Does Tufts Health Plan Cover Xarelto

Explore if Tufts Health Plan covers Xarelto, how to secure coverage, Xarelto costs without insurance, and find answers to FAQs.
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Xarelto Coverage by Tufts Health Plan

 

  • Xarelto is generally covered under Tufts Health Plan’s prescription drug benefits but requires prior authorization.
  •  

  • Coverage is usually for approved medical conditions such as prevention of stroke in patients with non-valvular atrial fibrillation, treatment of deep vein thrombosis (DVT), or pulmonary embolism (PE).
  •  

  • The plan may also cover Xarelto for the prevention of DVT after knee or hip replacement surgery.
  •  

  • To get Xarelto covered, patients need a prescription from a healthcare provider and must satisfy the medical necessity criteria set by Tufts Health Plan.
  •  

  • Patients may need to provide documentation of their medical condition and if they’ve previously tried and not responded well to other medications.
  •  

  • It is essential to consult directly with Tufts Health Plan or a healthcare provider for personalized assistance regarding coverage and prior authorization requirements.

 

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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.

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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 Xarelto Coverage with Tufts Health Plan

 

Verify Your Coverage Eligibility

 

  • Contact Tufts Health Plan customer service to confirm that you are eligible for prescription drug coverage under your plan. You can find the contact number on your insurance card.
  •  

  • Check the Tufts Health Plan formulary online to see if Xarelto is covered under your current plan.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the necessity of using Xarelto and ask them to provide you with a prescription if it is deemed suitable for your treatment.
  •  

  • Ensure your healthcare provider understands your insurance coverage needs and can provide any necessary documentation to support a prior authorization request if required by Tufts Health Plan.

 

Gather Required Documentation

 

  • If a prior authorization is needed, collect all necessary documents, including your doctor's prescription, medical records, and any prior authorization forms required by Tufts Health Plan.
  •  

  • Ensure all information is accurate and complete before submission to avoid any delays in processing.

 

Submit a Prior Authorization Request

 

  • Have your healthcare provider submit a prior authorization request to Tufts Health Plan. This can often be done electronically via the provider’s system or by faxing the documents to the plan.
  •  

  • Follow up with both your healthcare provider and Tufts Health Plan to ensure the request is submitted and being processed.

 

Contact Tufts Health Plan for Updates

 

  • After submission, regularly check the status of your prior authorization request by contacting Tufts Health Plan customer service.
  •  

  • Inquire about any additional information needed to expedite the approval process.

 

Understand Your Cost and Copayment

 

  • Once approved, review the details of your coverage, including any copayments or deductibles associated with filling your Xarelto prescription.
  •  

  • Ask Tufts Health Plan if there are generic or preferred medication alternatives that might reduce your out-of-pocket expenses.

 

Fill Your Prescription

 

  • Use an in-network pharmacy to fill your Xarelto prescription to maximize your coverage benefits.
  •  

  • Present your Tufts Health Plan insurance card to the pharmacist to ensure you receive the applicable cost savings on your prescription.

 

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FAQs

Does Tufts Health Plan Cover Xarelto

Explore if Tufts Health Plan covers Xarelto, how to secure coverage, Xarelto costs without insurance, and find answers to FAQs.
Curex allergy drops unboxing

Is Xarelto Covered by Tufts Health Plan

 

Xarelto Coverage by Tufts Health Plan

 

  • Xarelto is generally covered under Tufts Health Plan’s prescription drug benefits but requires prior authorization.
  •  

  • Coverage is usually for approved medical conditions such as prevention of stroke in patients with non-valvular atrial fibrillation, treatment of deep vein thrombosis (DVT), or pulmonary embolism (PE).
  •  

  • The plan may also cover Xarelto for the prevention of DVT after knee or hip replacement surgery.
  •  

  • To get Xarelto covered, patients need a prescription from a healthcare provider and must satisfy the medical necessity criteria set by Tufts Health Plan.
  •  

  • Patients may need to provide documentation of their medical condition and if they’ve previously tried and not responded well to other medications.
  •  

  • It is essential to consult directly with Tufts Health Plan or a healthcare provider for personalized assistance regarding coverage and prior authorization requirements.

 

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Tufts Health Plan's Approved Criteria for Xarelto Coverage

 

Approved Criteria for Xarelto Coverage by Tufts Health Plan

 

  • Xarelto is approved for coverage in individuals diagnosed with non-valvular atrial fibrillation (NVAF) who are at risk for stroke or systemic embolism.
  •  

  • Coverage extends to patients requiring treatment for deep vein thrombosis (DVT) or pulmonary embolism (PE), and for those seeking to reduce the risk of recurrence.
  •  

  • The drug is covered for patients undergoing hip or knee replacement surgery to prevent postoperative DVT and PE.
  •  

  • Patients with restricted mobility and undergoing acute medical illness treatment may also qualify for coverage to prevent thromboembolism risk.
  •  

  • Xarelto is approved for patients with coronary artery disease (CAD) or peripheral artery disease (PAD) to reduce the risk of major cardiovascular events, such as cardiovascular death, myocardial infarction, and stroke.
  •  

  • Coverage is provided for individuals when used in combination with aspirin to reduce cardiovascular diseases and related risks post-acute coronary syndrome.

 

Why Tufts Health Plan Might Deny Xarelto Coverage

 

Exclusion Criteria for Xarelto Coverage

 

  • Xarelto is not covered if it is prescribed for a condition that lacks sufficient FDA approval or medical evidence supporting its efficacy and safety.
  •  

  • Use of Xarelto that does not comply with the established dosing guidelines or recommended duration of use might be excluded from coverage.
  •  

  • If Xarelto is intended for off-label use that does not align with recognized clinical guidelines or lacks consensus in the medical community, coverage may be denied.
  •  

  • The prescription might not be covered if there's a less expensive, equally effective alternative that should be tried first as per the plan's fail-first policy.
  •  

  • Using Xarelto in combination with certain medications that may contraindicate or interfere with its effectiveness could result in denial.
  •  

  • Xarelto will not be covered if the patient does not meet the clinical criteria outlined in the plan's step therapy requirement, such as previously unsuccessful trials of other treatments.
  •  

  • Poor adherence to the plan’s required prior authorization process, such as insufficient documentation or failure to obtain pre-approval, may lead to denial of coverage.
  •  

 

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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 Tufts Health Plan

 

Verify Your Coverage Eligibility

 

  • Contact Tufts Health Plan customer service to confirm that you are eligible for prescription drug coverage under your plan. You can find the contact number on your insurance card.
  •  

  • Check the Tufts Health Plan formulary online to see if Xarelto is covered under your current plan.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor the necessity of using Xarelto and ask them to provide you with a prescription if it is deemed suitable for your treatment.
  •  

  • Ensure your healthcare provider understands your insurance coverage needs and can provide any necessary documentation to support a prior authorization request if required by Tufts Health Plan.

 

Gather Required Documentation

 

  • If a prior authorization is needed, collect all necessary documents, including your doctor's prescription, medical records, and any prior authorization forms required by Tufts Health Plan.
  •  

  • Ensure all information is accurate and complete before submission to avoid any delays in processing.

 

Submit a Prior Authorization Request

 

  • Have your healthcare provider submit a prior authorization request to Tufts Health Plan. This can often be done electronically via the provider’s system or by faxing the documents to the plan.
  •  

  • Follow up with both your healthcare provider and Tufts Health Plan to ensure the request is submitted and being processed.

 

Contact Tufts Health Plan for Updates

 

  • After submission, regularly check the status of your prior authorization request by contacting Tufts Health Plan customer service.
  •  

  • Inquire about any additional information needed to expedite the approval process.

 

Understand Your Cost and Copayment

 

  • Once approved, review the details of your coverage, including any copayments or deductibles associated with filling your Xarelto prescription.
  •  

  • Ask Tufts Health Plan if there are generic or preferred medication alternatives that might reduce your out-of-pocket expenses.

 

Fill Your Prescription

 

  • Use an in-network pharmacy to fill your Xarelto prescription to maximize your coverage benefits.
  •  

  • Present your Tufts Health Plan insurance card to the pharmacist to ensure you receive the applicable cost savings on your prescription.

 

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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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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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