Most Medicare prescription drug plans cover blood thinners like Xarelto. To get coverage, you’ll need a Medicare Part D or Medicare Advantage plan with Part D included.
Xarelto is the brand name of the drug rivaroxaban. It’s a prescription blood thinner that’s often used by people at risk of serious blood clots.
Xarelto requires less frequent blood tests and dose adjustments compared to similar medications. However, it has no generic version, so it can be costly out-of-pocket.
Medicare can help cover the cost of Xarelto if you have a plan that includes prescription drug coverage.
You can get prescription coverage with all Part D and Medicare Advantage (Part C) plans. Your cost will depend on the plan you have, but will be much less expensive than paying the full cash price.
Medicare will cover Xarelto in the majority of cases.
Approximately 96% of the most commonly prescribed drugs are included in the formularies of Medicare prescription drug plans. A formulary is a list of prescription drugs that the health plan covers. It includes generics, brand names, and specialty drugs.
Xarelto is commonly included in Medicare drug plan formularies. To get coverage, your doctor will need to prescribe Xarelto to treat or prevent one of the conditions it’s been approved for, such as deep vein thrombosis (DVT).
Your Medicare coverage for Xarelto will depend on which part of Medicare you’re using.
You’ll need to be enrolled in a part of Medicare that includes prescription drug coverage. Typically, this means you’ll need a Medicare Advantage (Part C) or a Medicare Part D plan.
Here’s the coverage that each part of Medicare does — or doesn’t — offer for Xarelto:
- Medicare Part A: Part A is hospital insurance. It doesn’t cover any prescriptions unless you take them while receiving inpatient care. So, it would cover Xarelto while you’re being cared for in a hospital or skilled nursing facility, but it wouldn’t cover the medication once you’ve returned home.
- Medicare Part B: Part B is medical insurance. It covers things like visits to doctors and specialists. It doesn’t offer any coverage for prescriptions.
- Medicare Part C: Part C is also known as Medicare Advantage. Advantage plans cover everything that parts A and B do. Plus, they often include extra coverage for things like prescriptions. An Advantage plan that includes Part D prescription coverage will generally cover Xarelto.
- Medicare Part D: Part D is prescription drug insurance. Part D plans will cover Xarelto as long it is included in their formulary.
- Medicare supplement: Medicare supplement insurance is also known as Medigap. Medigap plans help cover the out-of-pocket costs of using Medicare. They don’t provide extra coverage for prescriptions, including Xarelto.
The list price for a 30-day supply is $542, though different pharmacies seem to set the total cost higher at $596-$618. Ultimately, your out-of-pocket cost will depend on your insurance plan.
What do I do if I can’t afford Xarelto?
You might be able to use a coupon from Johnson & Johnson Innovative Medicine (formerly Janssen), the drug’s manufacturer, to help you cover the cost.
With commercial insurance, you may pay only $10 for each 30-90 day prescription. With government insurance like Medicare, you may pay about $89 a month for a 30-day supply or $250 for a 90-day supply.
You can also check which Advantage and Part D plans in your area cover Xarelto by using Medicare’s plan finder tool. This may also affect how much you pay.
Enter your ZIP code along with your current prescriptions, and the website will match you with plans in your area that cover Xarelto. It’ll also show you the copayment you can expect.
Xarelto is a blood thinner used to prevent blood clots and strokes. You can get coverage for your Xarelto prescription through Medicare.
You’ll need to have a plan with drug coverage, like a Part D plan or most Medicare Advantage (Part C) plans. The plan will need to include Xarelto in its formulary; most plans do.
You can shop for plans in your area using the Medicare website.