Concerns With Xifaxan For SIBO Treatment Not Being Covered
In our latest question and answer, the pharmacist discusses concerns with the high cost of Xifaxan for treating SIBO.
Good evening. Kaiser Permanente has rejected my son’s Rifaximin prescription for the treatment of SIBO. Where can I purchase it affordably?
Nov 28, 2024- Xifaxan is not FDA-approved for SIBO treatment, which is why many insurance plans don't initially cover it, though your doctor may be able to request coverage through a specific pathway outlined in your denial letter.
- Xifaxan is only available as a brand-name medication costing around $55 per tablet, making a typical 14-day course cost at least $2,300, with little variation in price between pharmacies.
- Your doctor may be able to prescribe alternative antibiotics like ciprofloxacin, norfloxacin, or metronidazole to treat SIBO at a lower cost if Xifaxan coverage cannot be obtained.
Answer
Thanks so much for reaching out to us!
I'm sorry to hear you are having issues with insurance coverage for your son's prescription for Xifaxan to treat SIBO (Small Intestinal Bacterial Overgrowth), but unfortunately, I am not surprised.
Although the use of Xifaxan for the treatment of SIBO is guideline-supported (Efficacy of rifaximin in treating small intestine bacterial overgrowth: a systematic review and meta-analysis), the drug is not FDA-approved for SIBO.
While insurance formularies and criteria for drug coverage vary by plan, it's certainly not uncommon that plans don't initially cover drugs that don't have an FDA-approved indication for their intended use.
Without more information on the denial you received from Kaiser, it's tough to give specific advice, but I urge you to look at the denial letter you received as it should have the specific reasons for denial. Oftentimes, there is a pathway to coverage that you can discuss with your doctor.
Xifaxan Cost & Availability
Unfortunately, Xifaxan is only available as a brand-name drug (i.e., there is no generic), and therefore, the cost is not only high but also likely to have little significant variation from place to place, unlike generic drugs where there is often more flexibility in pricing.
Xifaxan 550 mg tablets are around $55 or so per tablet, and since SIBO is typically treated with 3 tablets per day for 14 days, you're looking at at least $2,300 for a whole course—certainly not cheap.
I don't believe there are any places, either online or brick-and-mortar pharmacies, where you will find it any cheaper.
I do want to note that Xifaxan does have a savings card available from the manufacturer (Xifaxan Coupon Card), but based on the description on their website, the card only works if your plan covers at least a portion of the drug cost.
Alternatives
Since there isn't much room on price with Xifaxan being brand-only, you may want to consider alternative treatments.
Alternative antibiotics that can be used to treat SIBO include options like trimethoprim-sulfamethoxazole, norfloxacin, ciprofloxacin, metronidazole, tetracycline, or amoxicillin-clavulanic acid. While Xifaxan has the most evidence for benefit, since cost is a major restriction here, one of the alternative options I mentioned may be suitable.
I highly suggest speaking with your doctor regarding your options.
Final Words
Thanks again for reaching out, and please feel free to do so again anytime!
References & sources
Glossary — Terms in This Answer
- FDA-approved indication
- An official permission from the Food and Drug Administration for a medication to be used to treat a specific disease or condition.
- Formularies
- Lists of medications that an insurance plan will cover and pay for.
- SIBO
- Small Intestinal Bacterial Overgrowth, a condition where too many bacteria grow in the small intestine.
- Brand-name drug
- A medication sold under a manufacturer's trademarked name, typically more expensive than generic versions.
- Generic
- A medication that is chemically identical to a brand-name drug but typically costs much less because it is made by other manufacturers after the original patent expires.
- Rifaximin
- The active ingredient in Xifaxan, an antibiotic that works locally in the intestines to treat bacterial overgrowth.
- Trimethoprim-sulfamethoxazole
- An antibiotic combination medication that can be used as an alternative treatment for bacterial overgrowth in the small intestine.
- Metronidazole
- An antibiotic medication used to treat infections caused by bacteria and parasites.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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