Does Medicare Cover Xifaxan?

As we age, our health becomes a top priority. However, health care costs can be a significant burden, especially for those who rely heavily on medical services. This is where Medicare comes in. Medicare is a federal health insurance program for people aged 65 or older, younger people with disabilities, and people with end-stage renal disease. It covers a wide range of medical services, including prescription drugs. But does Medicare cover Xifaxan?

Xifaxan is a medication commonly used to treat irritable bowel syndrome and certain types of diarrhea. The cost of Xifaxan can be quite high, and many people wonder if Medicare covers this medication. In this article, we will explore the coverage of Xifaxan under Medicare, the conditions for coverage, and the costs involved. So, if you or a loved one is considering Xifaxan treatment, read on to find out if Medicare can help cover the costs.

Does Medicare Cover Xifaxan?

If you or a loved one is suffering from irritable bowel syndrome with diarrhea (IBS-D), you may have heard of Xifaxan as a treatment option. However, before starting any medication, it’s important to understand what your insurance will cover. In this article, we will explore whether Medicare covers Xifaxan.

What is Xifaxan?

Xifaxan, also known as rifaximin, is an antibiotic used to treat IBS-D. It works by reducing the number of bacteria in the gut that can cause diarrhea. Xifaxan is typically taken for two weeks and can provide relief from symptoms for up to six months.

How is Xifaxan prescribed?

Xifaxan is prescribed by a healthcare provider and is typically taken orally three times a day for two weeks. It’s important to take the medication as prescribed, even if your symptoms improve. If your symptoms do not improve after two weeks, or if they worsen, contact your healthcare provider.

What are the benefits of Xifaxan?

Xifaxan has been shown to be effective in reducing symptoms of IBS-D. In clinical trials, patients taking Xifaxan had a higher rate of symptom improvement compared to those taking a placebo. Additionally, Xifaxan is not absorbed into the bloodstream, which means it has fewer side effects than other antibiotics.

Does Original Medicare cover Xifaxan?

Original Medicare, which includes Part A and Part B, does not cover Xifaxan for the treatment of IBS-D. However, if you have a Medicare Advantage plan, your coverage may be different.

What is Medicare Advantage?

Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. Medicare Advantage plans are offered by private insurance companies and provide the same coverage as Original Medicare, but may also offer additional benefits such as prescription drug coverage, dental, vision, and hearing coverage, and wellness programs.

Does Medicare Advantage cover Xifaxan?

The coverage of Xifaxan under a Medicare Advantage plan can vary depending on the plan. Some plans may cover Xifaxan as a Tier 3 or Tier 4 drug, which means you would pay a higher copayment or coinsurance. It’s important to review the details of your plan’s formulary to understand your coverage for Xifaxan.

What is the cost of Xifaxan without insurance?

The cost of Xifaxan without insurance can vary depending on the pharmacy and location. The average retail price for a 14-day supply of Xifaxan is around $1,200. However, there are ways to reduce the cost of Xifaxan for those without insurance.

Are there any patient assistance programs for Xifaxan?

Yes, the manufacturer of Xifaxan offers a patient assistance program for those who meet certain eligibility requirements. The program provides Xifaxan at no cost to eligible patients or at a reduced cost for those with insurance.

Are there any generic versions of Xifaxan?

Yes, there is a generic version of Xifaxan called rifaximin. The cost of generic rifaximin is typically lower than the brand-name version, but it may not be covered by all insurance plans.

Conclusion

Xifaxan can be an effective treatment option for those suffering from IBS-D. While Original Medicare does not cover Xifaxan, Medicare Advantage plans may offer coverage for the medication. It’s important to review your plan’s formulary and understand your coverage before starting any medication. Additionally, patient assistance programs and generic versions of Xifaxan may be available to help reduce the cost of the medication.

Frequently Asked Questions

Does Medicare Cover Xifaxan?

Xifaxan is a medication used to treat hepatic encephalopathy, traveler’s diarrhea, and irritable bowel syndrome. It is covered by Medicare Part D as long as it is prescribed by a doctor and filled at a pharmacy that participates in Medicare.

However, coverage and costs may vary depending on the specific Medicare plan you have. It is important to check with your plan to see if Xifaxan is covered and what your out-of-pocket costs may be.

What is the Cost of Xifaxan with Medicare?

The cost of Xifaxan with Medicare depends on the specific plan you have. Medicare Part D plans have different formularies and drug tiers, which can affect the cost of the medication.

In general, Xifaxan may be covered by Medicare Part D with a copay or coinsurance. The amount you pay out-of-pocket for Xifaxan can also depend on whether you have reached the Medicare Part D coverage gap, also known as the “donut hole.” If you have questions about the cost of Xifaxan with Medicare, it is important to check with your plan or pharmacist.

Is Xifaxan Covered by Medicare Advantage?

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurance companies and provide the same benefits as Original Medicare (Part A and Part B) along with additional benefits such as prescription drug coverage (Part D).

Xifaxan may be covered by some Medicare Advantage plans, but coverage and costs may vary. It is important to check with your specific plan to see if Xifaxan is covered and what your out-of-pocket costs may be.

What is the Difference Between Xifaxan and Rifaximin?

Xifaxan is a brand name for the generic medication rifaximin. Both Xifaxan and rifaximin are medications used to treat hepatic encephalopathy, traveler’s diarrhea, and irritable bowel syndrome.

The main difference between Xifaxan and rifaximin is that Xifaxan is a brand name medication, while rifaximin is a generic medication. Generic medications are often less expensive than brand name medications, but they are required to have the same active ingredient and effectiveness as the brand name medication.

Can I Get Xifaxan Without a Prescription?

No, Xifaxan is a prescription medication that requires a doctor’s prescription. It is important to talk to your doctor about your symptoms and medical history to determine if Xifaxan is the right medication for you. Do not attempt to obtain Xifaxan without a prescription, as it can be dangerous and illegal.

Does Medicare Cover Prescription Medications?

In the world of healthcare, there are few things more confusing than insurance coverage. Medicare, the government-funded health insurance program for those over 65, is no exception. One medication that has sparked particular interest among Medicare beneficiaries is Xifaxan, a drug used to treat irritable bowel syndrome and other gastrointestinal issues. So, does Medicare cover Xifaxan? The answer is complex, but it ultimately depends on a variety of factors.

While Medicare Part B does cover some prescription drugs, Xifaxan is not one of them. However, it may still be covered under a Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage, depending on the specific plan and the patient’s individual circumstances. Additionally, some patients may be able to receive financial assistance through programs such as Extra Help or patient assistance programs offered by the manufacturer of Xifaxan. With all of these options available, it is important for Medicare beneficiaries to carefully review their coverage and explore all of their options to ensure that they are receiving the best possible care.