Is Xarelto Covered by Medicare? (2026)

Direct Answer: Does Medicare Cover Xarelto in 2026?

It depends on which part of Medicare applies. Original Medicare Part A and Part B do not cover Xarelto (rivaroxaban) tablets you take at home, since Part B only pays for physician-administered drugs. Medicare Part D and Medicare Advantage drug plans (MA-PD) do cover Xarelto in 2026, with a CMS-negotiated price of $197 for a 30-day supply under the Inflation Reduction Act.

What Original Medicare (Part A and Part B) Actually Covers

Original Medicare splits coverage between a hospital benefit and a medical benefit, and neither one is built for a daily pill you take at home. Medicare Part A covers Xarelto only when it's given to you during a covered inpatient hospital stay, bundled into the hospital's flat Part A payment with no separate drug copay. Medicare Part B covers drugs a clinician administers in an office or outpatient setting, such as injectable anticoagulants or clotting factor, plus routine blood tests. Part B does not cover oral, self-administered drugs like Xarelto outside a very short list of exceptions (oral anti-cancer drugs, oral anti-nausea drugs, and a few others), and rivaroxaban is not on that exceptions list.

One practical difference worth knowing: warfarin, an older blood thinner, requires regular INR blood monitoring that Part B covers as a lab test. Xarelto doesn't require that routine monitoring, which is one reason doctors prescribe it, but it also means there's no Part B service tied to the drug itself that would give you a coverage foothold under Original Medicare.

What Medicare Part D and Medicare Advantage (MA-PD) Cover in 2026

Medicare Part D prescription drug plans, and Medicare Advantage plans that bundle in drug coverage (MA-PD), are where Xarelto coverage actually lives. Xarelto was one of the first 10 drugs CMS selected for the Medicare Drug Price Negotiation Program created by the Inflation Reduction Act, and the negotiated price of $197 for a 30-day supply, 62% below the 2023 list price, took effect January 1, 2026. Most Part D and MA-PD formularies place Xarelto on Tier 3 as a preferred or non-preferred brand-name drug, though tier placement varies by plan.

The generic picture is changing fast. The FDA approved the first generic rivaroxaban, a 2.5 mg tablet made by Lupin and Taro, in March 2025, but that dose is approved only for coronary artery disease and peripheral artery disease, not the higher doses used for atrial fibrillation or DVT/PE prevention. Generic versions of the 10 mg, 15 mg, and 20 mg strengths, the doses most Xarelto patients actually take, received FDA approval in May 2025 and are still rolling out to pharmacies through 2026. That means many 2026 formularies still list brand-name Xarelto as the primary covered option for higher-dose indications, though that's expected to shift as generic supply expands.

Cost Without Coverage in 2026

If your plan doesn't cover Xarelto, or you haven't enrolled in a Part D or MA-PD plan yet, brand-name Xarelto costs roughly $517 to $805 per month at retail pharmacies in 2026, with GoodRx-style discount coupons bringing it down to around $500 to $540 per month. Generic rivaroxaban 2.5 mg, where it's available and appropriate for your indication, runs closer to $37 to $45 per month with a discount card, though the higher-strength generics used for stroke prevention and clot treatment are priced higher while supply is still ramping up in 2026.

Even with Part D or MA-PD coverage, your 2026 out-of-pocket cost depends on where you are in the benefit year. The standard Part D deductible in 2026 is $615, and once your total drug costs (yours plus your plan's) reach the $2,100 out-of-pocket cap, your plan covers 100% of covered drug costs, including Xarelto, for the rest of the year.

Extra Help and Financial Assistance Options

If your income is limited, Medicare's Extra Help program (the Part D Low-Income Subsidy) caps what you pay for Xarelto and other covered drugs. In 2026, Extra Help limits copays to $1.60 to $5.10 for generics and $4.90 to $12.65 for brand-name drugs like Xarelto, depending on your income tier. You generally qualify with income at or below 150% of the federal poverty level, about $23,940 for an individual or $32,460 for a married couple in 2026, and resources under $18,090 (individual) or $36,100 (couple).

Manufacturer copay cards for Xarelto typically can't be used if you have Medicare, since federal law bars drugmakers from offering copay assistance to people in federal health programs. Independent, nonprofit copay foundations that don't take manufacturer money, such as the PAN Foundation and the HealthWell Foundation, do accept Medicare beneficiaries and periodically open funds for anticoagulant medications, so it's worth checking their current disease-fund lists.

How to Find a Medicare Part D Plan That Covers Xarelto

Formulary coverage and tier placement for Xarelto vary plan by plan, so the only reliable way to know your real cost is to check directly. Use Medicare's Plan Finder at medicare.gov, enter Xarelto (or rivaroxaban) along with your other medications, and compare the estimated annual cost, tier, and pharmacy network across standalone Part D plans and Medicare Advantage MA-PD plans in your area. Pay attention to whether the plan requires prior authorization or step therapy for Xarelto, since some formularies want you to try a generic anticoagulant first.

• Annual Election Period (AEP): October 15 to December 7, 2026, to switch Part D or MA-PD plans for coverage starting January 1, 2027.
• Medicare Advantage Open Enrollment Period (MA OEP): January 1 to March 31, 2026, one plan switch allowed if you're already in an MA plan.
• A Special Enrollment Period may apply if you qualify for Extra Help, move, or lose other drug coverage mid-year.

Alternatives If Your Plan Doesn't Cover Xarelto

Since the answer to Xarelto coverage depends on your plan and which part of Medicare you're using, it helps to know your options if a denial or a high formulary tier gets in the way. Five concrete paths:

• Formulary exception request: ask your Part D or MA-PD plan, with your doctor's support, to cover Xarelto at a lower tier or without prior authorization if it's medically necessary for you specifically.
• Switch to generic rivaroxaban 2.5 mg if your indication is coronary or peripheral artery disease, the only dose with FDA-approved generics fully available in 2026.
• Apply to an independent copay foundation like the PAN Foundation or HealthWell Foundation, which accept Medicare beneficiaries for anticoagulant assistance when funds are open.
• Switch Part D or MA-PD plans during the Annual Election Period (October 15 to December 7, 2026) to a plan whose formulary favors Xarelto.
• Ask your doctor about a covered alternative anticoagulant, such as apixaban (Eliquis) or warfarin, if your plan's formulary favors a different drug in the same class for your condition.

Eligibility to Enroll in a Part D Plan That Covers Xarelto

To enroll in a Medicare Part D plan or an MA-PD plan, you must already have Medicare Part A or Part B and live in the plan's service area. Unlike ACA-compliant marketplace plans, Medicare drug coverage isn't medically underwritten, so a preexisting condition like atrial fibrillation or a clotting disorder can't be used to deny you enrollment or charge you more. Prescription drug coverage also isn't classified as one of the ACA's essential health benefits the way it is on the marketplace, since Medicare's drug benefit runs under its own separate statute (Part D of the Social Security Act) with its own formulary and cost-sharing rules.

Does Original Medicare cover Xarelto?

No, not when you take it as a pill at home. Original Medicare Part B only covers drugs a clinician administers in a clinical setting, and Part A covers Xarelto only if you receive it during a covered inpatient hospital stay. For everyday use, you need a Medicare Part D or Medicare Advantage (MA-PD) drug plan.

Does Medicare Advantage cover Xarelto?

Yes, if your Medicare Advantage plan bundles in prescription drug coverage (an MA-PD plan). It covers Xarelto under the same Part D rules as a standalone plan, including the 2026 CMS-negotiated price of $197 for a 30-day supply and the $2,100 annual out-of-pocket cap.

What is the cost of Xarelto without Medicare drug coverage in 2026?

Brand-name Xarelto runs about $517 to $805 per month at retail in 2026, or roughly $500 to $540 with a discount coupon. Generic rivaroxaban 2.5 mg, available for coronary and peripheral artery disease, costs closer to $37 to $45 per month with a discount card.

What is the 2026 Medicare negotiated price for Xarelto?

CMS negotiated a price of $197 for a 30-day supply of Xarelto, effective January 1, 2026, under the Inflation Reduction Act's Medicare Drug Price Negotiation Program. That is 62% below the 2023 list price used as the negotiation benchmark. CMS will remove Xarelto from the negotiated-price list starting January 1, 2027 because generic rivaroxaban has entered the market.

Is there a generic version of Xarelto covered by Medicare in 2026?

Partially. The FDA approved a generic rivaroxaban 2.5 mg tablet in March 2025, but that dose is approved only for coronary and peripheral artery disease, not for atrial fibrillation stroke prevention or DVT/PE, which use higher doses. Generic 10 mg, 15 mg, and 20 mg versions were approved in May 2025 and are still expanding onto pharmacy shelves and Part D formularies through 2026.

What if my Medicare Part D plan doesn't cover Xarelto?

Ask your plan for a formulary exception with your doctor's support, apply to an independent copay foundation like the PAN Foundation or HealthWell Foundation, or switch Part D/MA-PD plans during the Annual Election Period (October 15 to December 7, 2026). Your doctor may also suggest a covered alternative like Eliquis or warfarin.

Can Medicare Extra Help lower my Xarelto copay?

Yes. If you qualify for Extra Help in 2026, generally with income at or below 150% of the federal poverty level and resources under $18,090 (individual), your Xarelto copay is capped at $4.90 to $12.65 for the brand or $1.60 to $5.10 if you're on the generic, instead of standard Part D cost-sharing.

What's the difference between Xarelto coverage under Part B and Part D?

Part B never covers Xarelto tablets because they're self-administered at home, not given by a clinician. Part D and MA-PD plans are the only Medicare drug benefits that cover Xarelto, through your plan's formulary, with cost-sharing that runs through the 2026 deductible, initial coverage, and $2,100 out-of-pocket cap phases.