Xarelto is a blood thinner used to prevent blood clots that can cause a variety of serious medical issues. Its generic name is Rivaroxaban. Your healthcare provider could recommend the medication to reduce the risk of stroke, prevent specific conditions, or prevent blood clots from forming after surgery. 

A Medicare drug plan covers the cost of Xarelto and other blood thinners. In this post, we’ll explain how Medicare covers Xarelto and what out-of-pocket costs you can expect with your prescription drug plan. 

Key takeaways:

  • 100% of Medicare prescription drug (Part D) plans cover Xarelto, a blood thinner that reduces blood clots. 

  • Your cost for each Xarelto prescription filled (copay) will be between $0 to $22. Your exact cost depends on your Part D coverage.

  • If you have atrial fibrillation (AFib), it’s good to know that Medicare drug plans cover both Xarelto and Eliquis.

What is Xarelto?

If you have a high risk of blood clot formation, you may have heard about Xarelto. Doctors commonly prescribe Xarelto to treat and prevent blood clots. It belongs to a category of drugs called anticoagulants, or blood thinners. Blood thinners work by blocking something called factor Xa, the body’s clotting process. 

Xarelto helps:

  • Lower the risk of stroke

  • Lower the risk of stroke and complications for people with atrial fibrillation (AFib)

  • Treat and prevent deep vein thrombosis (DVT)

  • Treat and prevent pulmonary embolism (PE)

  • Reduce the risk of frequent blood clots

  • Lower the risk of heart complications for people with coronary artery disease and peripheral artery disease 

Blood clots can also form after hip or knee replacements, so doctors may also prescribe Xarelto after a surgery. People typically take Xarelto in pill form once a day in the evening with food. 

Does Medicare cover Xarelto?

Did you know that, without insurance, Xarelto can cost upwards of $600 for a month’s supply? Thankfully, Medicare covers Xarelto and most common prescription drugs. In fact, 100% of Medicare prescription drug plans help pay for Xarelto. 

With every Medicare drug plan (Part D), you’re responsible for a few different costs. Here’s what to expect:

  • A monthly premium, which will vary based on your specific policy

  • An annual deductible that can’t exceed $545 (some plans don’t have deductibles and some drugs don’t require a deductible)

  • Copays and coinsurance, which will be between $0-22 for Xarelto 

Every Medicare drug plan has its own formulary, which is the list of drugs that the policy covers. The formulary groups medications based on different tiers. There’s a tier for generic, preferred brand name, non-preferred brand name, and specialty drugs. Your copay will depend on which tier the medication belongs to. Since there is no generic alternative to Xarelto, you’ll likely pay a medium copay for the prescription.

How much you pay for Xarelto with Medicare

Like we mentioned above, your out-of-pocket costs and formulary will vary depending on the Part D coverage you have. For Xarelto, you can expect to pay between $0 to $22 for copays. 

Many Medicare beneficiaries rely on a prescription drug plan to stay healthy but, even with a drug plan, prescriptions can be expensive. The good news is that Medicare lawmakers are working on lowering the price of some expensive brand-name prescriptions to make them more accessible. Xarelto is on the list of the first ten drugs for Medicare to negotiate the price for on behalf of beneficiaries. 

Other blood thinners that Medicare covers

If you have atrial fibrillation (AFib), doctors can prescribe Xarelto or Eliquis. Both medications are blood thinners that help reduce the formation of blood clots. 

Medicare drug plans also cover Eliquis. You can generally expect to pay $2 to $18 for a 30-day supply of Eliquis with Part D coverage. 

If you have any questions about your Part D plan, formulary, or what fees are involved with a Medicare policy, we’d be glad to help. Call us today at 855-900-2427 or schedule an appointment for free, personalized advice from a licensed Chapter Medicare Advisor.

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