3-Step XIFAXAN Reimbursement
Step 1: Fill Out The Form
Download the Patient Information Form and fill it out.
Patient Information Form (PDF 19KB)
Patient Information Form (MS-Word)
For easy-to-follow instructions and an example of a filled-out Patient Information Form,
click below to view our brochure, "Completing the Patient Information Form."
Completing the Patient Information Form (PDF 254KB)
Step 2: Get Questions Answered
This free support service connects trained reimbursement analysts with XIFAXAN customers to answer questions
regarding the Patient Information Form and to provide reimbursement support. Our staff can also negotiate appeals
on behalf of your patients, should their claims be denied
XIFAXAN Reimbursement Helpline
1-866-XIFAXAN
1-866-943-2926
Open Monday through Friday, 8:30 AM to 5:30 PM Eastern Standard Time
What should you have before calling?
To make the most efficient use of your time, complete the Patient
Information Form (PDF 19KB) before calling and have it with you.
Step 3: Submit Completed Form
Completed claim forms must be submitted via this fax number.
XIFAXAN Reimbursement Fax Line
1-800-387-5807
Reasons to contact the XIFAXAN Reimbursement Helpline
The XIFAXAN Reimbursement Helpline can provide a timely solution to issues you may encounter either before or after submitting a patient claim for reimbursement.
- Receive current reimbursement policies for private payers, Medicaid, and Medicare
- Verify individual patient coverage
- Verify insurance coverage associated with the patient assistance program
- Conduct prior authorizations
- Manage negotiation of appeals on denied claims
- Receive customized information to assist with coverage or appeals
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Xifaxan® (rifaximin) Tablets are indicated for the treatment of patients (≥12 years of age) with travelers' diarrhea caused by non-invasive strains of
Escherichia coli. Xifaxan should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to pathogens other than Escherichia coli. Xifaxan should be
discontinued if diarrhea symptoms get worse or persist more than 24-48 hours and alternative antibiotic therapy should be considered.
In clinical trials, Xifaxan was generally well tolerated. The most common side effects (vs. placebo) were flatulence 11.3% (vs. 19.7%), headache 9.7% (vs. 9.2%), abdominal pain 7.2% (vs. 10.1 %), rectal tenesmus 7.2%
(vs. 8.8%), defecation urgency 5.9% (vs. 9.2%) and nausea 5.3% (vs. 8.3%).
Consult with your physician to see if this product is right for you.
For complete Prescribing Information, please click here.
For product information, adverse event reports, and product complaint reports please call:
Salix Product Information Call Center
Phone: 1-800-508-0024
Fax: 1-510-595-8183
Email: