2027 Medicare coverage of Xarelto

I had the same problem with my AARP United Healthcare Part D drug plan for 2027.  I called United Healthcare.  They investigated and told me they changed their position after the formularies were released in print and on the Medicare.gov websites, and that Xarelto will be covered in 2027 under Tier 3.  They were not able to provide me with anything in writing, but I could check the plan on January 1 and I would see the drug is covered.  She did not seem to realize I wanted proof before the Open Enrollment period ended.  Do we take a chance?

Same thing happening in Missouri. My Doctor has steadfastly refused to prescribe the generic. It is possible to have your MD request an exception to the formulary coverage, but I haven't heard back on the result yet. Currently on Wellcare which has removed Xarelto 20mg from the formulary list. Ironically the AARP approved plan also will not cover the drug in 2027. Looks like an issue that AARP should address. 

As of the last time I checked (five minutes ago), only one of the drug plans in my dad’s area (Long Island, NY) will cover Xarelto (SilverScript Choice), but it is a huge increase in cost compared to what he paid last year. He has Wellcare Value Script and his total drug costs for the year was around $600 (including his Xarelto). This year they’re looking at around $9500. If he went with SilverScript, he’d be paying around $4399.20 (including the premium) which is a steep increase. I don’t get how they can say that a generic option makes keeping Xarelto on the negotiated price list unnecessary when if you take more than the 2.5mg currently available as a generic, there are no options.

BTW your suggestion needs additional discussion:

I think a better course of action would be for you to consult a different chatbot.  I can’t find anywehre that says Xarelto is “carefully engineered as a single, extended-release tablet.”  And in fact, the NIH and Xarelto’s website say if someone can’t swallow the tablet, they can crush it.

I’m not sure what you mean by CVS providing coverage--it’s a pharmacy and not a prescription drug plan.

There’s something going on with name-brand Xarelto that I haven’t been following.  But one solution is to take the generic, which is free on Wellcare’s Value Script plan.  The only rub is you have to take 8 a day.  But hey, it’s free.

There’s someone on Reddit who has Wellcare and his prescription for 8 per day is covered.  It cost less than $10 in 2026, and will be $0 in 2027. 

People warn about quantity limits, but Wellcare’s formulary doesn’t have a quantity limit for generic Xarelto..