XIFAXAN has the best insurance coverage of all medications approved for IBS-D1
The resources below can help you find coverage for some of your adult patients.
Look up coverage in your area, make the PA process simpler, and learn how to avoid denials for appropriate patients taking XIFAXAN. When needed, please see examples* of a Letter of Medical Necessity and a Tier Exemption Request.
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|
|Prior authorization 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*
|Remember to ADD the following information:|
|Age||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.