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Does Medicare cover Xifaxan? Given the prevalence of GI problems and Xifaxan prescriptions written for older patients, one of the most common questions asked by people who need the drug.
The short answer is yes, but it still comes with some pretty significant out-of-pocket costs. That means Medicare is not necessarily the most cost-effective route for accessing the medication. In this guide, we’ll cover the ins and outs of Medicare’s Xifaxan coverage, plus how to access the drug most affordably.
- Xifaxan is used to treat GI conditions and disorders, like irritable bowel syndrome (IBS) and travelers’ diarrhea.
- Xifaxan is covered by Medicare Part D and Medicare Advantage plans.
- Because Xifaxan is classified as a Tier 5 drug, it has high co-pays and co-insurance. Together with deductible costs, it can cost $1000+ per year for people taking the medication.
- Canadian online pharmacies offer generic Xifaxan, Rifaximin (not yet available in the U.S.) at a 95% lower cost.
What is Xifaxan?
Xifaxan is the brand name for the generic drug rifaximin, which is an antibiotic used primarily to treat certain gastrointestinal (GI) conditions and disorders. It belongs to a class of antibiotics known as rifamycins, and it’s unique in its minimal systemic absorption. This means it primarily acts within the GI tract and doesn’t significantly enter the bloodstream.
The primary medical use of Xifaxan is for the treatment of travelers' diarrhea caused by non-invasive strains of E. coli, which is a common condition among people who travel to regions with poor sanitation or contaminated water sources.
Additionally, Xifaxan has become a popular prescription for the treatment of irritable bowel syndrome with diarrhea (IBS-D). It is believed to work by altering the balance of bacteria in the gut, which reduces the symptoms of IBS-D, such as abdominal pain and diarrhea.
Because Xifaxan has limited systemic absorption, it minimizes the risk of uncomfortable side effects that are common with other antibiotics, such as allergic reactions, rashes, or GI disturbances. This makes it a preferred choice to treat GI conditions because it can target bacteria in the gut without affecting the rest of the body.
Is Xifaxan Covered by Medicare?
With a valid prescription from a healthcare provider, Xifaxan is covered by Medicare. It’s important to note, however, that only certain Medicare plans cover prescription drugs: Medicare Part D and Medicare Advantage (Part C).
Medicare Part D
Medicare Part D is Medicare’s primary federal program for providing prescription drug coverage to Medicare beneficiaries. It is offered through private insurance companies approved by Medicare. Part D is specifically for helping individuals pay for the costs of prescription medications.
Medicare Advantage (Part C)
Medicare Advantage, also known as Medicare Part C, is an alternative way to receive Medicare benefits. It combines hospital, medical, and often prescription drug coverage into a single plan. These plans are also offered by private insurance companies approved by Medicare, and often but don’t always include drug coverage as part of their benefits package.
Even within these two categories, Medicare Part D and Medicare Advantage plans can vary widely in terms of drug coverage and costs. It's essential for beneficiaries to carefully review their plan's coverage documents, such as the Annual Notice of Change (ANOC) and Evidence of Coverage (EOC), in order to understand how Xifaxan or any other prescription medications are covered.
Since Medicare plans and their coverage can change annually, it's a good practice to contact Medicare or your plan provider for the most up-to-date information on Xifaxan coverage each year. Additionally, you can consider seeking advice from a Medicare counselor or advisor to get personalized guidance on your Medicare prescription drug coverage options.
Is Medicare-Covered Xifaxan the Most Cost-Effective?
Even with Medicare coverage, there are out-of-pocket costs to take into account when it comes to paying for Xifaxan and other prescription medications:
Every Medicare plan requires a monthly premium, which is a regular payment you make to your Medicare Part D or Medicare Advantage plan for drug coverage. The specific premium amount can vary depending on the plan you choose.
Deductibles are the initial amounts you must pay out of pocket for covered drugs before your Medicare prescription drug plan starts to contribute. The deductible amount can vary from one plan to another, but most Medicare Part D plans have a deductive around $500.
Copays or Coinsurance
Copays and coinsurance represent the portion of the drug cost that you are responsible for after meeting your deductible. Copays are fixed, set amounts you pay for each prescription, and coinsurance is usually expressed as a percentage (e.g., 20%), with the remaining percentage covered by Medicare.
Copays and coinsurance are particularly variable and depend on something called drug formulary tiers, which categorize drugs as follows:
Xifaxan is typically categorized as a Tier 5 drug, meaning copays are 30% of the retail cost. The average retail cost for Xifaxan in the U.S. is $2200 for a single 42-tablet prescription, meaning out-of-pocket costs would land around $660 for Medicare beneficiaries. This is after the $500 deductible. 
Depending on why and how often someone takes Xifaxan—and if they’re taking any other prescription medications—these costs can add up quickly.
Canadian Online Pharmacies: A More Affordable Alternative
Canadian online pharmacies are able to offer the very same drugs as those you find on U.S. markets, including Xifaxan, for just a fraction of the cost. There are a myriad of reasons why U.S. drug prices are so high, but Canada isn’t subject to any of them.
That means the retail costs of drugs like Xifaxan are significantly lower—even without Medicare coverage in the picture.
For example: At My Drug Center, you can order a 50-pill prescription for the generic version of Xifaxan, called Rifaximin (not yet available in the U.S.), for only $99.00—a staggering 95% cost savings.
This translates to several thousand dollars in annual cost savings for people taking Xifaxan regularly.
How to Order Xifaxan Online
Ordering Xifaxan and other prescription drugs from Canadian online pharmacies like My Drug Center is both safe and legal for United States residents, and you can do it in a few easy steps:
- Visit our ordering page and search for your medication
- Select your dosage and quantity, then add to cart
- Create an account with My Drug Center (only takes a few minutes)
- Mail us your prescription
- Wait for your prescription to arrive in just 3-4 weeks
Visit our website to learn more about this process and how My Drug Center can help you save on your next prescription.
The information in the article is not meant to be used for treatment or diagnosis. It is designed for general awareness and for information purposes only. Always consult a medical professional for your specific healthcare needs.