What to Know About Medicare and Xarelto Coverage

Written by 
Molly Burford
Article at a glance
  • Xarelto is a medication that is used to treat and prevent blood clots in certain conditions such as coronary artery disease or deep vein thrombosis. 

  • While Original Medicare does not include prescription drug coverage, beneficiaries can enroll in a separate drug plan known as Medicare Part D. Medicare Advantage plans may also include prescription drug coverage. Patients will have to check their specific Medicare Advantage plan to see if it includes prescription drug coverage. 

  • There are no generic versions of Xarelto available. As such, a higher copay may be possible but will vary based on someone’s specific Medicare plan.

  • There are ways to help individuals combat high prescription drug costs, including GoodRx, Medicaid, Extra Help program, etc.

Group of older adults laughing outside

Xarelto (rivaroxaban) is a type of anticoagulant that helps treat and lower the risk of developing blood clots.

Read on below to learn more about how coverage for Xarelto works with Medicare, including how Medicare drug coverage works in general.

What is Xarelto?

Xarelto (rivaroxaban) is a type of anticoagulant that helps treat and lower the risk of developing blood clots. Xarelto is administered by mouth in tablet form. 

Warnings and Side Effects

Common side effects include: 

  • Bleeding

  • Prolonged bruising

  • Heavy menstrual bleeding

  • Back pain

  • Stomach pain

How Expensive is Xarelto?

Because no generic version of Xarelto exists, it can be quite expensive, running up to almost $600 retail.

Does Medicare Cover Xarelto?

As a reminder, Original Medicare only consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). These Medicare parts do not include coverage for prescription drugs such as Xarelto. 

Those who only have an Original Medicare plan need to enroll in a Medicare prescription drug plan, known as Medicare Part D, in order to receive coverage. 

What is Medicare Part D?

Medicare Part D consists of Medicare’s prescription drug plans. Most Medicare Part D plans include a monthly premium, yearly deductible, copayments, and coinsurance. Medicare drug plans’ overall costs will vary. Factors that contribute to costs include: 

  • Prescriptions: What prescriptions a beneficiary needs and whether they’re on the drug plan’s list of covered medications, known as the plan’s formulary can affect cost.

  • Medication Tier: What tier the medication is in can affect the plan’s cost. The higher the tier, the more expensive a medication usually is. Most plans have five tiers. Tier information is provided on the plan’s formulary. 

  • Drug Benefit Phase: Which drug benefit phase the beneficiary is in can affect the plan’s cost,i.e. whether they’ve paid their deductible or if they’re in the catastrophic coverage phase.

  • Pharmacy: What pharmacy type and location impact Medicare Part D’s cost. 

  • Medicare Extra Help Enrollment: Whether a beneficiary is enrolled in the Medicare Extra Help program can impact their Medicare Part D cost.

Medicare enrollees are encouraged to compare Medicare prescription drug plans to find the best option for them.

Note: Learn more about Medicare Part D costs at this resource.

Does Medicare Part D Cover Xarelto? 

Most Medicare Part D plans cover Xarelto. That said, coverage and cost will still depend on the specific plan chosen. Copays range from $2 to $35, depending on a beneficiary’s coverage stage. For example, Medicare beneficiaries in the coverage gap stage may pay between $6–$35. Learn more about the Medicare Part D coverage gap at this resource.

Xarelto is also typically a Tier 3 medication. Quantity limits may apply, placing holds on how much medication a beneficiary is able to fill at one time.

Does Medicare Advantage Cover Prescription Drugs?

Medicare Advantage plans, also known as Medicare Part C or MA plans, may include prescription drug benefits. MA plans are a type of Medicare supplement plan and are provided by private insurance companies that are Medicare-approved. 

Medicare Part C plans consist of the standard Medicare coverage (Medicare Part A and Medicare Part B), in addition to other healthcare benefits including vision, hearing, and prescription drugs. Exact benefits will vary per plan. MA plan beneficiaries should confirm extra benefits with their insurance company.

Do Medicare Advantage Plans Cover Xarelto? 

Many Medicare Part C plans may cover Xarelto. However, it will depend on the specific MA plan chosen since not all Medicare Advantage plans include coverage for prescription drugs. If an MA plan does include prescription drug coverage, beneficiaries can look at their plan’s formulary for a list of covered drugs to see if Xarelto is included.

Man smiling at computer at kitchen table

How to Get Help Paying For Xarelto

Out-of-pocket costs for prescription medications can add up quickly, even with coverage. There are a number of programs that can help Medicare beneficiaries with these drug costs, however.

Extra Help Program 

The Extra Help Program is a Medicare program to help beneficiaries with limited income or resources pay for a Medicare prescription drug plan. Some people automatically will qualify for Extra Help, such as those who qualify for the QMB program, SLMB, or QI program under Medicare Savings Programs.

Those who do not automatically qualify can apply here.

SHIP

The State Health Insurance Assistance Program (SHIP) is a national program that helps Medicare beneficiaries, caregivers, and family members make informed choices about their Medicare benefits and navigate all of their options. 

Note: Learn more about SHIP at this resource.

GoodRx

GoodRx is both a website and mobile application that finds discount pricing for prescription medications. Visit its Xarelto page to learn more.

Medicaid (Dual Eligibles)

Beneficiaries eligible for the Medicaid Dual Eligibles” program will be eligible to use the Medicaid Drug Rebate Program (MDRP). This program helps to offset the Federal and state costs for prescription drugs. 

Note: Learn more about Medicaid Drug Rebate Program at this resource.

PACE

PACE stands for Program of All-Inclusive Care for the Elderly. It is a Medicare and Medicaid program that provides all the care and services covered by Medicare and Medicaid if authorized by someone’s health care team. This includes prescription drugs. Those in a PACE program do not need to enroll in a separate Medicare Part D drug plan.

Note: Learn more about PACE at this resource.

Medigap/​MedSupp

Medigap or MedSupp plans are supplemental Medicare plans that intend to fill in the gaps” of Original Medicare. Medigap plans often help with deductible, copayment, and coinsurance payments. 

When it comes to prescription drugs, someone cannot be enrolled in both a Medicare prescription drug plan as well as a have a Medigap policy with drug coverage. Learn more about Medigap and Medicare drug coverage at this resource.

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