Does Medicare Cover Blood Thinners Like Xarelto?

When does Medicare cover blood thinners, Xarelto specifically?

Medicare will cover Xarelto in the majority of cases.

Approximately 96 percent 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 and is considered a preferred brand name by most plans.

To get coverage, your doctor will need to prescribe Xarelto to treat or prevent one of the conditions it’s been approved for. Generally, this means your Xarelto prescription must aim to:

• treat deep vein thrombosis (DVT)
• prevent DVT
• treat pulmonary embolisms (PE)
• prevent PE
• reduce the risk of blood clots in people who’ve had them in the past
• reduce the risk of stroke in people who’ve been diagnosed with atrial fibrillation

Risks of taking a blood thinner

Since blood thinners slow down the clotting of your blood, it’s important to be extra careful of cuts, bruises, and injuries. It will take you longer to stop bleeding. Other bleeding risks include:

• heavy bleeding and more blood loss than typical
• internal bleeding
• heavy bleeding if you take certain other medications with Xarelto
• heavy bleeding if you drink too much alcohol

Which parts of Medicare cover Xarelto?

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) plan 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 you’re 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.

How much does Xarelto cost?

Your costs for Xarelto will depend on your dosage and your specific Medicare plan.

You might also be able to find coupons from local pharmacies to help you cover the cost. However, you may not be able to use certain coupons if you plan to use your Medicare coverage.

Some example costs are detailed below.

Costs of Xarelto

As you can see, you’ll pay the lowest cost when using your Medicare Advantage or Medicare Part D plan. It’s important to make sure the Medicare prescription drug plan you choose includes Xarelto on its formulary.

You can check which Advantage and Part D plans in your area cover Xarelto by using Medicare’s plan finder tool.

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.

What is Xarelto? 

Xarelto is a type of blood thinner called an anticoagulant. It works by slowing down the time it takes for your blood to clot.

You might get prescribed Xarelto if you have a history of blood clots or are at risk for developing them. The medication is often prescribed for people diagnosed with:

• DVT
• atrial fibrillation
• coronary artery disease
• peripheral artery disease

Xarelto requires less frequent blood tests than some other blood thinners. You also won’t need your dosage adjusted as frequently as similar medications tend to require.

However, there’s no generic form of Xarelto, so it can be expensive if you don’t have prescription coverage. And, like most medications, it may have a few side effects.

Common side effects of Xarelto include:

• back pain
• stomach pain

Some less common but serious side effects of Xarelto include:

• abnormal bleeding
• blood clots in your spine while getting an epidural or spinal puncture
• an increased risk of blood clots and stroke if you stop taking Xarelto

When to call your doctor if you take a blood thinner like Xarelto

Call your healthcare professional right away or go to the nearest emergency room if you have:

• loss of bladder or bowel control
• back pain
• numbness, tingling, or muscle weakness in your feet, legs, or anywhere else
• a fall
• a hit to your head
• a cut or other injury

Tell your healthcare professional if you plan to have any medical procedure that could cause bleeding, including:

• dental work
• an epidural
• a spinal puncture

Xarelto isn’t recommended for people who have an artificial heart valve or who’ve been diagnosed with kidney or liver problems.

The takeaway

• 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.