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
|Prior authorization 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 78% PA approval rate for IBS-D 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 Sample Letter of Medical Necessity
|Remember to ADD the following information:
||Patients must be 18 years or older
|Diagnosis of IBS-D
||ICD-10 code is K58.03‡
|Dosing for IBS-D
||XIFAXAN 550 mg 3 times a day for 2 weeks; #42 tablets2
Document any and all prescriptions (eg, antispasmodics and antidiarrheals) or over-the-counter medications that the patient has tried and failed for step edits.
Find ways to help your patients save on copays
Help your eligible|| patients save on XIFAXAN
86% 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 2019.1
Patients who need assistance with their monthly copays can call 1-866-XIFAXAN (1-866-943-2926).
Get copay card details
Find practice and patient resources
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