eliquis.
  •  

  • The patient must meet the diagnostic criteria for which Eliquis is deemed effective treatment.
  •  

  • Coverage is subject to formulary guidelines, which may require trying other medications before Eliquis is approved.

 

Basic Rules

 

  • Members should consult their plan documents for detailed coverage information as different plans may have varying levels of coverage.
  •  

  • Out-of-pocket costs like co-pays or coinsurance may apply.

 

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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 Eliquis Coverage with Tufts Health Plan

 

Check Eliquis Formulary Status

 

  • Visit the Tufts Health Plan website and navigate to their formulary page to check if Eliquis is included in their covered medications.
  •  

  • Look for any specific notes or restrictions on Eliquis, such as prior authorization or step therapy requirements.

 

Contact Tufts Member Services

 

  • Call the Tufts Health Plan Member Services number located on the back of your insurance card for personalized assistance.
  •  

  • Confirm Eliquis coverage details, including any copayments, coinsurance, or deductible that may apply.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor the necessity of Eliquis for your treatment plan and any alternative medications that may be more cost-effective or have better coverage.
  •  

  • If Eliquis is needed, ensure your doctor is aware of any prior authorization forms or additional documentation required by Tufts Health Plan.

 

Submit a Prior Authorization Request

 

  • If required, assist your healthcare provider in submitting a prior authorization request using the correct forms available on the Tufts Health Plan website.
  •  

  • Ensure that this request includes a detailed explanation of why Eliquis is necessary for your treatment, as per your doctor’s evaluation.

 

Review Pharmaceutical Assistance Programs

 

  • Investigate if you qualify for any pharmaceutical assistance programs that may help cover the cost of Eliquis, in addition to your Tufts Health Plan coverage.
  •  

  • Contact the Eliquis manufacturer to inquire about any available coupons or savings programs for eligible patients.

 

Monitor Your Coverage

 

  • Stay informed about any changes to your coverage by regularly reviewing updates from Tufts Health Plan regarding the formulary and policy changes.
  •  

  • Keep an open line of communication with both your healthcare provider and Tufts Health Plan for any future medication needs.

 

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FAQs

Does Tufts Health Plan Cover Eliquis

Explore Eliquis coverage with Tufts Health Plan, reasons for denial, steps for approval, costs without insurance, and FAQs in this detailed guide.
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Is Eliquis Covered by Tufts Health Plan

 

Coverage for Eliquis

 

  • Tufts Health Plan generally covers Eliquis, a medication used to prevent blood clots, specifically for conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism.
  •  

  • Coverage often depends on the specific plan and the patient's medical necessity as evaluated by their healthcare provider.

 

Criteria for Coverage

 

  • Prescriptions must be filled by an in-network pharmacy.
  •  

  • A prior authorization might be required, meaning the prescribing doctor must provide information to justify the necessity of Eliquis.
  •  

  • The patient must meet the diagnostic criteria for which Eliquis is deemed effective treatment.
  •  

  • Coverage is subject to formulary guidelines, which may require trying other medications before Eliquis is approved.

 

Basic Rules

 

  • Members should consult their plan documents for detailed coverage information as different plans may have varying levels of coverage.
  •  

  • Out-of-pocket costs like co-pays or coinsurance may apply.

 

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Tufts Health Plan's Approved Criteria for Eliquis Coverage

 

Eliquis Coverage Criteria by Tufts Health Plan

 

  • **Age Requirement**: Coverage is available for adult patients aged 18 and above.
  •  

  • **Indications**: The patient must be diagnosed with one of the following medical conditions:
    • Atrial Fibrillation that is non-valvular and requires anticoagulation to prevent stroke and systemic embolism.
    • Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).
    • Reduction in the risk of recurrence of DVT and PE following initial treatment.
    • Prophylaxis of DVT, which may lead to PE, in patients who have undergone knee or hip replacement surgery.
  •  

  • **Previous Treatments**: The patient should have tried and failed, or have a clinical reason preventing the use of, other anticoagulant therapies such as warfarin, unless contraindicated or not tolerated.
  •  

  • **Prescriber Requirements**: Request must come from a specialist in cardiology, hematology, or internal medicine. Alternatively, the prescribing physician should be coordinating care with one of these specialists.
  •  

  • **Dosage Criteria**: The dosage prescribed must align with the approved dosage guidelines for the specific medical condition being treated without exceeding the maximum recommended daily dose.
  •  

  • **Monitoring Plan**: Evidence of a monitoring plan to assess efficacy and safety of Eliquis usage should accompany request for coverage.
  •  

  • **Patient Education**: The patient must be willing to participate in educational programs about the safe use of Eliquis and the importance of adherence to prescribed therapy.
  •  

 

Why Tufts Health Plan Might Deny Eliquis Coverage

 

Why Tufts Health Plan Might Deny Eliquis Coverage

 

  • Non-Compliance with Prior Authorization Requirements: If a patient does not meet the specific criteria established by Tufts Health Plan's prior authorization process, coverage for Eliquis may be denied. This can include failure to provide necessary documentation or medical history.
  •  

  • Off-Label Use: Eliquis prescribed for conditions that are not FDA-approved or not covered under Tufts Health Plan's formulary guidelines might be subject to denial. Off-label use without sufficient scientific support or evidence may not be covered.
  •  

  • Preference for Alternative Treatments: If Tufts Health Plan has designated alternative medications that are considered clinically equivalent and more cost-effective, they might deny coverage for Eliquis in favor of these alternatives.
  •  

  • Non-Formulary Drug: Eliquis may be on a non-preferred status on Tufts Health Plan's formulary. If Eliquis is classified as a non-formulary drug without a medical necessity override, the plan might deny coverage.
  •  

  • Coverage Limitations and Exclusions: Certain policies might explicitly exclude anticoagulants like Eliquis based on plan-specific restrictions or limitations, resulting in denial of claims.

 

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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 Tufts Health Plan

 

Check Eliquis Formulary Status

 

  • Visit the Tufts Health Plan website and navigate to their formulary page to check if Eliquis is included in their covered medications.
  •  

  • Look for any specific notes or restrictions on Eliquis, such as prior authorization or step therapy requirements.

 

Contact Tufts Member Services

 

  • Call the Tufts Health Plan Member Services number located on the back of your insurance card for personalized assistance.
  •  

  • Confirm Eliquis coverage details, including any copayments, coinsurance, or deductible that may apply.

 

Consult With Your Healthcare Provider

 

  • Discuss with your doctor the necessity of Eliquis for your treatment plan and any alternative medications that may be more cost-effective or have better coverage.
  •  

  • If Eliquis is needed, ensure your doctor is aware of any prior authorization forms or additional documentation required by Tufts Health Plan.

 

Submit a Prior Authorization Request

 

  • If required, assist your healthcare provider in submitting a prior authorization request using the correct forms available on the Tufts Health Plan website.
  •  

  • Ensure that this request includes a detailed explanation of why Eliquis is necessary for your treatment, as per your doctor’s evaluation.

 

Review Pharmaceutical Assistance Programs

 

  • Investigate if you qualify for any pharmaceutical assistance programs that may help cover the cost of Eliquis, in addition to your Tufts Health Plan coverage.
  •  

  • Contact the Eliquis manufacturer to inquire about any available coupons or savings programs for eligible patients.

 

Monitor Your Coverage

 

  • Stay informed about any changes to your coverage by regularly reviewing updates from Tufts Health Plan regarding the formulary and policy changes.
  •  

  • Keep an open line of communication with both your healthcare provider and Tufts Health Plan for any future medication needs.

 

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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.

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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