Does Medicare Cover Xarelto? Coverage and 2026 Costs

Which part of Medicare covers Xarelto?

Xarelto (the brand name for rivaroxaban) is a blood thinner, or anticoagulant, that you swallow as a pill at home. Because you take it yourself rather than having a provider administer it, it is covered as a prescription drug under Medicare Part D — the part of Medicare that pays for outpatient medications.

Original Medicare (Part A and Part B) does not cover Xarelto. Part A covers inpatient hospital care, and Part B covers doctor visits and certain drugs given in a clinical setting. A take-home pill like Xarelto does not fall under either one.

You can get Part D coverage in two ways: a standalone Part D drug plan (often paired with Original Medicare) or a Medicare Advantage plan that includes drug coverage (called an MA-PD plan). Either route covers Xarelto, subject to that specific plan's rules.

The 2026 Medicare-negotiated price for Xarelto

Xarelto was one of the first 10 drugs chosen for the Medicare Drug Price Negotiation Program created by the Inflation Reduction Act. The negotiated price — called the Maximum Fair Price — takes effect January 1, 2026.

For Xarelto, the negotiated Maximum Fair Price is $197 for a 30-day equivalent supply, down from a 2023 list price of $517. That is a 62% reduction. This negotiated price is what plans use as the basis for the drug's cost; it does not by itself equal your copay, which still depends on your plan's design and where you are in the year.

• Negotiated Maximum Fair Price: $197 per 30-day supply (effective Jan 1, 2026)
• Prior 2023 list price: $517 per 30-day supply
• Reduction: 62%

What you'll actually pay with Medicare in 2026

Your out-of-pocket cost for Xarelto depends on your specific Part D or MA-PD plan. Xarelto is a brand-name drug, so plans typically place it on a higher tier (for example, a Tier 3 brand tier), and the copay or coinsurance varies from plan to plan.

Most plans also charge an annual deductible, set by each plan up to a federal maximum, that you pay before your plan's cost-sharing begins. After the deductible, you pay your plan's copay or coinsurance for Xarelto.

A major 2026 protection: Part D out-of-pocket spending on covered drugs is capped at $2,100 for the year. Once your spending on covered drugs reaches that cap, you pay $0 for covered Part D drugs — including Xarelto, if it's on your formulary — for the rest of the calendar year.

On top of any drug copays, Part D plans charge a monthly premium. The 2026 national base beneficiary premium is $38.99 per month; your actual plan premium may be higher or lower. If you went without creditable drug coverage after you were first eligible, a late-enrollment penalty of 1% of $38.99 per full uncovered month can be added to your premium for life.

• Xarelto is usually on a brand tier; copay varies by plan
• You may owe your plan's deductible first
• 2026 Part D out-of-pocket cap: $2,100, then $0 for covered drugs
• 2026 national base Part D premium: $38.99/month (plan premiums vary)

Formularies, tiers, and coverage rules

Medicare drug coverage of Xarelto is never automatic across every plan. The drug must be on your plan's formulary (its list of covered drugs), and it must be prescribed for a covered, FDA-approved condition.

FDA-approved uses of Xarelto include reducing stroke risk in people with non-valvular atrial fibrillation (AFib); treating deep vein thrombosis (DVT) and pulmonary embolism (PE) and reducing their recurrence; preventing blood clots after hip or knee replacement surgery; reducing major cardiovascular events in coronary or peripheral artery disease (taken with aspirin); and preventing venous blood clots in certain acutely ill medical patients.

Plans may apply utilization management before they cover Xarelto. This can include prior authorization (your plan must approve it first) or step therapy (you may need to try another drug first). Because formularies, tiers, copays, and restrictions differ by plan, always confirm the details for your exact plan using Medicare's Plan Finder.

• Covered only if Xarelto is on your plan's formulary
• Must be prescribed for an FDA-approved condition
• Plans may require prior authorization or step therapy
• Check your specific plan at Medicare.gov's Plan Finder

Programs that can lower your Xarelto costs

If you have limited income and resources, the Extra Help program (also called the Part D Low-Income Subsidy) can sharply reduce your drug costs. In 2026, people who qualify pay no more than $12.65 for each covered brand-name drug — so Xarelto would cost at most $12.65.

To qualify for full Extra Help in 2026, your countable resources (assets) generally must not exceed $16,590 for an individual or $33,100 for a married couple living together; these limits are higher (about $18,090 single / $36,100 married) when the standard $1,500-per-person burial allowance is counted. People who have Medicaid, a Medicare Savings Program, or Supplemental Security Income (SSI) automatically qualify.

Higher-income beneficiaries pay more. The Part D income-related monthly adjustment amount (IRMAA) is an extra charge added to your premium if your income is high. In 2026 the Part D IRMAA surcharge ranges from $14.50 to $91.00 per month and applies when your 2024 modified adjusted gross income was above $109,000 (single) or $218,000 (joint).

• Extra Help (LIS): max $12.65 per covered brand drug in 2026
• 2026 full LIS resource limits: $16,590 single / $33,100 married (higher with burial allowance)
• Medicaid, an MSP, or SSI = automatic Extra Help qualification
• Part D IRMAA: $14.50–$91.00/mo extra above $109k single / $218k joint (2024 income)

How to find the right plan and switch if needed

The single best tool is Medicare's Plan Finder at Medicare.gov/plan-compare. Enter Xarelto (and your other drugs) and your pharmacy, and the tool shows each plan's formulary status, drug tier, estimated copay, deductible, premium, and any restrictions like prior authorization. This lets you compare total yearly cost, not just the premium.

If you have a Medicare Advantage plan, check whether it includes drug coverage (MA-PD); those plans cover Xarelto through their own formulary and cost-sharing rules, just like a standalone Part D plan.

You can change plans during the Medicare Open Enrollment Period each fall (October 15 – December 7), with the new coverage starting January 1. If you switch, re-check that your new plan still covers Xarelto on a tier and at a cost that works for you, since formularies can change from year to year. A licensed Medicare advisor can also help you compare options at no cost to you.