Image shows a XIFAXAN (rifaximin) Copy Card - $0 copay instant savings card.

XIFAXAN Instant Savings Card

$0 COPAY FOR ELIGIBLE PATIENTS

The XIFAXAN Instant Savings Card program may provide eligible, commercially insured patients savings on their monthly copays for XIFAXAN.

Patients who need assistance with their monthly copays for XIFAXAN can call 1-866-XIFAXAN (1-866-943-2926).

 
 
Get XIFAXAN Instant Savings Cards To Distribute To Eligible Patients

*Eligibility Criteria, Terms and Conditions: This offer is only valid for patients with commercial insurance, including commercially-insured patients without coverage for Xifaxan. Patients without commercial insurance are not eligible. Commercially-insured patients with coverage for Xifaxan will receive savings to reduce their copay to as little as $0. Commercially-insured patients without coverage for Xifaxan will receive savings off of retail price to reduce the out-of-pocket cost to as little as $50. Maximum benefits and number of uses apply. For information about the maximum benefits and number of uses please visit www.xifaxan.com and/or call the helpline 1-866-XIFAXAN (option 1). Patient is responsible for all additional costs and expenses after application of the maximum benefits. You must activate this coupon before using it by visiting Xifaxan.com, calling 1-866-XIFAXAN, or texting PAYZERO to 24109. Message and data rates may apply. The full terms can be viewed at https://copaysavingsprogram.com/110/Xifaxan/sms-terms. This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. This offer is only good in the USA at participating retail pharmacies. This offer cannot be redeemed at other locations, including government-subsidized clinics or facilities. This offer is not valid where otherwise prohibited, taxed, or otherwise restricted. Patient is responsible for reporting receipt of co-pay assistance to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. This offer cannot be combined with other offers. This card has no cash value. No other purchase is necessary. This offer is nontransferable. No substitutions are permitted. This card is not health insurance. You understand and agree to comply with the terms and conditions of this offer as set forth above. Salix Pharmaceuticals reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer expires on December 31, 2019.

XIF.0173.USA.18

Help patients get access to XIFAXAN

Image shows a webpage from healthcare.gov

Dual Medicare and Medicaid eligibility

Some of your low-income patients may qualify for both Medicare and Medicaid. You can direct them to healthcare.gov to determine eligibility.

Image shows a medical necessity form.

Medical Necessity Form

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 this Sample Letter of Medical Necessity (PDF) on behalf of your patient who has been prescribed XIFAXAN.

Image shows a medicare part d coverage determination request form.

Tier Exemption Form

If a Medicare patient has a high copay/coinsurance for XIFAXAN due to high Medicare Part D Tier status, you can submit a Medicare Part D Coverage Determination Request Form (PDF) to request a minimized copay on behalf of your patient.

 

NOTE: These sample forms are provided for informational purposes only. As a reminder, it is the responsibility of the HCP and/or their office staff, as appropriate, to determine the correct diagnosis, treatment protocol, and content of all such forms for each individual patient.

 

Reference: 1. Data on file. Salix Pharmaceuticals. Bridgewater, NJ.

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.

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.
  • There is an increased systemic exposure in patients with severe (Child-Pugh Class C) hepatic impairment. Caution should be exercised when administering XIFAXAN to these patients.
  • Caution should be exercised when concomitant use of XIFAXAN and P-glycoprotein (P-gp) and/or OATPs inhibitors is needed. Concomitant administration of cyclosporine, an inhibitor of P-gp and OATPs, significantly increased the systemic exposure of rifaximin. In patients with hepatic impairment, a potential additive effect of reduced metabolism and concomitant P-gp inhibitors may further increase the systemic exposure to rifaximin.
  • In clinical studies, the most common adverse reactions for XIFAXAN were:
    • HE (≥10%): Peripheral edema (15%), nausea (14%), dizziness (13%), fatigue (12%), and ascites (11%)
    • IBS-D (≥2%): Nausea (3%), ALT increased (2%)
  • INR changes have been reported in patients receiving rifaximin and warfarin concomitantly. Monitor INR and prothrombin time. Dose adjustment of warfarin may be required.
  • XIFAXAN may cause fetal harm. Advise pregnant women of the potential risk to a fetus.

To report SUSPECTED ADVERSE REACTIONS, contact Salix Pharmaceuticals at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please click here for full Prescribing Information.

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.

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.