Understanding Xifaxan and Its High Cost
Xifaxan, with the active ingredient rifaximin, is an antibiotic that is uniquely designed to work in the intestines with minimal absorption into the rest of the body [1.2.4]. This makes it an effective treatment for conditions like Irritable Bowel Syndrome with Diarrhea (IBS-D) and for reducing the risk of overt Hepatic Encephalopathy (HE) recurrence [1.2.4].
The primary reason for Xifaxan's high price is that it is a brand-name drug with no FDA-approved generic equivalent available in the United States [1.5.1, 1.5.3]. The manufacturer, Salix Pharmaceuticals, holds patents that may not expire until 2029, preventing lower-cost generics from entering the market [1.5.2, 1.2.6]. Without insurance, a 14-day course for IBS-D can cost over $2,500 [1.7.4].
Is There a Generic for Xifaxan?
As of late 2025, there is no generic version of Xifaxan available for sale in the United States [1.5.1, 1.5.3]. While fraudulent online pharmacies might offer illegal generic versions, these are potentially unsafe and should be avoided [1.5.3]. The FDA has granted tentative approval for a generic, but final approval and availability are stalled by patent protections until at least 2028 or 2029 [1.5.2, 1.5.5].
Method 1: Manufacturer Savings and Assistance Programs
Salix, the manufacturer of Xifaxan, offers two main programs to help patients afford the medication.
XIFAXAN Savings Card
For patients with commercial insurance that covers the medication, the XIFAXAN Savings Card may allow them to pay as little as $0 for their prescription [1.2.1]. This program is not for patients on government plans like Medicare or Medicaid and excludes those paying full cash price [1.3.2]. There are maximum benefits and other restrictions, so it is important to check the full eligibility criteria [1.2.1].
Bausch Health Patient Assistance Program
The Bausch Health Patient Assistance Program is designed for individuals who have no insurance or whose insurance does not cover Xifaxan [1.3.7, 1.2.6]. Eligible patients who meet the income and residency requirements may receive their medication at no cost for up to one year, after which they must reapply [1.2.6]. An important update for 2025 is that Bausch Health (Salix's parent company) will cease participation in some optional Medicaid programs as of October 1, 2025. Medicaid patients who lose coverage may become eligible for this Patient Assistance Program (PAP) [1.3.1, 1.3.3].
Method 2: Prescription Discount Cards
For those paying cash, prescription discount cards can offer substantial savings. Services like GoodRx and SingleCare provide free coupons that can lower the price significantly. For example, a SingleCare coupon could reduce the price of 42 tablets of 550mg Xifaxan to around $2,195 from a much higher retail price [1.2.3]. It is crucial to remember that these discount cards cannot be used in conjunction with insurance [1.2.2]. It is always recommended to compare prices from different discount card services and different pharmacies to find the best deal [1.2.3].
Method 3: Navigating Insurance Coverage
Getting your insurance to pay for Xifaxan is often the most effective way to reduce costs. However, many insurance plans, including Medicare, require a prior authorization (PA) [1.2.2]. This is a process where your doctor must justify the need for Xifaxan to the insurance company [1.2.2].
Common PA criteria include [1.8.1, 1.8.3, 1.8.6]:
- For HE: Often, the patient must be using it as an add-on therapy with lactulose or have an intolerance to lactulose [1.8.1, 1.8.3].
- For IBS-D: Insurers may require that the patient has tried and failed on other, cheaper medications first, like antispasmodics or loperamide [1.8.6]. They may also limit the number of treatment courses a patient can receive [1.8.2, 1.8.5].
If your insurance denies coverage, work with your doctor's office to appeal the decision. Proactively starting the PA process from the doctor's office often has a higher success rate than if it's initiated by the pharmacy [1.3.3].
Method 4: Exploring Therapeutic Alternatives
Discussing alternative medications with your doctor is another key strategy. Depending on your condition, other more affordable options may be available.
| Condition | Xifaxan (Rifaximin) | Common Alternatives | Cost & Efficacy Notes |
|---|---|---|---|
| Hepatic Encephalopathy (HE) | Reduces ammonia-producing bacteria in the gut. Often used as an add-on therapy [1.6.3]. | Lactulose: Considered first-line therapy. It works by reducing ammonia production and absorption [1.6.3]. | Lactulose is the "gold standard" and significantly cheaper but can have side effects like bloating and diarrhea [1.6.2]. Rifaximin is often added when lactulose alone is not enough [1.6.1]. |
| IBS-D | An antibiotic that targets gut bacteria believed to contribute to symptoms [1.2.3]. | Alosetron (Lotronex), Eluxadoline (Viberzi), Antispasmodics (Dicyclomine), Antidepressants [1.2.5, 1.7.1]. | Alternatives often treat the symptoms rather than the potential bacterial cause [1.2.3]. Some, like generic alosetron, can be much cheaper than Xifaxan [1.7.1]. |
| Traveler's Diarrhea | Effective for E. coli-caused diarrhea [1.2.4]. | Azithromycin, Ciprofloxacin [1.2.3]. | Generic antibiotics like azithromycin are often the preferred and more affordable first choice for traveler's diarrhea [1.2.3]. |
Conclusion: Your Action Plan for Cheaper Xifaxan
Facing a high prescription cost for Xifaxan can be daunting, but you have several powerful options. The best path depends on your insurance status. If you have commercial insurance, the manufacturer's savings card is your first step [1.4.2]. If you are uninsured or underinsured, apply immediately to the Bausch Health Patient Assistance Program [1.3.7]. For everyone else paying cash, compare prices using discount cards like SingleCare [1.2.3]. Most importantly, maintain an open dialogue with your healthcare provider. They are your most valuable resource in navigating prior authorizations and exploring whether a more affordable therapeutic alternative is right for you [1.2.5].
