Is a Xarelto generic available?

In this article:

• Is there a generic for Xarelto?
• How much is generic Xarelto?
• Is Xarelto covered by insurance?
• Generic alternatives to Xarelto

In this article

• Is there a generic for Xarelto?
• How much is generic Xarelto?
• Is Xarelto covered by insurance?
• Generic alternatives to Xarelto

Xarelto is an anticoagulant medication (commonly referred to as a blood thinner) and Factor Xa inhibitor. It comes in tablet and oral suspension form. Xarelto treats and prevents blood clots. Adults who have had deep vein thrombosis (DVT), a pulmonary embolism, hip replacement surgery, or knee surgery are some populations who may take this prescription medication. 

Xarelto is marketed by a subsidiary of Johnson & Johnson (J&J). The medication was developed by the Bayer company, which holds the patent. Its active ingredient and generic name are rivaroxaban. While both forms (the generic and brand-name) have benefits, both also have side effects.

Is there a generic for Xarelto?

Like some other prescription drugs, a generic version of Xarelto has been FDA-approved in the United States (and some other countries, such as Canada and the United Kingdom) since March 4, 2025. 

How much is generic Xarelto?

The price difference between rivaroxaban and Xarelto is significant. Let’s discuss the price difference for 60 tablets. Rivaroxaban, without insurance, typically costs around $688.81. With a SingleCare prescription discount card, it can cost as little as $192.54. However, for Xarelto, the cost may be $821.02 without insurance, and around $502.55 with a SingleCare coupon.

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Is Xarelto covered by insurance?

Most insurance plans and Medicare Part D cover Xarelto. If a patient doesn’t have insurance, they can buy medicine at a more affordable price by using a SingleCare prescription discount card. With that discount card, people can buy Xarelto for as low as $502 and its generic form, rivaroxaban, for as low as $192.

Generic alternatives to Xarelto

If Xarelto isn’t an option for whatever reason, other medications can serve as viable treatment options. Some common Xarelto alternatives include the following. The brand-name drugs are listed first, with their effective generics in parentheses. 

• Eliquis (apixaban)
• Coumadin and Jantoven (warfarin)
• Pradaxa (dabigatran)
• Plavix (clopidogrel)
• Brilinta (ticagrelor)

Additionally, Xarelto has some off-label uses for heart conditions in adult patients. “While not FDA-approved for these indications, Xarelto is used in clinical practice for a variety of indications, including treatment of acute heparin-induced thrombocytopenia (HIT), post-percutaneous coronary intervention (PCI) with stent placement (after stabilization with initial management), and superficial vein thrombosis,” says Dr. Claudia Cometa, Pharm.D., an experienced clinical pharmacist in Florida and the founder and CEO of Avanti Health Consultants.

It’s also used off-label for patients who have an increased risk of clotting but don’t meet specific guidelines, atrial flutter, heparin-induced thrombocytopenia treatment in clinically stable patients, and left ventricular thrombus treatment or prevention, according to Dr. Erika Gray, Pharm.D., a UCSF-trained pharmacist and the founder and chief medical officer at ToolBox Genomics and MyToolBox Genomics.

However, prescriptions for off-label use don’t occur frequently. “Unlike other medications, Xarelto is less commonly used off-label,” Dr. Gray affirms.

Xarelto’s alternatives also have off-label use. “Sometimes, patients will need an alternative to Xarelto because of insurance reasons or decreased kidney function,” Dr. Gray says. 

The alternatives can be taken for the same reasons that Xarelto is used off-label, she continues. Dr. Cometa notes these additional uses:

• Plavix: atrial fibrillation and after coronary artery bypass graft (CABG) surgery
• Pradaxa and Eliquis: valvular atrial fibrillation, heart failure, left ventricular thrombus, superficial vein thrombosis, and pulmonary hypertension
• Warfarin: secondary prevention of stroke and transient ischemic attacks

“Some of these conditions have medical literature to support their use, which can provide medical providers a lot of confidence in using these agents despite their lack of FDA approval in these scenarios,” Dr. Cometa adds.

To save money, or for another reason, a patient may want to switch from Xarelto to the generic. Dr. Cometa says there’s no solid, guideline-directed consensus on how, but the manufacturer recommends the following steps: 

1. Stop Xarelto.
2. Start a parenteral (IV or SC) anticoagulation when the next Xarelto dose would be due, along with the first dose of warfarin.
3. Continue the parenteral anticoagulant and warfarin until the INR is therapeutic for the condition being treated, then stop the parenteral anticoagulant and continue warfarin.

“Most commonly, patients are transitioned onto a DOAC (direct oral anticoagulant), aka Xarelto, from heparin drips or low molecular weight heparin (enoxaparin),” Dr. Gray adds.

On the note of switching, it’s important to note that a pharmacist can dispense generic drugs when a patient’s prescription is for Xarelto—but only in one case. 

“Rivaroxaban was recently approved as a 2.5 mg tablet only; therefore, a pharmacist can dispense the generic rivaroxaban if the prescription is for Xarelto 2.5 mg and the provider does not indicate any notation not to substitute on the prescription,” Dr. Cometa says. 

What the latter looks like, Dr. Gray explains, is no check mark by the “dispense as written” box. “I always double-check with prescribers in these situations,” she adds.

Last but not least, let’s discuss withdrawal symptoms that may occur when a patient skips doses or faces a shortage. “The most significant and potentially life-threatening symptom of stopping Xarelto is a rebound hypercoagulability, or increased risk for blood clots,” Dr. Cometa says. “This could result in a stroke, clot in the legs, or clot in the lungs.” 

She’s also heard of patients noting emotional disturbances and sleep disruption when stopping Xarelto.

If a dose is missed, Dr. Gray recommends that patients take it as soon as they remember and avoid taking a double dose.

Further, if there’s a shortage or issue with insurance coverage, she suggests talking to your prescriber or a provider at the pharmacy. They may be able to provide an alternative in the meantime.