Xarelto costs vary widely depending on your Medicare plan and pharmacy

Your out-of-pocket cost for Xarelto (rivaroxaban) under Medicare depends on which plan you have, which pharmacy you use, and whether you've reached your deductible or entered the coverage gap. There is no single Medicare price — the same medication costs different amounts at different pharmacies and under different plans. A month's supply might cost you $10 at one pharmacy and $150 at another, even on the same plan.

Most Medicare Part D plans cover Xarelto, but it usually sits on a higher tier, meaning you pay more than you would for a generic blood thinner. The actual amount you owe depends on where you are in your plan's yearly cycle: whether you're still meeting your deductible, in the initial coverage phase, in the coverage gap (also called the "donut hole"), or in catastrophic coverage.

Key Takeaways

  • Xarelto is typically a tier 3 or tier 4 medication on Medicare Part D plans, so your copay or coinsurance will be higher than for generic alternatives.
  • The same pharmacy may charge different prices depending on which Medicare plan you use, so comparing plans matters more than comparing pharmacies alone.
  • You can call your plan's customer service number (on your insurance card) to find out your exact copay before you fill the prescription.
  • Some people pay less by switching to a generic blood thinner like apixaban (Eliquat) or dabigatran (Pradaxa), which may be on a lower tier.
  • GoodRx and similar discount programs sometimes offer lower prices than Medicare, but only if you don't use your insurance.

How Medicare Part D tiers affect your Xarelto cost

Medicare Part D plans organize drugs into tiers, and your copay or coinsurance depends on which tier the drug is on. Tier 1 is usually generic drugs with the lowest cost. Tier 2 is preferred brand-name drugs. Tier 3 and tier 4 are non-preferred brands and specialty drugs, where you pay the most. Xarelto almost always lands on tier 3 or tier 4.

If Xarelto is tier 3 on your plan, you might pay a flat copay (like $50 or $75 per month) or a percentage of the cost, called coinsurance. If it's tier 4, your copay could be $100 or more, or you might pay 25% to 33% of the drug's price. Some plans use coinsurance instead of a flat copay, which means you pay a percentage of what the pharmacy charges — and that percentage stays the same whether you're in the initial coverage phase or the coverage gap.

The only way to know your exact copay is to check your plan documents or call your plan's customer service line. The number is on your Medicare card. Have your prescription ready when you call, because the representative will need to know the dose and quantity your doctor prescribed.

What happens in the coverage gap and catastrophic phase

Once you and your plan have spent $5,850 on covered drugs in 2024 (this amount changes yearly), you enter the coverage gap. In the gap, you pay a larger share of the drug's cost — currently 25% for brand-name drugs like Xarelto. This can make your monthly cost jump significantly.

Once your out-of-pocket spending reaches $7,050 in 2024 (also changes yearly), you enter catastrophic coverage. At that point, Medicare pays most of the cost, and you pay only a small copay — usually around $11 for a generic or $33 for a brand-name drug. If you take Xarelto year-round, you may reach catastrophic coverage by late fall or winter.

Your plan's customer service line can tell you how much you've already spent toward your deductible and coverage gap limits. Knowing where you are in the year helps you understand whether a price increase is temporary (because you've moved into the gap) or permanent (because your plan changed).

Comparing your plan's price to other options

If your current plan's Xarelto copay feels high, you have several options. First, check whether your plan covers generic alternatives like apixaban (Eliquat) or dabigatran (Pradaxa). These may be on a lower tier and cost less. Your doctor would need to agree to the switch, but many cardiologists and primary care doctors are comfortable with it if you've been stable on Xarelto.

Second, you can compare plans during the annual Medicare open enrollment period (October 15 to December 7 each year). Plans change their formularies — the list of covered drugs — every year, and Xarelto's tier can move up or down. A plan that charges you $75 a month this year might charge $50 next year, or vice versa. The Medicare Plan Finder tool on Medicare.gov lets you enter your current drugs and see what each plan in your area would charge.

Third, some people find lower prices through discount programs like GoodRx or SingleCare, but only if they don't use their insurance. If you use your Medicare Part D plan, the pharmacy must bill your plan, and you pay your plan's copay. You cannot use both your insurance and a discount code at the same time. Discount programs are worth checking only if your plan's copay is very high or if you don't have Part D coverage.

Medicare Advantage plans and Xarelto

If you have a Medicare Advantage plan (Part C) instead of Original Medicare with Part D, your Xarelto cost works differently. Medicare Advantage plans set their own formularies and copays, so the price varies widely by plan and region. Some Advantage plans cover Xarelto cheaply; others don't cover it at all or require prior authorization from your doctor before they'll pay.

Call your Advantage plan's customer service number to ask whether Xarelto is covered, what tier it's on, and what your copay would be. If your plan doesn't cover it or charges too much, you can switch to a different Advantage plan or to Original Medicare with Part D during open enrollment. Many people switch specifically because their current plan's drug coverage doesn't match their prescriptions.

Manufacturer discounts and patient information programs

Janssen Pharmaceuticals, which makes Xarelto, offers a copay card program for people with commercial insurance and Medicare Part D. The card can reduce your copay to as low as $10 per month, but only if your plan allows manufacturer copay information. Some plans do; others don't. You can search for the current offer on Xarelto's official website or ask your pharmacist whether the copay card works with your plan.

If you have limited income, Janssen also runs a patient information program that may cover Xarelto for free. You would need to meet income limits and have no other insurance coverage for the drug. Your doctor's office or a social worker can help you find out whether you may have access to and how the process works.

Steps to find your actual Xarelto cost before filling

Call your Medicare plan's customer service number (on your insurance card) and have ready: your prescription dose (for example, 20 mg once daily), the quantity your doctor prescribed (30 tablets, 90 tablets, etc.), and your pharmacy's name. Ask the representative: "What is my copay for Xarelto at this pharmacy?" and "What tier is Xarelto on my plan?"

If the copay is higher than you expected, ask whether a generic alternative is on a lower tier. Then call your doctor's office and ask whether they would consider switching you. Many doctors are willing to try a different blood thinner if cost is a barrier.

If you're in the coverage gap and the copay jumps, ask your plan whether you may have access to for the Extra Help program (also called Low-Income Subsidy). This federal program pays part or all of your Part D costs if your income and resources are below certain limits. You can explore through Social Security or your state Medicaid office.

Frequently Asked Questions

Does Medicare cover Xarelto at all?

Most Medicare Part D plans cover Xarelto, but not all. Some plans exclude it or require your doctor to get prior authorization first. Call your plan to confirm it's covered before your doctor writes the prescription. If your plan doesn't cover it, you can switch plans during open enrollment or ask your doctor about a covered alternative.

Why is my Xarelto copay so much higher this month?

You likely entered the coverage gap. Once you and your plan spend $5,850 on drugs in a year, you pay 25% of the brand-name drug cost instead of your regular copay. This is temporary — once you reach catastrophic coverage (around $7,050 out-of-pocket), your copay drops again. Call your plan to confirm where you are in the yearly cycle.

Can I use a GoodRx coupon instead of my Medicare plan?

Not at the same time. If you use your Medicare Part D plan, the pharmacy bills your plan and you pay your copay. If you want to use a GoodRx coupon, you must tell the pharmacy not to bill your insurance. Compare the GoodRx price to your plan's copay and use whichever is lower, but you can only use one method per fill.

What if my doctor won't switch me to a cheaper blood thinner?

Ask your doctor why Xarelto is the right choice for you specifically. If they explain that you need Xarelto and not an alternative, ask whether the Janssen copay card or patient information program might help. If cost remains a barrier, tell your doctor — they may have samples or know of other resources. You can also ask your plan about the Extra Help program if your income is low.

Will my Xarelto copay be the same next year?

No. Plans change their formularies and copays every year. Xarelto might move to a higher or lower tier, or your plan might change its copay structure entirely. During open enrollment (October 15 to December 7), use Medicare.gov's Plan Finder to see what your drugs would cost under each plan in your area, then switch if you find a better deal.