How Much Does Xarelto Cost with Medicare?
- Find out how much you might pay for Xarelto with a Medicare drug plan and how Medicare drug coverage works. Learn how to find a Medicare plan that covers Xarelto.
Xarelto is a brand name blood thinner drug that is covered by most Medicare Part D plans and Medicare Advantage plans (Medicare Part C) that include prescription drug coverage. There may be rare situations in which Xarelto is covered by Medicare Part A or Part B when administered by a health care professional in an inpatient setting. But Medicare Part A and Part B do not typically cover prescription drugs obtained at pharmacies.
You can compare Medicare Part D plans – including how much Xarelto costs with each plan – online for free, with no obligation to enroll. You can even find out if your pharmacy is part of a plan’s preferred pharmacy network.
How Much Will You Pay for Xarelto with Medicare?
How much you pay for Xarelto with Medicare will depend on a few things.
Xarelto pills are available in 2.5-, 10-, 15- and 20-milligram doses. The dosage level you are prescribed will play a role in the cost, as will the length of your prescription. But the biggest determining factor in your cost for Xarelto is your Medicare plan’s drug benefits and the coverage level (or coverage “stage”) you are currently in.
Medicare Part D and Medicare Advantage plans with prescription drug coverage (MA-PD plans) use four different stages of coverage.
- The first stage is the deductible stage. You are responsible for the full cost of your prescription drugs while in this stage until your deductible has been met. No Medicare drug plan is allowed to have a deductible higher than $505 in 2023, and some plans have no deductible at all.
- The second coverage stage of a Medicare drug plan is the copayment or coinsurance stage. You will enter this stage once your deductible has been satisfied. (If your plan has no deductible, you will begin the year in this stage.)
During this stage, you are responsible for a copayment (flat fee) or coinsurance (percentage of the cost) each time you fill a prescription. Copayments and coinsurance amounts typically depend on the type of drug being covered. Commonly used generic drugs typically being in the lowest cost tier of a drug plan’s formulary (list of drugs it covers). Many Medicare plans offer low or even $0 copays for this drug tier. Rarer brand name drugs typically are on higher tiers and have higher copays or coinsurance costs.
Medicare drug plans typically use a 5-tier system with generic drugs being in tier 1 and specialty drugs in tier 5. The higher the tier, the more you will likely have to pay in copayments or coinsurance. Xeralto is most commonly found in tier 3, which consists of preferred brand name drugs.
- The third coverage stage is the coverage gap, or “donut hole.” You will enter this stage once you and your plan have combined to pay for $4,660 worth of covered drugs in 2023. You will be responsible for 25% of the cost of your drugs during this stage.
- The final coverage stage is the catastrophic coverage stage. You will enter this stage once you reach $7,400 in out-of-pocket costs for covered drugs in 2023. You will have minimal charges for any covered drugs during this stage.
What Tier is Xarelto?
Many Medicare Part D plans list brand-name Xarelto as a Tier 3 drug. Most plans have five tiers, and the higher the tier, the more you may have to pay for a refill.
Tier 1 and Tier 2 drugs typically include commonly prescribed generic drugs and lower-cost name-brand drugs. Drugs in higher tiers generally consist of rare and more expensive medications. As with any drug, the cost of Xarelto is partly affected by the tier in which it is categorized.
An Example of Xarelto Costs with Medicare
Let’s use an example of a Medicare Part D plan member to better illustrate an Xerelto price with Medicare.
John has a Medicare Part D plan from a leading insurance carrier. Under his plan, drugs in tiers 1 and 2 have no annual deductible, but drugs in tiers 3, 4 and 5 come with the standard $445 annual deductible.
John is prescribed a 30-day supply of Xarelto. The manufacturer cost for a 30-day supply is $492. Because Xarelto is a tier 3 drug, John is responsible for the first $445 in order to satisfy the deductible. After making the $445 payment to meet his deductible, John then must make a $40 copayment for the remainder of the cost.
John pays a total of $485 for this 30-day prescription of Xarelto, which is only $7 less than the retail cost.
Although John’s costs are high for the initial prescription, his savings are then reflected in each of his subsequent refills. After 30 days, John’s doctor determines the Xarelto is effective and prescribes another 30-day supply. This time, John is only responsible for the $40 copayment to have the prescription filled. He is now saving more than $450 off the retail price of the drug.
After 30 more days, John’s doctor prescribes a 90-day supply which John can receive through the mail. (Many Medicare drug plans feature mail-order delivery for 90-day prescriptions.) John’s copayment for the 90-day supply is $120, meaning he has saved more than $1,300 off the retail price for this refill.
As you can see, the more you use a Medicare plan to pay for a drug like Xarelto, the more you can save.
It should be noted that while websites like GoodRx.com offer Xarelto coupons and discounts for drugs like Xarelto, these deals may not always be valid when using a Medicare drug plan.
Find Medicare Plans That Cover Your Prescription Drugs
On top of the deductible and copayments or coinsurance associated with Medicare drug plans, there is also often a monthly premium in order to belong to the plan. However, many Medicare Advantage plans that cover prescription drugs also feature $0 premiums.
Contact a licensed insurance agent for help finding the best Medicare drug plan for your needs at the most affordable price. You can also compare plans online for free, including what drugs they cover – such as Xarelto – and how much you can expect to pay for them.