Access &
Savings
- In this section:
- Prior Authorizations
- Look Up Coverage
- Copay Savings Card
Navigate patient access to help start their treatment
The resources below can help you find XIFAXAN 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.
94%
of eligible,† commercially insured patients who had coverage for XIFAXAN paid $10 or less for their prescription when a copay card or e-voucher was applied in the last year (October 2023 to October 2024).1
Get copay card details98%
of commercially insured patients have coverage for XIFAXAN.2,‡,§
100%
of Medicare Part D patients have coverage for XIFAXAN.2,‡,§
XIFAXAN has a straightforward prior authorization (PA) process
Being proactive with PAs may lead to higher approval rates.3 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.
Prior Authorization (PA)Considerations Brochure
Common reasons for PA denials
Double-check PA, fill in missing information, and resubmit.
Double-check dosing
- For IBS-D: XIFAXAN 550 mg, 3 times a day/14 days, 42 tablets4
- For OHE: XIFAXAN 550 mg, twice daily, 60 tablets4; if coverage allows refills, write for 180 tablets
Double-check ICD-10 code and resubmit*
- K58.0: Irritable bowel syndrome with diarrhea5
- K76.82: Hepatic encephalopathy; indicate lactulose history if applicable5
*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. Salix Pharmaceuticals does not guarantee coverage or reimbursement for the product.
Include information on why XIFAXAN is necessary and how you expect it to help the patient.
Double-check coverage; Medicare excludes certain kinds of drugs, but XIFAXAN is not in those categories.
You can ask insurance plan to reevaluate; XIFAXAN is covered for 98% of commercially insured patients and 100% of Medicare Part D patients.2,*,†
*Salix Pharmaceuticals does not guarantee coverage or reimbursement for the product.
†Formulary status subject to change.
Initiate PAs in office vs awaiting pharmacy initiation when necessary
- In general, PAs proactively generated by prescribers had a higher dispense rate than PAs initiated by pharmacies3
- To start a PA for XIFAXAN, you can go to covermymeds.com or call 1-866-452-5017
- 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.
Sample Letter of Medical NecessityThe XIFAXAN PA process is a simple way to help your adult patients diagnosed with IBS-D gain access to the treatment you prescribe
When a PA is required, be sure the following information is included and accurate:
Accurate indication of IBS-D:
K58.0, the ICD-10 code for IBS-D5,ll
Age:
18 years or older4
Approved dosing for IBS-D:
#42 XIFAXAN 550-mg tablets, 3 times a day by mouth for 2 weeks4
Previous therapies tried and failed
(eg, antidiarrheals, antispasmodics, loperamide, SSRIs, TCAs, and other OTC medications)
XIFAXAN has the best insurance coverage of all medications approved for IBS-D2
The XIFAXAN Coverage Lookup Tool
Use the tool below to help you determine how a patient’s
prescription drug insurance covers XIFAXAN in your ZIP code.‡
Patients who need assistance with their monthly copays can call 1-866-XIFAXAN (1-866-943-2926).
IBS-D, irritable bowel syndrome with diarrhea; OHE, overt hepatic encephalopathy.
*NOTE: These sample forms are provided for informational purposes only. As a reminder, it is the responsibility of the healthcare professional and/or their office staff, as appropriate, to determine the correct diagnosis, treatment protocol, and content of all such forms for each individual patient.
†Patient is not eligible if he/she participates in, 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.
‡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. Salix Pharmaceuticals does not guarantee coverage or reimbursement for the product.
References: 1. Data on file. Patient Copay October 2023 to October 2024. Salix Pharmaceuticals, Bridgewater, NJ. 2. Data on file. MMIT October 2024. Salix Pharmaceuticals, Bridgewater, NJ. 3. Data on file. XIFAXAN CMM Executive Summary 2022. Salix Pharmaceuticals, Bridgewater, NJ. 4. XIFAXAN. Prescribing information. Salix Pharmaceuticals; 2023. Accessed November 27, 2024. https://shared.salix.com/globalassets/pi/xifaxan550-pi.pdf 5. ICD-10. Centers for Medicare & Medicaid Services. Updated September 26, 2024. Accessed December 2, 2024. www.cms.gov/Medicare/Coding/ICD10
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.
XIFAXAN® (rifaximin) 550 mg tablets are indicated 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.
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