Concerns With Xifaxan For SIBO Treatment Not Being Covered

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!