Essential Details on Medicare Coverage for Xarelto

Explaining Medicare Coverage for Xarelto

Xarelto, a vital medication for treating and preventing blood clots, is essential for many individuals. For those on Medicare, understanding how Xarelto is covered can offer valuable insight. Let’s explore what you need to know through this guide.

What is Xarelto?

Xarelto (rivaroxaban) is an oral anticoagulant medication commonly prescribed for conditions that heighten the risk of blood clots, such as deep vein thrombosis (DVT), pulmonary embolism, and reducing stroke risk in individuals with atrial fibrillation.

Common Side Effects of Xarelto

While taking Xarelto, you may experience side effects like bleeding, prolonged bruising, heavy menstrual periods, back pain, or stomach pain.

Medicare Coverage for Xarelto

Original Medicare, encompassing Part A (hospital insurance) and Part B (medical insurance), does not cover prescription drugs like Xarelto. To obtain coverage for such medications, enrollment in a Medicare Part D prescription drug plan is necessary.

Understanding Medicare Part D

Medicare Part D provides coverage for prescription drugs, with costs varying based on factors such as the specific prescriptions required, medication tiers, drug benefit phases, chosen pharmacy, and eligibility for Medicare Extra Help.

Is Xarelto Covered Under Medicare Part D?

Most Medicare Part D plans cover Xarelto, but coverage specifics and costs hinge on the chosen plan. It’s often categorized as a Tier 3 medication, with potential quantity limits.

Medicare Advantage and Xarelto

Medicare Advantage plans (Part C), offered by private insurance companies, frequently include prescription drug coverage. If enrolled in a Part C plan, verify if Xarelto is among the covered drugs.

Medigap and Prescription Drugs

Medigap plans, supplementing Original Medicare, do not provide coverage for prescription drugs, including Xarelto, since 2005. To secure coverage for Xarelto, enrollment in a Part D plan is typically required.

Cost of Xarelto with Medicare

Xarelto’s cost under Medicare varies depending on the plan. Uninsured, it can be quite expensive, but utilizing pharmacy coupons or having Medicare Advantage or Part D coverage can significantly lower copayments.

Generic Version of Xarelto

Presently, no generic version of Xarelto is available, but this may change following the expiration of its patent at the conclusion of 2024.

Getting Help with Xarelto Costs

For individuals facing challenges with Xarelto costs, programs like the Extra Help Program, State Health Insurance Assistance Program (SHIP), GoodRx, Medicaid’s Drug Rebate Program, and PACE offer financial assistance.

Frequently Asked Questions

• Is Xarelto covered by Medicare? Xarelto isn’t covered under Original Medicare, but it may be covered by some Medicare Advantage and Part D plans.
• Is there a generic form of Xarelto? Currently, no generic form is available, but this could change post-2024.