Medicare & Insurance

Understanding Medicare Coverage for Xarelto: Key Information

Medicare Coverage for Xarelto Explained

Xarelto, a medication used to treat and prevent blood clots, is crucial for many people. If you’re on Medicare, understanding how it covers Xarelto can be very helpful. This guide will walk you through what you need to know.

What is Xarelto?
Xarelto (rivaroxaban) is an anticoagulant medication that’s taken orally. It’s commonly prescribed for conditions that increase the risk of blood clots, such as deep vein thrombosis (DVT), pulmonary embolism, and to reduce stroke risk in individuals with atrial fibrillation.

Common Side Effects of Xarelto
While taking Xarelto, you might experience side effects like bleeding, prolonged bruising, heavy menstrual periods, back pain, or stomach pain.

Medicare Coverage for Xarelto
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), doesn’t cover prescription drugs like Xarelto. To get coverage for such medications, you’ll need to enroll in a Medicare Part D prescription drug plan.

Understanding Medicare Part D
Medicare Part D covers prescription drugs, but costs can vary based on factors like the specific prescriptions you need, the medication tier, the drug benefit phase you’re in, your chosen pharmacy, and whether you qualify for Medicare Extra Help.

Is Xarelto Covered Under Medicare Part D?
Most Medicare Part D plans do cover Xarelto. However, coverage details and costs depend on the specific plan you choose. It’s often categorized as a Tier 3 medication, with possible quantity limits.

Medicare Advantage and Xarelto
Medicare Advantage plans (Part C), offered by private insurance companies, often include prescription drug coverage. If you have a Part C plan, check if Xarelto is on your plan’s list of covered drugs.

Medigap and Prescription Drugs
Medigap plans, which supplement Original Medicare, don’t cover prescription drugs, including Xarelto, as of 2005. If you need coverage for Xarelto, you’ll likely need a Part D plan.

Cost of Xarelto with Medicare
The cost of Xarelto under Medicare varies by plan. Without insurance, it’s quite expensive, but using pharmacy coupons or having Medicare Advantage or Part D can significantly reduce your copays.

Generic Version of Xarelto
Currently, there’s no generic version of Xarelto, but this could change after its patent expires at the end of 2024.

Getting Help with Xarelto Costs
For those struggling with the cost of Xarelto, programs like the Extra Help Program, State Health Insurance Assistance Program (SHIP), GoodRx, Medicaid’s Drug Rebate Program, and PACE can provide financial assistance.

Frequently Asked Questions

  • Is Xarelto covered by Medicare? Xarelto isn’t covered under Original Medicare, but it may be covered by some Medicare Advantage and Part D plans.
  • Is there a generic form of Xarelto? No generic form is currently available, but this might change post-2024.

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