Xarelto assistance for Medicare patients

In this article:

• Does Medicare cover Xarelto?
• How much does Xarelto cost with Medicare?
• Assistance programs for Medicare patients
• How to save on Xarelto with Medicare: Step-by-step

In this article

• Does Medicare cover Xarelto?
• How much does Xarelto cost with Medicare?
• Assistance programs for Medicare patients
• How to save on Xarelto with Medicare: Step-by-step

Xarelto (rivaroxaban) is a blood thinner that blocks the activity of certain clotting substances in order to treat or prevent blood clots. Although Xarelto is effective, it’s also expensive, and people with Medicare sometimes have intimidating out-of-pocket costs. Fortunately, there are also several avenues of Xarelto assistance for Medicare patients. Here’s what you need to know. 

Does Medicare cover Xarelto?

Yes, many Medicare Part D and Medicare Advantage plans cover Xarelto, but it’s not always a simple process. To get coverage, many plans require a diagnosis of one of the FDA-approved conditions, like atrial fibrillation, deep vein thrombosis (DVT), or pulmonary embolism. Using Xarelto for off-label conditions like superficial vein thrombosis might not guarantee the same coverage.

“When I have Medicare patients, I usually find that they have to go through the prior authorization process before they even receive their first prescription,” says Eleonora Fedonenko, MD, board-certified internist and medical director of Your Laser Skin Care. “That’s because Xarelto falls into Tier 3 of most Part D plans, which means insurers will require documentation that the drug is medically necessary before approving it. From my experience, there is an increase in approval once the correct documentation is implemented from the first day.”

Every Medicare plan’s formulary is different, so the tier system can vary, but Xarelto is still most often in a higher tier. Tiers 1 and 2 are usually reserved for generic drugs and preferred brands, respectively, which means that Tier 3 drugs have more cost-sharing and higher copays for the patient. The FDA approved a generic version of rivaroxaban in 2025, so that’s a potential alternative for patients worried about cost, although only certain doses are available.

During the Annual Enrollment period, you can compare Medicare Part D plans on Medicare.gov to find the one with the most accessible Xarelto coverage.

How much does Xarelto cost with Medicare?

It ultimately depends on your specific plan, but Xarelto can cost anywhere between $0 and $197 for people with Medicare Part D, unless it is not on a plan’s formulary. Xarelto is one of several high-cost drugs that received discounts for 2026 through the Medicare Drug Price Negotiation Program. These negotiations put a cap on the price of Xarelto at $197. If your plan provides better coverage, you might pay much less, but you won’t have to pay more than that. Per Dr. Fedonenko, “what kind of Part D plan the patient chooses is more important than people realize, as tier placement varies from one plan to another, and can make the difference between paying about $89 a month and much more.”

If you and your healthcare provider decide generic rivaroxaban will work for you instead, you might get lower out-of-pocket costs from a plan that’s added it to its formulary.

Without any type of insurance coverage,or if the drug is off-formulary, the average cost of Xarelto is $805 for 60, 2.5mg tablets, and the generic version costs $686 per 60, 2.5mg tablets on average. With coupons like the ones from SingleCare, that price can drop as low as $48.

What assistance programs are available for Medicare patients taking Xarelto?

If your out-of-pocket costs seem insurmountable, even after Medicare coverage, there are a few reliable ways to save money on Xarelto, including Medicare Extra Help, Medicaid, and Xarelto coupons. 

Medicare Extra Help (Low-Income Subsidy)

For patients who need financial assistance with their premiums, deductibles, copays for prescription drugs, or other medical expenses, Medicare has a program called “Extra Help.” Medicare Part D beneficiaries who meet the income and other applicable eligibility requirements are likely to qualify.

“I make sure to mention at the beginning of every relevant conversation that out-of-pocket costs for patients who qualify for Medicare’s Extra Help program can be as low as $12.65 for every brand-name prescription,” Dr. Fedonenko says. And for generic drugs, Extra Help’s copay limit is $5.10 in 2026.

Extra Help is different from Medicare Savings Programs, which are run by individual states and help pay for Medicare Part A and Part B expenses. However, people who qualify for the Medicare Savings Program will automatically qualify for Extra Help, as will people with SSI and people with both Medicare and Medicaid. 

Generic rivaroxaban

Generic drugs are often much cheaper than their brand-name reference drugs, and that includes rivaroxaban, which the FDA approved in 2025. The only issue is that this approval applies “only to the 2.5 mg dose indicated for coronary artery disease and peripheral artery disease,” Dr. Fedonenko says. “The higher doses that actually are being used for atrial fibrillation or DVT/pulmonary embolism by Medicare patients are currently only tentatively approved by the FDA and not yet commercially available as generics. So for most of my patients taking Xarelto, it doesn’t yet offer a generic alternative.”

But if you only require a 2.5 mg dose, you could save money with a generic version. Talk to your healthcare provider to see if generic rivaroxaban is a good option for your specific situation.

Medicare drug price negotiation

As of Jan. 1, 2026, Xarelto is one of several drugs that received a discount from the Inflation Reduction Act’s Medicare drug price negotiation. As a result, the maximum out-of-pocket cost for Medicare beneficiaries is $197. Your cost might be lower, however, depending on your plan and whether you qualify for Extra Help

SingleCare prescription savings

Even if you have Medicare, you can use SingleCare coupons to find the best price on Xarelto at nearby pharmacies. You just can’t use these discounts on top of your Medicare coverage: You have to choose one or the other. But some patients find that they pay less by paying cash and using SingleCare than simply paying their insurance plan’s copay. For example, you could pay under $50 for a 30-day supply of Xarelto at certain CVS pharmacies by using SingleCare’s coupon card. 

Manufacturer’s patient assistance program

Xarelto’s manufacturer, Johnson & Johnson (Janssen Pharmaceuticals), has its own patient assistance program called J&J withMe, and it includes Xarelto. To qualify for J&JwithMe, your income must be equal to or less than 300% of the Federal Poverty Level. For Medicare patients with an income less than 150% of the FPL, you must also prove that you’re not eligible for Extra Help.

There’s also a specific Xarelto savings card, but it’s not available to anyone who has Medicare, Medicaid, or any other government-sponsored programs.

How to save on Xarelto with Medicare: Step-by-step

Perhaps the easiest ways to save on Xarelto are by switching to generic rivaroxaban or getting a SingleCare coupon card. But there are several steps you can take that will help:

• First, check your Medicare Part D plan’s formulary to see how it covers Xarelto. The plan you already have might provide adequate coverage.
• If not, talk to your healthcare provider about switching to generic rivaroxaban, since it’s usually cheaper.
• Either way, SingleCare coupons can drastically reduce the cost, and signing up is free.
• If you meet their eligibility requirements, Medicare Extra Help, Medicaid, and J&J withMe can be viable options too.
• And when Annual Enrollment rolls around, you can compare Medicare Part D plans to find the one with the best coverage.

Every step of the way, keep your healthcare provider in the loop, since they can provide personalized advice on how to proceed and which medications are best for you.