Medicare Part D covers Xarelto, but your out-of-pocket cost depends on which plan you have and which tier the drug sits on

Xarelto (rivaroxaban) is a blood thinner prescribed to prevent blood clots and reduce stroke risk, often for people with atrial fibrillation or after certain surgeries. Medicare Part D prescription drug plans do cover it, but whether you pay $10, $50, or more per month depends on your specific plan's formulary — the list of drugs it covers and at what cost level.

Not every Part D plan covers Xarelto the same way. Some plans place it on a higher cost tier, meaning you pay more out of pocket. Others may require you to try a different blood thinner first before they will cover Xarelto. The only way to know your actual cost is to check your plan's formulary or call your plan directly.

If you have Original Medicare (Part A and B only) without a Part D plan, Xarelto is not covered at all. You would need to enroll in a Part D plan or find another way to pay for the medication.

Key Takeaways

  • Medicare Part D plans cover Xarelto, but the cost tier and coverage rules vary by plan.
  • Your monthly copay or coinsurance for Xarelto can range from around $10 to $100 or more, depending on your plan's formulary.
  • Some plans may require prior authorization or step therapy, meaning your doctor must show you tried another drug first.
  • You can check your plan's formulary on Medicare.gov or by calling your plan's customer service number.
  • If Xarelto costs too much under your current plan, you may be able to switch to a different Part D plan during the annual enrollment period.

How to find out what your plan charges for Xarelto

The fastest way is to log into your plan's website and search the formulary by drug name. Most Part D plans post their formularies online, and you can filter by medication name to see which tier Xarelto is on and what your copay will be.

If you do not have online access or prefer to speak with someone, call the customer service number on the back of your insurance card. Have your plan name and member ID ready. Ask the representative which tier Xarelto is on, what your copay or coinsurance will be, and whether your doctor needs to get prior authorization before the pharmacy can fill it.

If you are not yet enrolled in a Part D plan and want to compare costs before you sign up, use the Medicare Plan Finder tool at Medicare.gov. Enter Xarelto as a medication you take, and the tool will show you plans in your area and estimate your annual drug costs under each one.

What "tier" means and why it affects your cost

Part D plans organize drugs into tiers, usually numbered 1 through 5. Tier 1 drugs (generic, lowest cost) might have a $5 copay. Tier 2 or 3 drugs (preferred brand-name or non-preferred generics) might be $25 to $50. Tier 4 or 5 drugs (specialty or non-preferred brand-name) can be $75 to $150 or more per month.

Xarelto is a brand-name drug with no generic version available yet, so most plans place it on Tier 3 or Tier 4. This means your copay is usually higher than it would be for a generic blood thinner like warfarin. However, some plans negotiate lower costs, so the exact amount varies.

Once you reach your plan's deductible (if it has one) and then hit the coverage gap — sometimes called the "donut hole" — your costs change again. During the gap, you pay a larger share of the drug cost. After you spend enough out of pocket to reach catastrophic coverage, your copay drops to a small amount for the rest of the year.

Prior authorization and step therapy requirements

Some Part D plans require prior authorization before they will cover Xarelto. This means your doctor must submit a request to the plan explaining why you need this specific drug. The plan reviews the request and either approves or denies it, usually within a few business days.

Other plans use step therapy, which means you must try a different blood thinner first — often a generic or lower-cost option — before the plan will cover Xarelto. If that first drug does not work for you or causes side effects, your doctor can request an exception, and the plan may then cover Xarelto.

Ask your doctor's office to check with your plan before your first prescription. If your plan requires prior authorization or step therapy, the office can handle the paperwork so there is no delay in getting your medication.

What to do if Xarelto costs too much under your plan

If your copay is higher than you can afford, you have several options. First, ask your doctor whether a generic blood thinner like warfarin or apixaban (Eliquat) would work for you. These are often on lower tiers and cost less.

Second, check whether the manufacturer of Xarelto offers a copay card or patient information program. Bayer, the maker of Xarelto, runs programs that can reduce your out-of-pocket cost. Your doctor's office or pharmacist can help you find and enroll in these programs.

Third, you can switch to a different Part D plan during the annual enrollment period (October 15 to December 7 each year). Use the Medicare Plan Finder to compare plans and see which ones charge less for Xarelto. If you have a may have access to life event — such as losing other insurance or moving — you may be able to switch outside the annual period.

If cost is a barrier, talk to your doctor before you skip doses or stop taking the medication. Your doctor may be able to work with your plan to get an exception, or find a lower-cost alternative that is right for your condition.

Original Medicare and Xarelto coverage

If you have Original Medicare (Part A and Part B) without a Part D prescription drug plan, Medicare does not cover Xarelto at all. You would pay the full pharmacy price, which is typically $300 to $400 per month depending on the dose and your pharmacy.

To get coverage, you need to enroll in a Part D plan. You can join during the annual enrollment period or if you have a may have access to event. If you missed the important date and do not have a may have access to reason, you may face a late enrollment penalty when you do sign up, so it is worth reaching out to Medicare to ask about your options.

If you are on a limited income, you may be may be able to access for the Low-Income Subsidy (LIS) program, which helps pay Part D premiums and drug costs. Contact your local Medicaid office or call 1-800-MEDICARE to learn whether you may have access to.

Frequently Asked Questions

Does Medicare Part B cover Xarelto?

No. Part B covers medications given in a hospital or doctor's office, not pills you take at home. Xarelto is a tablet, so only Part D (prescription drug coverage) covers it. If you do not have Part D, you must pay out of pocket or enroll in a Part D plan.

What if my doctor says I need Xarelto but my plan will not cover it?

Your doctor can request an exception or appeal the plan's decision. This is called a coverage information request. The plan must respond within 72 hours for urgent requests. Your doctor's office can file this on your behalf, so ask them to do so if your plan initially denies coverage.

Can I use a GoodRx coupon or discount card instead of my Part D plan?

You can, but you cannot use both at the same time. If the GoodRx price is lower than your Part D copay, you can pay cash and use the coupon. However, this out-of-pocket spending does not count toward your Part D deductible or out-of-pocket maximum, so it may cost you more overall. Compare the two prices before you decide.

Will Xarelto ever have a generic version covered at a lower cost?

Xarelto's patent protection expires in 2026, after which generic versions may become available. Once a generic is on the market, Part D plans will likely place it on a lower tier with a smaller copay. Until then, brand-name Xarelto will remain more expensive than generic blood thinners.

What happens to my Xarelto coverage if I switch Part D plans?

Your new plan may cover Xarelto at a different cost or with different requirements. Before you switch, use the Medicare Plan Finder to check the formulary of any plan you are considering. Make sure Xarelto is covered and compare the copay to your current plan. Your doctor can also help you understand whether a different blood thinner might work if your new plan does not cover Xarelto as favorably.