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.
|Reason for denial
||Considerations for avoiding denial
|PA not completed
||Double-check PA, fill in missing information, and resubmit
|Dosing does not match Indication
- 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 patients1*‡
Improve the PA process for XIFAXAN with CoverMyMeds
In 2019, PAs had a 91% 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 $8.95/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