Cost & Benefit Support Information
You and your insurance company will be talking a lot, both before and after your surgery. That is why it’s so important to make sure all your paperwork is in order. While insurance covers everything from your actual knee replacement to your hospital care and beyond, we are focusing on the anticoagulant (or blood thinner) your doctor may prescribe for you. This is because everyone who has a hip or knee replacement will take some sort of blood clot prevention medication. XARELTO® (rivaroxaban tablets) is the newest kind of anticoagulant, so you will probably have the most questions about it. Answers to the most common questions can be found in these sections:
- 1-888-XARELTO (1-888-927-3586)
- Understanding your Medicare Part D benefits and coverage for XARELTO®
- Private payers
We are here for you. Just call 1-888-XARELTO (1-888-927-3586, Mon–Fri, 8AM–8PM, ET) to learn about:
- A patient cost-assistance program
- Other sources that can help with cost
- Resources about XARELTO®
Understanding your Medicare Part D benefits and coverage for XARELTO®
Getting XARELTO® after your hip or knee replacement surgery is an important part of following the treatment plan your surgeon has developed for you. XARELTO® has been approved for use in helping to prevent blood clots following hip or knee replacement surgery.
Do I have prescription drug coverage for my XARELTO® therapy?
As a Medicare enrollee, you may have joined Part D, which offers coverage for prescription drugs. You may have either a separate Medicare Prescription Drug Plan (PDP) or you may get your prescription drugs as part of your Medicare managed care plan. For either type of plan, Medicare Part D benefits may cover XARELTO® after your hip or knee replacement surgery. Check with your plan to be sure.
How does my plan cover XARELTO®?
Before surgery, your doctor or hospital may need to check your Medicare Part D prescription drug benefits to see if you can get XARELTO® and how much it will cost. Some plans may ask that the physician get prior authorization before you can get XARELTO®. Your Medicare Part D plan may cover the total cost of XARELTO®, or only part of it.
If you want to appeal a decision made by your Medicare Part D plan, your doctor has the right to ask for certain “exceptions.” Your doctor can request an exception from your plan if:
- You need a drug that is not listed on your plan
- A coverage policy should be waived for you
- You should pay less for a nonpreferred drug because the preferred drug for the same condition is not as effective for you
If an exception is requested, your doctor will need to explain to your prescription plan why you need the drug, including why other drugs are not as effective for you and why this drug is better for you.
Does Medicare Part D coverage change based on where I am discharged to after surgery?
Medicare Part D coverage for XARELTO® may change based on the type of facility you are discharged to after your surgery.
You may be able to get XARELTO® through your Medicare Part D benefit when you are discharged to your home. The actual amount you pay may vary, and you will be responsible for your monthly premium, yearly deductible, co-payment or co-insurance amounts, and any out-of-pocket costs during your coverage gap.
If you are discharged home with home healthcare support, you may be able to get XARELTO® through your Medicare benefit.
Sometimes you may be able to get XARELTO® through your Medicare benefit if you are discharged to a skilled nursing or long-term-care facility.
Understanding Your Pharmacy Benefits and Coverage for XARELTO® (rivaroxaban tablets)
How do commercial insurance plans cover my XARELTO® therapy?
As a commercial insurance plan enrollee, your plan may cover prescription medications. Your prescription medication benefits may cover XARELTO® after your knee replacement surgery. This coverage varies from plan to plan. Usually, private payers do not have specific rules about covering treatments like XARELTO®, but you, your doctor, or the hospital may need to check with your plan to see if you can get coverage for XARELTO®.
What are the private payer coverage rules for XARELTO®?
Before surgery, your doctor or the hospital may need to check your prescription medication benefits and receive prior authorization for XARELTO®. Your plan may have a formulary that places XARELTO® into a tier that has a specific cost associated with it that you must pay. Your plan may also limit how many XARELTO® tablets you can get during a certain period of time.
Does private payer coverage change based on where I am discharged after surgery?
You may be able to get XARELTO® through your private payer prescription medication benefit when you are discharged from the hospital after surgery to your home, into the care of a home health agency, or if you go to a skilled nursing facility. The amount you will pay can vary, but you must usually pay your monthly premium, yearly deductible, and co-payment or co-insurance amounts. Typically, private payer plans do not have rules about covering oral anticoagulants (blood thinners) like XARELTO® when you are getting care from home health agencies or in skilled nursing or long-term care facilities.
For more information on your Medicaid benefits, please visit your state’s specific Web site.
For additional assistance on your private payer plan benefits, please visit your plan’s specific Web site.
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WHAT IS XARELTO® (rivaroxaban)?
XARELTO® is a prescription medicine used to reduce the risk of stroke and blood clots in people with atrial fibrillation, not caused by a heart valve problem. For patients currently well managed on warfarin, there is limited information on how XARELTO® and warfarin compare in reducing the risk of stroke.
XARELTO® is also a prescription medicine used to treat deep vein thrombosis and pulmonary embolism, and to help reduce the risk of these conditions occurring again.
XARELTO® is also a prescription medicine used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had knee or hip replacement surgery.
IMPORTANT SAFETY INFORMATION
WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT XARELTO®?
- For people taking XARELTO® for atrial fibrillation:
- People with atrial fibrillation (an irregular heart beat) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. XARELTO® lowers your chance of having a stroke by helping to prevent clots from forming. If you stop taking XARELTO®, you may have increased risk of forming a clot in your blood.
- Do not stop taking XARELTO® without talking to the doctor who prescribes it for you. Stopping XARELTO® increases your risk of having a stroke.
- If you have to stop taking XARELTO®, your doctor may prescribe another blood thinner medicine to prevent a blood clot from forming.
- XARELTO® can cause bleeding, which can be serious, and rarely may lead to death. This is because XARELTO® is a blood thinner medicine that reduces blood clotting. While you take XARELTO® you are likely to bruise more easily and it may take longer for bleeding to stop.
You may have a higher risk of bleeding if you take XARELTO® and take other medicines that increase your risk of bleeding, including:
- Aspirin or aspirin-containing products
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Warfarin sodium (Coumadin®, Jantoven®)
- Any medicine that contains heparin
- Clopidogrel (Plavix®)
- Other medicines to prevent or treat blood clots
Tell your doctor if you take any of these medicines. Ask your doctor or pharmacist if you are not sure if your medicine is one listed above.
Call your doctor or get medical help right away if you develop any of these signs or symptoms of bleeding:
- Unexpected bleeding or bleeding that lasts a long time, such as:
- Nosebleeds that happen often
- Unusual bleeding from gums
- Menstrual bleeding that is heavier than normal, or vaginal bleeding
- Bleeding that is severe or that you cannot control
- Red, pink, or brown urine
- Bright red or black stools (looks like tar)
- Cough up blood or blood clots
- Vomit blood or your vomit looks like "coffee grounds"
- Headaches, feeling dizzy or weak
- Pain, swelling, or new drainage at wound sites
Spinal or epidural blood clots (hematoma): People who take a blood thinner medicine (anticoagulant) like XARELTO®, and have medicine injected into their spinal and epidural area, or have a spinal puncture, have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis). Your risk of developing a spinal or epidural blood clot is higher if:
- A thin tube called an epidural catheter is placed in your back to give you certain medicine
- You take NSAIDs or a medicine to prevent blood from clotting
- You have a history of difficult or repeated epidural or spinal punctures
- You have a history of problems with your spine or have had surgery on your spine
If you take XARELTO® and receive spinal anesthesia or have a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots.Tell your doctor right away if you have back pain, tingling, numbness, muscle weakness (especially in your legs and feet), or loss of control of the bowels or bladder (incontinence).
XARELTO® is not for patients with artificial heart valves.
WHO SHOULD NOT TAKE XARELTO®?
Do not take XARELTO® if you:
- Currently have certain types of abnormal bleeding. Talk to your doctor before taking XARELTO® if you currently have unusual bleeding.
- Are allergic to rivaroxaban or any of the ingredients of XARELTO®.
WHAT SHOULD I TELL MY DOCTOR BEFORE OR WHILE TAKING XARELTO®?
Before taking XARELTO®, tell your doctor if you:
- Have ever had bleeding problems
- Have liver or kidney problems
- Have any other medical condition
- Are pregnant or plan to become pregnant. It is not known if XARELTO® will harm your unborn baby. Tell your doctor right away if you become pregnant while taking XARELTO®. If you take XARELTO® during pregnancy, tell your doctor right away if you have bleeding or symptoms of blood loss.
- Are breastfeeding or plan to breastfeed. It is not known if XARELTO® passes into your breast milk. You and your doctor should decide if you will take XARELTO® or breastfeed.
Tell all of your doctors and dentists that you are taking XARELTO®. They should talk to the doctor who prescribed XARELTO® for you before you have any surgery, medical or dental procedure.
Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal supplements. Some of your other medicines may affect the way XARELTO® works. Certain medicines may increase your risk of bleeding. See "What is the most important information I should know about XARELTO®?"
Especially tell your doctor if you take:
- Ketoconazole (Nizoral®)
- Itraconazole (Onmel™, Sporanox®)
- Ritonavir (Norvir®)
- Lopinavir/ritonavir (Kaletra®)
- Indinavir (Crixivan®)
- Carbamazepine (Carbatrol®, Equetro®, Tegretol®, Tegretol®-XR, Teril™, Epitol®)
- Phenytoin (Dilantin-125®, Dilantin®)
- Phenobarbital (Solfoton™)
- Rifampin (Rifater®, Rifamate®, Rimactane®, Rifadin®)
- St. John’s wort (Hypericum perforatum)
Ask your doctor if you are not sure if your medicine is one listed above. Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.
HOW SHOULD I TAKE XARELTO®?
Take XARELTO® exactly as prescribed by your doctor.
Do not change your dose or stop taking XARELTO® unless your doctor tells you to.
- Your doctor will tell you how much XARELTO® to take and when to take it.
- Your doctor may change your dose if needed.
If you take XARELTO® for:
- Atrial Fibrillation: Take XARELTO® 1 time a day with your evening meal.
If you miss a dose of XARELTO®, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
- Blood clots in the veins of your legs or lungs:
- Take XARELTO® once or twice a day as prescribed by your doctor.
- Take XARELTO® with food at the same time each day.
- If you miss a dose of XARELTO®:
- and take XARELTO® 2 times a day: Take XARELTO® as soon as you remember on the same day. You may take 2 doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time.
- and take XARELTO® 1 time a day: Take XARELTO® as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
- Hip or knee replacement surgery: Take XARELTO® 1 time a day with or without food. If you miss a dose of XARELTO®, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
- If you have difficulty swallowing the tablet whole, talk to your doctor about other ways to take XARELTO®.
- Your doctor will decide how long you should take XARELTO®. Do not stop taking XARELTO® without talking to your doctor first.
- Your doctor may stop XARELTO® for a short time before any surgery, medical or dental procedure. Your doctor will tell you when to start taking XARELTO® again after your surgery or procedure.
- Do not run out of XARELTO®. Refill your prescription for XARELTO® before you run out. When leaving the hospital following a hip or knee replacement, be sure that you have XARELTO® available to avoid missing any doses.
- If you take too much XARELTO®, go to the nearest hospital emergency room or call your doctor right away.
- Atrial Fibrillation: Take XARELTO® 1 time a day with your evening meal.
WHAT ARE THE POSSIBLE SIDE EFFECTS OF XARELTO®?
Please see "What is the most important information I should know about XARELTO®?"
Tell your doctor if you have any side effect that bothers you or that does not go away.
Call your doctor for medical advice about side effects. You are also encouraged to report side effects to the FDA: visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to Janssen Pharmaceuticals, Inc., at 1-800-JANSSEN (1-800-526-7736).
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