XIFAXAN has excellent insurance coverage for patients with overt HE1
The resources below can help you find coverage for some of your adult patients.
Look up coverage for XIFAXAN in your area, make PAs simpler, learn how to avoid denials for appropriate patients, and locate a Low-income Subsidy for appropriate patients for XIFAXAN. When needed, we have an example of a Letter of Medical Necessity and a Tier Exemption Request as well.
Get XIFAXAN coverage by plan in your area
The XIFAXAN Coverage Lookup Tool can help you determine how a patient's prescription drug insurance covers XIFAXAN in your ZIP code.*
Find helpful information if your patient’s plan requires a PA
Simplifying the PA process for XIFAXAN
Being proactive with PAs leads to higher approval rates.1 View the brochure below to see simple directions for submitting a PA for XIFAXAN when needed.
Plus, learn how to avoid common reasons for a denial for appropriate patients by expanding the chart.
|Reason for denial||Considerations for avoiding denial|
|PA not completed||Double-check PA, fill in missing information, and resubmit|
|Dosing does not match Indication||Double-check dosing
|Invalid diagnosis code||Double-check ICD-10 code and resubmit§
|Did not try & fail formulary alternative||Include information on why XIFAXAN is necessary and how you expect it to help the patient|
|Product is a plan exclusion||Double-check coverage; Medicare excludes certain kinds of drugs, but XIFAXAN is not in those categories|
|Medication not covered||You can ask insurance plan to reevaluate; XIFAXAN is covered for 99% of commercially insured patients and 95% of Medicare patients1*‡|
Improve the PA process for XIFAXAN with CoverMyMeds
Letter of Medical Necessity||
Low-Income Subsidy Program
Your eligible patients may be entitled to “Extra Help” through the Low-Income Subsidy program.
LIS recipients are entitled to branded prescription drugs at an affordable cost—no more than $9.20/prescription—which is a Medicare Part D benefit.4
Your patient may already be enrolled, however, if they aren’t they can visit here to determine eligibility and apply for benefits.