How much does Xarelto cost with Medicare?
Without insurance, the cash price of Xarelto in 2022 is anywhere from $400-500 for a 30-day supply. Patients who have prescription insurance through Medicare pay between $2-18 on average for Xarelto. The amount an individual pays for Xarelto depends on various factors such as:
- Medicare coverage type
- the insurer’s formulary tier list (list of covered drugs)
- if the individual has reached their annual deductible amount
- copayments or coinsurance
What is Xarelto?
Xarelto (rivaroxaban) is an anticoagulant (blood thinner) medication. The brand name Xarelto is owned by Bayer AG, Janssen Pharmaceuticals, Inc., and Johnson & Johnson. In the United States, rivaroxaban was approved for medical use in 2011.
It works by inhibiting thrombin, a protein involved in the formation of blood clots. Xarelto is available as a tablet that can be taken by mouth with or without food.
Xarelto is used to:
- prevent blood clots from forming in people who have undergone knee or hip replacement surgery
- treat and reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE)
- reduce the risk of stroke and systemic embolism in people with nonvalvular atrial fibrillation
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Is there a generic version of Xarelto?
There is no generic version of Xarelto currently available in the United States. The earliest possible date that a generic version could be available is 2039, which is when the patent for Xarelto expires.
What’s the cheapest way to get Xarelto?
The best way to find the lowest price for Xarelto is to compare prices at different pharmacies. You can also try using a prescription drug discount card or prescription assistance programs. Manufacturer assistance programs help by providing discounts for eligible individuals. Other ways to save on Xarelto may include using a mail-order pharmacy or looking for a Xarelto coupon.
Some insurance plans may help with reducing the cost of Xarelto, but may also have higher copays, deductibles or premium fees. It’s always best to speak with your insurance company about coverage and costs before buying Xarelto.
You may be able to save money by switching to a Medicare Advantage Prescription Drug (MAPD) plan that includes prescription drug coverage, or by enrolling in a Medicare Part D prescription drug plan.
You may also try asking your healthcare provider for free Xarelto samples to help you decide if Xarelto is the right medication for you before purchasing.
Xarelto is an expensive medication but there are possible ways to reduce the cost.
Does Medicare cover Xarelto?
Medicare Part A (hospital insurance) does not cover Xarelto because it is not a hospital-administered medication.
Medicare Part B (medical insurance) does not cover Xarelto because it is considered an outpatient medication.
Medicare Part D plans (prescription drug plans) and Medicare Advantage plans with prescription drug coverage (MAPDs) may cover Xarelto.
If you have the Original Medicare and would like coverage for Xarelto, you may need to enroll in a stand-alone Part D plan or a Medicare Advantage Prescription Drug (MAPD) plan that includes prescription drug coverage.
Medicare Part D plans and Xarelto coverage
Medicare Part D plans (PDPs) and Medicare Advantage Prescription Drug (MAPD) plans are required to cover all FDA-approved drugs. Since Xarelto is an FDA-approved drug, it must be covered by all PDPs and MAPDs that offer prescription drug coverage.
Each plan has its own guidelines on what it will cover for each type of drug in its formulary (list of covered drugs). Some plans may also have Xarelto on a higher tier of their formulary (list of covered drugs), which may result in patients paying a higher coinsurance or copayment for the medication. Other plans may also exempt Xarelto from the annual deductible amount.
If an individual has a Medicare Part D prescription drug plan or a Medicare Advantage Prescription Drug (MAPD) plan, they will likely pay a monthly premium, an annual deductible, and coinsurance or copayments for their Xarelto medication. The average monthly premium for a Medicare Part D prescription drug plan in 2022 is $33, according to CMS. No Medicare drug plan may have a deductible of more than $480 in 2022 which means that you are responsible for the first $480 of out of pocket costs for your prescription drugs before your coverage commences.
Medicare Part D prescription drugs are the most common way of obtaining coverage from Medicare for prescription drugs such as Xarelto. If an individual has Medicare Part D, also called prescription drug coverage, they may be able to get Xarelto at a lower cost. Part D plans have a list of covered drugs (formulary drug list) and use tiered formularies. The cost of Xarelto depends on which tier the drug is placed in.
There are four tiers:
- Preferred or Generic (lower-cost drugs)
- Non-preferred or Brand-name prescription drugs (higher-cost drugs)
- Specialty (very high-cost drugs)
- Not Covered Drugs
If an individual has Medicare Part B, they may be able to get help with the costs of Xarelto through the Xarelto Savings Program. The Xarelto Savings Program offers free or low-cost medications to eligible patients. To see if you qualify for this program, visit the manufacturer’s website or speak with your doctor.
Xarelto and Medicare Advantage
Medicare Advantage plans (Medicare Part C) are offered by private insurance companies and are required to cover all of the same benefits as Original Medicare.
Some Medicare Advantage plans may also offer prescription drug coverage. If an individual has a Medicare Advantage plan that includes prescription drug coverage, they may be able to get Xarelto at a lower cost. Similar to Medicare Part D plans, the cost of Xarelto will depend on the tier of the drug in the formulary, and whether the individual has met their deductible amount yet. To see what your specific insurance plan covers, you can view your insurance plan’s formulary by contacting your insurance plan’s customer service department.
You may also compare Medicare Advantage plans that include prescription drug coverage on the Medicare website. When you compare plans, be sure to look at the total cost of the plan, not just the monthly premium.
Can Medigap plans help me save money on Xarelto?
No, Medigap plans do not cover prescription drugs.
Medigap plans are supplemental insurance plans that help cover some of the costs that Original Medicare does not cover. These plans do not cover prescription drugs, so they would not help an individual save money on Xarelto.
If you have a Medigap plan and are enrolled in a Medicare Part D plan or a Medicare Advantage Prescription Drug (MAPD) plan, your Medigap plan will not pay for any of the costs associated with your prescription drug coverage, including premiums, deductibles, coinsurance, and copayments.
How much does Xarelto cost with Medicare?
Medicare patients with Part D coverage pay on average $2-18 for Xarelto.
Xarelto assistance for Medicare patients
If you have been prescribed Xarelto and need help paying for the medication, there are a few options that may be able to help.
- The Xarelto Savings Program offers low-cost medications to eligible patients. To see if you qualify for this program, visit the manufacturer’s website or speak with your doctor.
- Patient Assistance Programs (PAPs) are programs offered by pharmaceutical companies to help patients who cannot afford their medications. Eligible patients may be able to get Xarelto for free or at a reduced cost.
- You may also be eligible for Extra Help. Extra Help is a program offered by the Social Security Administration that helps eligible Medicare patients with the costs of prescription drugs, including premiums, deductibles, and coinsurance. To see if you qualify for Extra Help, visit the Social Security Administration website or call 1-800-772-1213. You can also contact your state’s Medicaid office to see if Extra Help is a program that helps people with limited income and resources pay for their prescription drugs.
- Your doctor might be able to give you free samples of Xarelto to try. Doctors sometimes receive free samples from pharmaceutical companies to help their patients who cannot afford their medications.
- There are also alternative medications available including Eliquis, Pradaxa and Savaysa.
A medical professional has reviewed this article.