Xifaxan is one of the most expensive orally administered drugs a general gastroenterologist prescribes, and the reason is simple: after twenty-two years on the market it still has no commercially available generic. Salix and Bausch Health have defended the 550 mg tablet through a long run of patent litigation, and the result is a cash price that most people find hard to believe when the pharmacy quotes it.
The other thing that surprises people is that Xifaxan is really three different purchases. The 200 mg tablet for travelers’ diarrhea is a three-day course. The 550 mg tablet for IBS with diarrhea is a 14-day course that can be repeated up to twice. The same 550 mg tablet for hepatic encephalopathy is taken twice daily indefinitely. Those are wildly different bills. Every figure below was researched on September 3, 2026.
What Does Xifaxan Cost Without Insurance?
Dosing comes from the FDA-approved prescribing information. Cash retail comes from Drugs.com. The Medicare column is 2024 average spending per dosage unit and per prescription claim from the CMS Part D Spending by Drug file, the most recent year published. There is no federal acquisition-cost benchmark for this drug: queries against the CMS NADAC survey return zero rows for both rifaximin and Xifaxan at every strength, which is unusual and is itself a sign of how narrow the distribution is.
| Xifaxan purchase | Low | Average | High |
|---|---|---|---|
| One 550 mg tablet | $54.19 | $60.00 | $65.81 |
| IBS-D course, 550 mg three times daily for 14 days (42 tablets) | $2,275.86 | $2,519.94 | $2,764.02 |
| Hepatic encephalopathy, 550 mg twice daily, 30 days (60 tablets) | $3,251.25 | $3,599.92 | $3,948.79 |
| Medicare Part D average paid per Xifaxan prescription, 2024 | $2,779.31 | $2,779.31 | $2,779.31 |
| One 200 mg tablet | $13.04 | $13.04 | $13.04 |
| Travelers’ diarrhea, 200 mg three times daily for 3 days (9 tablets) | $117.36 | $117.36 | $117.36 |
| Smallest listed 200 mg package, 30 tablets | $391.11 | $391.11 | $391.11 |
| Savings card price, commercial insurance with coverage only | $0 | $0 | $0 |
The low and high on the 550 mg rows are the two independent per-tablet figures, $54.19 from Medicare Part D and $65.81 from Drugs.com cash retail, with the midpoint in between. Treat the $117.36 travelers’ diarrhea figure as the drug content of the course, not a purchasable package. Pharmacies dispense from a 30-count bottle, and unless a pharmacist will break it, expect to be charged closer to the full $391.11.
For scale, Medicare Part D spent $1.16 billion on Xifaxan across 416,690 claims for 104,805 beneficiaries in 2024, and the average per-claim number barely moved from 2023, when it was $2,838.70.
What Drives the Price
No marketed generic. This is the whole story. FDA granted Actavis Labs FL final approval for a generic rifaximin 550 mg tablet on March 19, 2026, and FDA’s Drugs@FDA record shows that application with a prescription marketing status rather than a tentative one. Seven other applications, from Norwich, Mylan, Alkem, Zydus, Sandoz and Cipla, remain at tentative approval, meaning FDA has cleared the science but patents or exclusivity block the launch. Drugs.com’s generic availability page, updated July 9, 2026, states plainly that no pricing is available and the product does not appear to be commercially available.
The strength split is a fivefold price difference. The 200 mg tablet costs $13.04 and the 550 mg costs $65.81. That is not a proportional 2.75x for 2.75 times the drug, it is 5x, because the two strengths sit in different competitive positions.
The indication decides the duration, and duration decides the bill. Three days, fourteen days, or forever. Hepatic encephalopathy is the indication that turns Xifaxan into a permanent line item, and it is also the indication where stopping is a serious clinical decision rather than a budgeting one.
Distribution is narrow. The absence of any NADAC row is a tell. NADAC surveys what retail community pharmacies actually pay for a drug, and a product that does not generate enough independent-pharmacy invoice data to publish a national average is one that mostly moves through specialty and mail channels.
Retreatment is built into the label. The IBS-D regimen explicitly allows up to two retreatments with the same 14-day course. Budget for the possibility of three courses, not one, if that is the indication.
Cash Price vs. Insurance
This is a drug where paying cash is almost never the right move if you have any coverage at all. Salix’s savings card brings an eligible commercially insured patient to as little as $0, and the program terms state that patients without commercial insurance, and patients whose plan does not cover Xifaxan, are not eligible. There is no cash discount anywhere close to that.
If you are uninsured, the realistic paths are patient assistance through the manufacturer, a 340B-priced pharmacy attached to a federally qualified health center or safety-net hospital, or a hospital financial assistance policy if the drug is being dispensed as part of hospital care. On a drug at this price point, an application is worth the paperwork.
One practical note on the pharmacy quote itself: because the retail price is so high, pharmacies vary a lot in what they will do with a partial fill or a bottle break, and a phone call to two or three pharmacies before you transfer the prescription can be worth several hundred dollars on the 200 mg course.
How to Pay Less
Ask about manufacturer patient assistance first. At $2,276 and up per course, this is the highest-value phone call you will make. The savings card is explicitly closed to you if you are uninsured, so the number to call is the patient support line on the Xifaxan site rather than the copay program. Ask specifically for the patient assistance program, not the savings card, and start the application before you fill, because approval is not instant.
Ask about a 340B pharmacy. Federally qualified health centers and disproportionate-share hospitals buy drugs at deeply discounted 340B prices and many pass that through to uninsured patients on a sliding scale. Our guide to free and sliding-scale clinics explains how to find one and what to ask.
Use hospital charity care if the drug is part of a hospital admission. Hepatic encephalopathy frequently starts with an inpatient stay, and the drug charge on that bill is negotiable in a way the retail counter is not. See hospital charity care for eligibility, which is often more generous than people expect, and how to negotiate medical bills for what to say once you have the itemized statement.
Price the 200 mg course at more than one pharmacy. For travelers’ diarrhea specifically, the difference between a nine-tablet partial fill and a 30-count bottle is roughly $274. Ask directly whether the pharmacy will dispense exactly the quantity written.
Recheck generic availability before every refill. This is the rare drug where the price could fall by 80% or more on a single day. One generic already has final FDA approval and seven more are tentatively approved. Ask your pharmacist at each fill whether a generic rifaximin has launched.
Do not skip the underlying workup to save money. IBS-D and hepatic encephalopathy are both diagnoses of exclusion in part, and the cheaper move is usually to get the diagnostic question settled once. Colonoscopy costs without insurance covers what the most common workup should cost as a cash payer.
The Bottom Line
Xifaxan is a $2,276 to $2,764 purchase for a 14-day IBS-D course and a $3,251 to $3,949 monthly purchase for hepatic encephalopathy, with the 200 mg travelers’ diarrhea strength a distant fourth of that at $391.11 a bottle. The savings card is worthless to an uninsured patient, so patient assistance and 340B pricing are the two levers that actually move the number.
Watch the generic. Approval landed in March 2026 and the launch has not, but when it does this page will need a full rewrite rather than a refresh. If your diagnosis is IBS with constipation rather than diarrhea, the drug economics are completely different and Linzess costs covers that side. For reflux and acid-suppression drugs, see omeprazole and PPI costs.