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.

Let’s get started. What do you need to know?

Look up coverage

Prior Authorizations

Low-income Subsidy

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.

View PA Considerations Brochure

Plus, learn how to avoid common reasons for a denial for appropriate patients by expanding the chart.

Common reasons for PA denials

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 For IBS-D: XIFAXAN 550 mg, three times a day/14 days, 42 tablets² For OHE: XIFAXAN 550 mg, twice daily, 60 tablets²; if coverage allows refills, write for 180 tablets
Invalid diagnosis code	Double-check ICD-10 code and resubmit^§ K58.0 Irritable bowel syndrome with diarrhea³ K72.9 Hepatic failure, unspecified³
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 patients^1*‡

*Salix Pharmaceuticals does not guarantee coverage or reimbursement for the product.

^‡Formulary status subject to change.

^§The ICD-10 codes and all other patient access related information are provided for informational purposes only. It is the treating physician’s responsibility to determine the proper diagnosis, treatment and applicable ICD-10 code.

Improve the PA process for XIFAXAN with CoverMyMeds

In 2020, PAs had a 90% approval rate for XIFAXAN for OHE when submitted through CoverMyMeds.¹ To start a PA for XIFAXAN, you can go to covermymeds.com or call 1-866-452-5017.

Letter of Medical Necessity^||

For both commercially and government insured patients, your practice may need to file an appeal if a patient is denied coverage for XIFAXAN. Please fill out and submit a Letter of Medical Necessity on behalf of your patient who has been prescribed XIFAXAN.

View Letter of Medical Necessity example

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.

View Low-income subsidy brochure

View a Tier Exemption request example

*Salix Pharmaceuticals does not guarantee coverage or reimbursement for the product.

^†Patient is not eligible if he/she participates in or seeks reimbursement or submits a claim for reimbursement to any federal or state healthcare program with prescription drug coverage, such as Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state healthcare program (each a Government Program) or where prohibited by law. Patient must be enrolled in, and must seek reimbursement from or submit a claim for reimbursement to, a commercial insurance plan. Offer excludes full cash-paying patients. Maximum benefits and other restrictions apply. Visit https://xifaxan.copaysavingsprogram.com or call 1-866-XIFAXAN for full eligibility criteria, terms and conditions.

^‡Formulary status subject to change.

^||NOTE: These sample forms are provided for informational purposes only. As a reminder, it is the responsibility of the HCP and/or their office staff, as appropriate, to determine the correct diagnosis, treatment protocol, and content of all such forms for each individual patient.

of eligible^†, commercially insured patients who had coverage for XIFAXAN paid less than $10 for their prescription when a copay card or eVoucher was applied in 2020.¹

of commercially insured patients have coverage for XIFAXAN^1‡

More than 70% of these patients have access to XIFAXAN without step therapy.¹

of Medicare patients have coverage for XIFAXAN^1‡

INDICATIONS

XIFAXAN^® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.

IMPORTANT SAFETY INFORMATION

XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components in XIFAXAN. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema, and anaphylaxis.
Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including XIFAXAN, and may range in severity from mild diarrhea to fatal colitis. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued.

XIFAXAN has excellent insurance coverage for patients with overt HE1