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Xarelto is a brand of rivaroxaban. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 2,805 of 5,492 Medicare Part D and Medicare Advantage drug plans (51.1%) list Xarelto on their formulary, across 186 of 286 formularies. The most common placement is tier 3 (2,454 plans, 87.5% of those covering it). 30 of the covering plans require prior authorization (1.1%), 7 step therapy and 2,674 a quantity limit.
427 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $42, 72 of them $0; 2,378 charge coinsurance instead — median 23% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
Xarelto has a Medicare negotiated price (maximum fair price) of $197 for a 30-day supply, which applies. The negotiated price lowers what the plan pays; the member's copay or coinsurance still follows the plan's tier.
2026: 5,496 of 5,496 plans covered it (100%); 2027: 2,805 of 5,492 (51.1%).
Of 4,367 plans offered in both years, 0 added it to the formulary and 2,310 dropped it.
Among plans covering it both years, 170 moved it to a higher tier and 3 to a lower one; 19 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 99 |
| Tier 2 | 38 |
| Tier 3 | 2,454 |
| Tier 4 | 214 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 40 of 323 | 12.4% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,671 of 3,200 | 52.2% | 1.5% |
| Special needs plans (SNP) | 1,094 of 1,969 | 55.6% | 0.5% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 728 of 728 | Tier 3 | 0 |
| Aetna Medicare | 631 of 631 | Tier 3 | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 112 of 112 | Tier 3 | 0 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 0 of 80 | No tier listed | 0 |
| Alignment Health Plan | 77 of 77 | Tier 3 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 3 | 0 |
| Wellpoint | 63 of 63 | Tier 3 | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 36 of 36 | Tier 3 | 0 |
| Capital Blue Cross | 8 of 35 | Tier 4 | 0 |
| Prominence Health Plan | 29 of 29 | Tier 3 | 0 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 3 | 0 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 3 | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 59 of 114 | 51.8% |
| Alaska | 1 of 9 | 11.1% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 81 of 147 | 55.1% |
| Arkansas | 33 of 85 | 38.8% |
| California | 263 of 397 | 66.2% |
| Colorado | 53 of 106 | 50% |
| Connecticut | 31 of 54 | 57.4% |
| Delaware | 15 of 43 | 34.9% |
| District of Columbia | 6 of 12 | 50% |
| Florida | 323 of 545 | 59.3% |
| Georgia | 59 of 149 | 39.6% |
| Guam | 0 of 1 | 0% |
| Hawaii | 31 of 50 | 62% |
| Idaho | 15 of 45 | 33.3% |
| Illinois | 57 of 132 | 43.2% |
| Indiana | 74 of 138 | 53.6% |
| Iowa | 31 of 64 | 48.4% |
| Kansas | 44 of 84 | 52.4% |
| Kentucky | 41 of 121 | 33.9% |
| Louisiana | 41 of 125 | 32.8% |
| Maine | 18 of 52 | 34.6% |
| Maryland | 30 of 49 | 61.2% |
| Massachusetts | 68 of 89 | 76.4% |
| Michigan | 86 of 182 | 47.3% |
| Minnesota | 23 of 63 | 36.5% |
| Mississippi | 34 of 104 | 32.7% |
| Missouri | 83 of 170 | 48.8% |
| Montana | 3 of 27 | 11.1% |
| Nebraska | 26 of 51 | 51% |
| Nevada | 48 of 100 | 48% |
| New Hampshire | 6 of 25 | 24% |
| New Jersey | 39 of 73 | 53.4% |
| New Mexico | 19 of 68 | 27.9% |
| New York | 132 of 215 | 61.4% |
| North Carolina | 91 of 176 | 51.7% |
| North Dakota | 8 of 26 | 30.8% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 82 of 171 | 48% |
| Oklahoma | 25 of 81 | 30.9% |
| Oregon | 47 of 92 | 51.1% |
| Pennsylvania | 152 of 323 | 47.1% |
| Puerto Rico | 41 of 64 | 64.1% |
| Rhode Island | 12 of 29 | 41.4% |
| South Carolina | 36 of 89 | 40.4% |
| South Dakota | 12 of 30 | 40% |
| Tennessee | 92 of 156 | 59% |
| Texas | 198 of 407 | 48.6% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 20 of 53 | 37.7% |
| Vermont | 2 of 14 | 14.3% |
| Virginia | 55 of 144 | 38.2% |
| Washington | 60 of 114 | 52.6% |
| West Virginia | 26 of 69 | 37.7% |
| Wisconsin | 32 of 96 | 33.3% |
| Wyoming | 3 of 13 | 23.1% |
Medicare Part D paid for 11,887,740 30-day fills of Xarelto in 2024 for about 1,320,644 enrollees, at an average total cost of $523.99 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Xarelto and the rest of a client's list on every plan in their county.
Estimate Xarelto costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.