Rivaroxaban is the generic name for Xarelto. Medicare covers the cost of the prescription medication, including Xarelto, under certain conditions.
A person must be enrolled in a Medicare Part D prescription drug plan or a Medicare Advantage plan that includes prescription drug coverage to get costs covered.
This article explores Xarelto and other blood thinners, and Medicare and Medigap coverage for Xarelto. It also looks at costs, including generic brand options.
Xarelto is an FDA-approved prescription anticoagulant containing the drug rivaroxaban.
Anticoagulants thin the blood, making it takes longer to form a clot and thereby reducing the risk of blood clots in common conditions such as atrial fibrillation and deep vein thrombosis.
Xarelto may help reduce the risk of severe cardiovascular events in conditions such as coronary artery disease and peripheral artery disease.
Xarelto oral tablets range in strength from 2.5 mg, 10 mg, 15 mg, to 20 mg. According to Janssen Pharmaceuticals, more than 40 million people globally use Xarelto.
Doctors may prescribe Xarelto or other blood thinners to a person with a history of blood clots or at risk of developing them.
The FDA recommends Xarelto for:
- treating or preventing deep vein thrombosis (DVT)
- treating or preventing pulmonary embolisms (PE)
- reducing the risk of stroke for people diagnosed with atrial fibrillation (AF)
- reducing the risk of blood clots in a person who has previously experienced them, or because they have coronary artery disease or peripheral artery disease
As with other medications, Xarelto has possible side effects, including back or stomach pain, or bleeding problems.
Doctors do not recommend Xarelto for people with kidney and liver problems or who have an artificial heart valve.
For Medicare to cover Xarelto, doctors must use it as approved by the FDA.
Medicare coverage depends on the plan in which a person is enrolled. For example, original Medicare (Part A and Part B) does not generally cover prescription drugs. However, if a person is enrolled in Medicare Part D or in a Medicare Advantage (Part C) plan that covers prescriptions, they will have coverage for Xarelto.
Here is an outline of the different parts of Medicare and how they relate to Xarelto coverage.
Medicare Part A
Medicare Part A covers hospital and inpatient stays. Typically, it does not cover any prescription drugs unless a person receives the drug as an inpatient. Therefore, if a person in the hospital is prescribed Xarelto, Medicare Part A covers the cost while they are in the hospital. After they leave, coverage stops.
Medicare Part B
Medicare Part B is medical insurance covering doctor’s visits or consultations with specialists. It does not provide coverage for prescription drugs.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, provides the same coverage level as Medicare parts A and B and may include extra benefits such as prescription drug coverage. Most Advantage plans have a drug list, called a formulary. A person can check with their plan’s formulary to find out if Xarelto is covered.
Learn more about Medicare Advantage here.
Medicare Part D
Medicare Part D covers prescription drugs. Each plan has a list or formulary of drugs it covers. Providing Xarelto appears on the formulary, Medicare Part D covers the cost.
Learn more about Medicare Part D here.
Medigap plans
Medicare supplement or Medigap plans help people reach the out-of-pocket expenses associated with Medicare. They do not provide additional coverage for prescription medications, including Xarelto.
People can use the government’s Medicare plan finding tool to see which Medicare Advantage and Part D plans cover Xarelto.
How much a person pays for Xarelto depends on the prescribed dosage, and the coverage provided by their Medicare plan.
The manufacturers list the full price of Xarelto at $470 per month, and state that most people pay between $0 and $47 per month in out-of-pocket costs depending on their insurance coverage.
In addition, some pharmacies may provide coupons towards the cost of the drug, which may be used with their Medicare coverage.
Is there a generic brand?
There are no generic alternatives to Xarelto, although the patents for the brand drug expire during the next few years, which may allow for a generic version to be manufactured.
Doctors prescribe Xarelto to thin an individual’s blood and help prevent blood clots and strokes.
Medicare covers the cost if a person has prescription drug coverage through a Part D or Medicare Advantage plan, and the drug is on the formulary.