![]() For example, if a blood vessel in the body becomes damaged, a clot will form to attempt to heal the site. There are a few different circumstances that could result in blood clotting being harmful to the body. When you are at risk for developing a blood clot too easily, Eliquis is a commonly prescribed medication that blocks certain clotting substances in the blood and makes it thinner and less likely to clot. While coagulation plays a very important part in the body as it prevents you from bleeding too much with injuries, it can also be potentially harmful to the body. This also allows the site to begin the healing process so that it can restore the original tissue and functionality. The thicker blood can then create a blood clot, which serves as a scab and seals off the site to stop the bleeding. These factors work to make blood thicker and almost gel-like. These factors all play important roles in the body to prevent excess bleeding, especially when an injury occurs.įor example, if you get a cut on your arm, your body will send clotting factors to the injury site. ![]() The blood naturally contains a number of different clotting factors. This means that it prevents clots from forming when they are not supposed to. Medicare provides coverage for a wide range of different prescription drugs through its Medicare Part D benefits, allowing Medicare recipients to obtain coverage for Eliquis if they are eligible and enroll in Part D coverage.Įliquis works as an anticoagulant for the blood. This medication also has a generic version, which is known as apixaban, and it is used by many individuals across the United States. That means that you will pay the copay/co-insurance you would be responsible for under your plan plus the difference between the cash price and the plan allowance if the cash price is higher than the contracted rate.Eliquis is a prescription medication that has a number of protective benefits for the body, especially when it comes to the health of your heart and blood vessels. If our Direct Member Reimbursement policy requirements are met, you will be reimbursed at the “any willing provider in-network contracted rate” instead of the cash price minus any applicable co-pays. Your request will be processed according to your benefit coverage and you will be notified of the outcome. ![]() We will review the Direct Member Reimbursement Request form and make an initial out-of-network coverage determination. Mail the completed Direct Member Reimbursement form along with a prescription label or pharmacy printout and a cash register receipt for your covered prescription drug to: To receive reimbursement for our portion of your cost, you will have to submit a Direct Member Reimbursement Form. Please note that even if we pay for covered prescription drugs filled at an out-of-network pharmacy, you may still pay more than you would have paid if you had filled your prescriptions at an in-network pharmacy. You are administered a vaccine covered by your plan in a physician’s office. ![]() high-cost and/or special drugs) cannot be obtained through CVS Caremark Mail Service Pharmacy or Exactus Specialty pharmacy due to the medication being out-of-stock or any other reasons The covered drug is out of stock at any network pharmacy in your area.The covered drug is prescribed for a medical emergency or urgent care and you are unable to fill your prescription immediately at a network pharmacy because there are no 24-hour network pharmacies within a reasonable driving distance.There are no participating network pharmacies when you travel outside of your service area.The formulary, pharmacy network, and/or provider network may change at any time.An out-of-network pharmacy is a retail, long-term care, home infusion, or ITU pharmacy that is not in your plan’s network.Īs a rule, prescription drugs filled at out-of-network pharmacies are only covered by your plan if you are unable to use a network pharmacy for any of these reasons: ![]() If an in-network pharmacy is not available, you may need to use an out-of-network pharmacy to fill your prescriptions. Benefits, formulary, pharmacy network, premium and/copayments/coinsurance may change on January 1 of each year. WellCare has contracts with pharmacies that equal or exceed the Centers for Medicare and Medicaid Services (CMS) requirements for pharmacy access in your area. Beneficiaries must use network pharmacies to access their prescription drug benefit. You will be responsible for any necessary out of pocket expense according to your Part D benefit. When you fill your prescription at a participating pharmacy, you will simply need to present your WellCare ID card. In-network and Out-of-network Pharmacy Costs ![]()
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