Access & Savings
XIFAXAN has excellent insurance coverage1
The resources below can help you find coverage for some of your adult patients.
Look up coverage 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. We have an example* of a Letter of Medical Necessity and a Tier Exemption Request as well.
93%
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 (June 2022 to June 2023)2
Get copay card details98%
of commercially insured patients have coverage for XIFAXAN1,‡,§
100%
of Medicare Part D patients have coverage for XIFAXAN1,‡,§
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.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 download
Common Reasons for PA Denials
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Double-check PA, fill in missing information, and resubmit.
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Double-check dosing
- For IBS-D: XIFAXAN 550 mg, three times a day/14 days, 42 tablets.4 Patients who experience a recurrence of symptoms can be retreated up to 2 times
- For OHE: XIFAXAN 550 mg, twice daily, 60 tablets4; if coverage allows refills, write for at least 5
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Double-check ICD-10 code and resubmit¶
- K58.0: Irritable bowel syndrome with diarrhea5
- K76.82: Hepatic encephalopathy
Indicate lactulose history if applicable5
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Include information on why XIFAXAN is necessary and how you expect it to help the patient.
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Double-check coverage; Medicare excludes certain kinds of drugs, but XIFAXAN is not in those categories.
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You can ask insurance plan to reevaluate; XIFAXAN is covered for 98% of commercially insured patients and 100% of Medicare Part D patients1,‡,§
The XIFAXAN PA process is a simple way to help your adult patients diagnosed with OHE gain access to the treatment you prescribe
When a PA is required, be sure the following information is included and accurate:
Indication of OHE:
K76.82, the ICD-10 code for OHE (Indicate lactulose history if applicable)5,¶
Age:
18 years or older4
Dosing for OHE:
#60 XIFAXAN 550-mg tablets, twice daily with refills4
Previous therapies tried and failed
(eg, lactulose)
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
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.
Low-Income Subsidy Program
Patients could pay as little as $10.35 per prescription
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 $10.35/prescription—which is a Medicare Part D benefit.6
Your patient may already be enrolled, however, if they aren’t they can visit healthcare.gov to determine eligibility and apply for benefits.
Low-income Subsidy Brochure download Tier Exemption Request downloadGet XIFAXAN coverage by plan in your area
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).
*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 code 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. MMIT September 2023. Salix Pharmaceuticals, Bridgewater, NJ. 2. Data on file. Patient Copay June 2022 to 2023. 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 January 3, 2024. https://shared.salix.com/globalassets/pi/xifaxan550-pi.pdf 5. ICD-10. Centers for Medicare & Medicaid Services. Updated December 1, 2021. Accessed January 4, 2024. www.cms.gov/Medicare/Coding/ICD10 6. Help with drug cost. CMS. Accessed January 4, 2024. https://www.medicare.gov/basics/costs/help/drug-costs
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 reduction in risk of overt hepatic encephalopathy (HE) recurrence 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.
XIF.0183.USA.23V2.0