How to Access Affordable Xifaxan (rifaximin)

Written by Lucia Mueller | Reviewed by a licensed U.S. pharmacist | Posted November 16, 2022

Xifaxan (rifaximin) is an expensive medication for the treatment of a common problem: IBS. The list of symptoms of irritable bowel syndrome is a miserable laundry list: cramping, abdominal pain, bloating, gas, diarrhea, constipation, etc. And most conditions that call for brand-name treatment these days should tack on yet another: anxiety – due to the excessive costs expected for treatment. 

Xifaxan is a very popular medication and the pharmaceutical industry is cashing in. The average retail price for 60 Xifaxan 550 mg tablets sold at U.S. pharmacies is $3,271.84 – a steep 22% increase from the average price in 2019 ($2,686.95). Medicare spent over $844 million on Xifaxan in the year 2020 alone. It’s not covered by most private insurance plans in the U.S., so paying for it can certainly be daunting. 

Who spends what on brand-name Xifaxan?

As is so often the case with brand drug prescriptions with lackluster insurance coverage, Americans start looking elsewhere. The Xifaxan price comparison below illustrates why they would be tempted: Xifaxan sold in Canada is 80% cheaper than the average price at U.S. retail pharmacies. Our neighbors to the North (and South, too, by the way) certainly have a reputation for selling affordable medication. And, however much someone may warn you about purchasing “foreign” drugs, Xifaxan is a great weapon in a game of dinnertime “got ya!” Xifaxan, sold on pharmacy shelves in the United States for six times the price at Canadian pharmacies, is manufactured in Canada. Most of our medication supply is foreign-produced.

Cost Comparison of IBS Medication Xifaxan (rifaximin)

  Price per Xifaxan 550mg tablet
Out-of-pocket at U.S. pharmacies $54.72
Medicare  $43.07
Walgreens with a GoodRx Coupon $53.03
Walmart with a U.S. Coupon on $45.13
An independent U.S. pharmacy with a U.S. Coupon on $34.96
A Canadian mail order pharmacy accredited through the PharmacyChecker Verification Program $8.67

Prices collected October 2022

Rifaximin is marketed under the name “Zaxine” in Canada by the exact same pharmaceutical company that sells “Xifaxan” in the United States: Salix Pharmaceuticals. It is likely that the rifaximin a patient orders from Canada, for a fraction of the U.S. price tag, is the same exact drug manufactured in the same exact facility as the one sold in the U.S. This batch is for marketing in Canada? Slap a “Zaxine” label on it! For the United States? Well, that’s “Xifaxan,” for which Medicare should pay 80% more than Canadian pharmacies.

When shopping internationally, it’s important to note different names under which rifaximin may be marketed. Arming yourself with this information will ensure that you get the medicine you need, in addition to protecting your wallet. Beyond Zaxine, Xifaxan (rifaximin) is also marketed internationally under the names Targaxan and Xifaxanta. Work with your prescriber to ensure that these foreign brand alternatives make sense for you to pursue. Cost is a large part of patients adhering to their prescribed drug therapies, so your clinician should be happy to help.

Compare Xifaxan Costs

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Xifaxan (rifaximin) Savings – ordering the generic from abroad

With Xifaxan projected to enjoy patent protection until 2029, cost relief through generic competition isn’t exactly around the corner domestically. However, the generic is available to order online from pharmacies located overseas, specifically in India. This Indian online pharmacy-sold generic, rifaximin, is manufactured by Sun Pharmaceutical Industries, an Indian multinational pharmaceutical company that has actually reached a settlement agreement with the U.S.-sold brand Xifaxan manufacturer Bausch Health (Salix Pharmaceuticals) to permit Sun Pharma’s generic rifaximin U.S. entry in 2028. Other generic rifaximin manufacturers to look for: Teva and Sandoz, with Norwich looking for FDA approval as well.

While you can absolutely save money on the brand by shopping online, the steeper discounts on the generic are certainly nothing to balk at, especially when you know it’s coming from accredited pharmacies that are properly licensed in the country where they are located. The Indian generic rifaximin is 92% cheaper than the UK-sold brand Targaxan (rifaximin); 99% cheaper than the US-sold brand Xifaxan (rifaximin).

Compare Rifaximin Costs

Comparing Xifaxan (rifaximin) Brand & Generic Costs

Drug Strength (Quantity) U.S. Average Retail Price U.S. Prescription Discount Card Price Canadian Pharmacy Price (with shipping) International Pharmacy Price (with shipping)
Xifaxan 550 mg (60 tablets) $3,271.84 $2090.22 $541.99* $530.40**
Rifaximin (generic Xifaxan) 550 mg (60 tablets) Not available in the U.S. Not available in the U.S. Not available at Canadian pharmacies $44.82***

*This is the price of Zaxine, a brand name of rifaximin marketed in Canada. 

**This is the price of Targaxan;  a brand name of rifaximin marketed in the United Kingdom. 

***This is the price of rifaximin, generic equivalent to Xifaxan, manufactured by Sun Pharmaceuticals and sold in India

Prices recorded November 2022

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Where are Xifaxan and generic Rifaximin manufactured?

Xifaxin sold at your local U.S. pharmacy is not made in the U.S. In fact, 68% of brand-name finished drug formulations sold in the U.S. are manufactured outside of the U.S. Packaging of Xifaxan sold in the United States shows that the active ingredient, rifaximin, is produced and finished in Canada. The generic rifaximin, sold at accredited online pharmacies, is manufactured in India by Sun Pharmaceuticals. As noted before, Xifaxan is marketed internationally under the names Targaxan, a product in the UK; Xifaxanta, a product of the EU/UK; and Zaxine, sold in Canada. UK-sold Xifaxanta (rifaximin) is likely manufactured in Italy.

Xifaxan Packaging Label

U.S. label of Xifaxan 550mg. Source: National Library of Medicine

U.S. label of Xifaxan 200mg. Source: National Library of Medicine

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Will Medicare pricing of Xifaxan be negotiated?

Perhaps you’ve heard that Medicare will have the power to negotiate prescription drug prices soon. 

The FDA approved Xifaxan in May 2004, which means it has 18 years of market exclusivity here in the U.S. What’s more, it’s expected to maintain this trend of patent protection through October 2029. These are good indicators for Medicare negotiation, but the fact that Xifaxan is 44th on Medicare’s list of top expenditure single-source drugs in 2020 makes it too close a call to say the drug price would ever be negotiated under the current provisions of the Inflation Reduction Act. We analyzed the likely candidates for negotiation here.

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Other Ways to Cut Xifaxan Costs

Talk to your doc!

Work with your clinician or pharmacist to find a cheaper therapeutic alternative to Xifaxan. Don’t be shy about talking cost! High prices in the U.S. are swiftly becoming the norm, and your care providers are there to make sure you adhere to your prescribed drug therapies. Currently, Xifaxan is the only antibiotic specifically for IBS approved by the FDA. However, there are alternative medications often used to manage IBS symptoms such as Lubiprostone (Amitiza), Linaclotide (Linzess), and Dicyclomine hydrochloride (Bentyl). Alternative antibiotics for traveler’s diarrhea may include Azithromycin, Levofloxacin, Ciprofloxacin, Ofloxacin, and Rifamycin SV.

Xifaxan $0 Copay Savings Card

Do you already have insurance and are just suffering from an annoying copay for Xifaxan? The Xifaxan website advertises a savings card through which “most eligible patients with commercial insurance and coverage may pay as little as $0 for their Xifaxan prescription.” If you have insurance, this is definitely worth looking into.

Xifaxan $0 Copay Savings Card

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Tips for Dealing with Traveler’s Diarrhea

Sometimes, traveler’s diarrhea hits people from the stress associated with traveling. Other times, it’s a result of contaminated food or water. The locals may not be affected by the same food or water you eat because they have developed a natural immunity to the bacteria in that area.

You may be able to avoid the need to take Xifaxan (rifaximin) or other medications if you take certain preventative actions.  Here are two simple rules for avoiding diarrhea while traveling: 1) Be mindful of what you eat and drink sterilized or bottled water only; 2) Only consume prepared meals if they are boiled, cooked, or peeled.

More often than not, traveler's diarrhea starts, quite inconveniently, as soon as people arrive at their destinations. The majority of cases improve without treatment within one to two days and all symptoms disappear within a week. Please remember rifaximin will not be effective in treating traveler's diarrhea that is bloody or that occurs in conjunction with a fever.

Common signs and symptoms of traveler's diarrhea

  • Rapid onset of the passing of over three loose stools a day
  • Nausea
  • Abdominal cramping
  • Urgent need to pass stools
  • Vomiting
  • Fever

If symptoms of high fever, bloody stools, and unbearable abdominal pain with diarrhea last longer than two days, you should consult your care provider as soon as possible. If you prefer a doctor that speaks your language while traveling, a local embassy or consulate will certainly be able to help you locate one.

Tips on eating while traveling:

  • Don't eat from street vendors.
  • Don’t consume unpasteurized milk and dairy products, including ice cream.
  • Don’t consume raw or undercooked meat, fish, and shellfish.
  • Only consume foods that are well-cooked and served hot.
  • Only eat fruits and vegetables that you can peel, like bananas, oranges, and avocados.
  • Avoid fruits like grapes or berries.

Tips on drinking while traveling:

  • Avoid unsterilized water. If you must consume local water, boil for at least three minutes.
  • Avoid ice cubes made with local water.
  • Avoid juices made with local water.
  • Avoid swimming in water that may be contaminated.
  • Keep your mouth closed while showering and swimming.
  • In high-risk areas use bottled water to brush your teeth.
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