Does anyone really know the answer to this question, “Why is Rifaximin so expensive?”

Note: This post was originally published on February 5, 2016 as “Where There’s a Will.” The stories told below are all from back then. I have not taken Rifaximin and/or Neomycin in well over a year because my gut is healed.

It seems as though most people find it incredibly difficult to obtain the antibiotic they need. (And when I say need, you must know that I rarely ever say I need an antibiotic. I have not been to a traditional doctor’s visit in years.)

What is Rifaximin?

Rifaximin treats traveler’s diarrhea and irritable bowel syndrome by stopping the growth of the bacteria that cause diarrhea. It treats hepatic encephalopathy by stopping the growth of bacteria that produce toxins and that may worsen liver disease.

Rifaximin is a nonabsorbable, broad-spectrum antimicrobial that inhibits bacterial RNA synthesis by binding the β-subunit of microbial RNA polymerase. It targets the gastrointestinal tract and works by reducing the quantity of gas-producing bacteria and altering the predominant species of bacteria present. In vivo animal studies suggest additional beneficial mechanisms of rifaximin, including reducing mucosal inflammation and visceral hypersensitivity.

Clinical studies have demonstrated that rifaximin improves symptoms associated with IBS, such as bloating, flatulence, stool consistency, and abdominal pain, and has a side-effect profile similar to placebo. Although additional investigation into optimal dosing, treatment duration, and potential resistance is required, rifaximin presents as a safe and beneficial addition to the current management options for IBS. (source)

What is Rifaximin SIBO antibiotic IBS #sibo #ibs #antibiotic

Rifaximin and Neomycin Cost

In order to rid the overgrowth, both Rifaximin and Neomycin are needed, since I have both the Hydrogen and Methane versions of SIBO.

If you know anything about SIBO, you know that the combination is the hardest to get rid of.

About a year ago, I did an extended round of Rifaximin and it cost us about $1,200 (out of pocket), and that’s with phenomenal insurance coverage.

Several weeks ago, my doctor sent the prescription in to our pharmacy, and later that day I received a phone call,

Hi. Before we fill your prescription, we wanted to let you know that it’s going to be about $1,800 for the Rifaximin. Since this is a mortgage payment for many people, we needed to get your approval before moving forward.

I about died. On principal alone, I denied it. I told them I’d go back to my doctor, and figure something out.

Back-and-forth and back-and-forth we went. Our insurance wasn’t willing to do anything. The final option was a pharmacy in Australia my doctor has a good relationship with.

I still had no idea how much it would cost, but I told myself and Ryan that my options were this:

  1. Pray that in Australia they wouldn’t completely rob me.
  2. LIVE with the overgrowth, but completely nix all FODMAP foods and go almost 100% Paleo, GAPS/SCD (which by the way might not take care of it entirely, but instead would just help me manage symptoms).

Ryan is amazing and said that he didn’t want me to have to struggle through option #2, and that if option #1 wouldn’t work, we would pay the $1,800 here.

I denied that, with deep conviction. Again, on principal alone.

Australia Comes Through

Earlier this week the email came through that everything was approved and done. I have tracking confirmation that the Rifaximin is en route to me as I type this.

just checked its status, and the Rifaximin is now in Los Angeles, which means I should have it in hand by Monday.

My total bill: $277.92

Side note: The Neomycin was only about $24 in the US.

Why is Rifaximin so Expensive?

Click HERE to save this for later.

Why is Rifaximin So Expensive? #sibo #guthealth #antibiotic #rifaximin

I have been trying to investigate why Rifaximin is so expensive. But I have kind-of-sort-of stopped because it’s draining, and it flat out makes me furious.

Rifaximin = A “Rare” Drug?

My pharmacist told me it’s because the drug is “rare.” I have to call BS on this because I know two women who have gotten the exact same thing as I am getting, and have paid less than $20 for the entire supply. Their common denominator is that a traditional Western medicine doctor wrote their prescriptions and sent them off.

If the pharmacist is right, then people should be very afraid since SIBO diagnosis is on the rise.

And if I am right that it’s a matter of functional vs. traditional doctor’s prescription then the fact still stands that as long as people stay sick and miserable the wonderful world of “health care” stays rich and abundant.

Not “For” SIBO?

Rifaximin is commonly known as an expensive drug for travelers diarrhea. It has been argued that:

A. SIBO is Not Real and

B. Rifaximin won’t help those with SIBO.

Thus, doctor’s won’t prescribe it and even if they do, it’s usually a 2-week course (which, by the way, if your SIBO is bad enough, you’ll still be miserable at the 2-week mark likely – read THIS).

3 Reasons Why Rifaximin for SIBO is so expensive #rifaximin #sibo #guthealth #ibs

Traditional vs. Alternative Medicine

We all make choices about how we live and the health care we choose to provide ourselves and our families. I have a very ugly past filled with choices which left me ill in my adult life. I am not proud of them, and I have been extremely vocal about doing my very best to not let other young women follow in those same footsteps.

But on the flip side, once I became so ill, I did every single thing in my power to avoid excuses about why I wasn’t getting better and to avoid the medical trap that society as a whole falls into.

I spend hundreds, heck – let’s be brutally honest, thousands of dollars to get the help I need now. This isn’t some whimsical, fruity-loopy wizardry I’m into.

I see a function MD, a “real” doctor with the exact same credentials as any traditional doctor. They attended the same school but one doctor chose the path of getting to a root problem vs. masking problems by suppressing symptoms.

And it’s only been through my illness that I have been able to see the VALUE in this. For as much as I hate illness, I feel grateful for this awakening in my life daily.

It gave me a new lease on life.

Without my whimsical,fruity-loopy wizardry doctor, I would have lived my whole life with SIBO, Adrenal Fatigue, and failing hormones and instead bought into taking drugs like Canasa while believing diet and lifestyle didn’t matter.

Farmers Market Cherries. New Lease on Life

Where There’s a Will

Our health care system has left a bitter taste in my mouth. Very bitter.

But like everything else in life, we have a choice.

I could stay bitter OR I could find a way to get what I need and do all the things I need to do to get better.

Not only does it allow me to feel 100% again but it also ensures that I don’t have to rely on our health care system.

Those who don’t have the will won’t ever find the way, and this, ultimately, is exactly what our health care system wants.

There is no money in getting better.

But you can get better, I promise!

If you want to read through my full SIBO healing journey and also where I got the Rifaximin, check out Reasonable SIBO.


If you liked this post, you might also enjoy:

  1. My 28-Day Rifaximin and Neomycin SIBO Journal
  2. Top 15 Low-FODMAP High-Fiber Foods
  3. SIBO Q&A with A Gutsy Girl


Where There's a Will Why is Rifaximin for SIBO so expensive? #SIBO #guthealth #healthyliving #ibs #ibd

Where There's a Will SIBO Rifaximin Traditional vs. Western Medicine

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  1. I don’t think its a western vs functional medicine issue. I went to a traditional doctor and they still charged me $1100 for the Rifaximin. I have no idea why. I at the time was VERY low income, so I was able to call the manufacturer and get a discount due to that. Otherwise it’s nearly impossible to get the drugs you need. I HATE our pharmaceutical industry!! So enraging that you were able to get it so much cheaper from another country.

  2. Hello, I am in the same boat as we speak. SIBO hit like a brick and made me an emotional wreck! I am trying to get Xifaxan approved also!! I did get a coupon from for $1000 off…but the bill will still be around $1100 after that out of my pocket! Was there a specific pharmacy you went through in LA? I’m at my wits end! Took me months of doctor jumping to find anyone to treat this.

      1. Hi, big questions: did taking the Rifaximum work? did you get better? one round or more? are you ok now?

        I hope so!

  3. A year ago I had emergency surgery for a bowel obstruction which resulted in emergency surgery and part of my bowel had to be removed. The part that was removed was my ascending colon which includes the cecum, appendix and the all important ileocecal valve, which works to keep bacteria out of the small intestine. I suffer now from continual SIBO unless on xifaxan. I found an excellent doctor who actually tested me for SIBO and prescribed xifaxan. It’s been a miracle for me. My insurance has zero co-pay but I’m waiting on the other shoe to drop. I’m 61 and will be on Medicare in a few years. I can only pray that it will cover this med. At this point, he’s keeping me on it twice a day because symptoms would return after only 4-5 weeks when taking it 3x day for 2 weeks. I don’t know why it’s so prohibitively expensive for some and for others nothing. Our healthcare system sucks. I’m lucky right now with my insurance but who knows what can happen? Best of luck to all. I hope you find this wonderful med and get well.

    1. I took it! Search my blog for “Rifaximin.” And you’re so right….it did wonders for me. I have been symptom free for months and months, and I know that was a piece that helped:) Thanks for stopping by!

      1. Can I just take Rifaximin twice a day for 2 weeks? Will that work? I am only 100lbs so maybe 3 times a day too strong?

  4. So happy for you!! This is not a pleasant deal at all. I’m wondering if part of the reason it is covered for me is because I have suffered from IBS my whole life and I believe some insurance will cover xifaxan for that reason, but not sure. I’m keeping your blog handy for when/if I need these resources. Thank you for putting it up!

  5. Greetings! I’d like to find out more information about ordering this medication from Australia. Apparently, Xifaxan (Rifaximin) is also used for patients with Hepatic Encephalopathy, which my father has as a result of cancer metastasis. We recently received notice from the insurance company that Xifaxan, the only drug that helps my father’s liver function, and is ultimately keeping him alive, is no longer covered. The out of pocket cost is more than what we can reasonably afford to pay on a monthly basis. So far, we’ve been able to pull the $1,500 together for a one month supply, but ongoing, I’m not sure how we will be able to afford this.
    I’m grateful for any information that you’re able to share.

      1. Hi Sarah, just checking to see if you been happy with the quality of your prescription? Very much appreciated your story and your pharmacy information.

      2. Did you just email them a copy of your prescription? How was the ordering process? Im highly considering going this route

  6. My husband picked up my prescription for Xifaxan and the pharmacist said, “You must have fantastic insurance. This drug costs $1600…” at which point my husband started to hyperventilate, but then she continued, “but with your insurance, it cost you nothing!” I couldn’t believe ANY medication would cost $1600, so I really hope this works for my IBSD which has caused me to lose at least one day a week of work for the last 6 months!

  7. My Dad was diagnosed with SIBO and was prescribed Rifaximin, but was told by a United Stated medical professional to purchase the drug from a Canadian pharmacy for $120 for a 30 day supply instead of paying several thousand in the United States, the USA medical, insurance and pharmaceutical system is the absolute most corrupt and fraudulent in the world and we pay the most for healthcare per person of any country in the world.

    1. May I ask where you got this prescription? I can’t believe I’m just finding this blog post. I’ve been living with Sibo for 2 years plus because I can’t afford the drug. I was tested for it after literally pushing my doctor for it.

    2. I’m having the same issue with my dad’s coverage. Do you mind sharing what pharmacy in Canada you went through?

  8. My insurance denied any coverage of rifaximin. They sent me a long letter saying that if the doctor had diagnosed me with IBS, then it would have been covered. I paid out of pocket for 20 pills and felt like crying thinking how much money we were spending when we have a 2 year old and I’m spending crazy money for 20 pills of something.

  9. Xifaxan is the brand name and in the U.S. its the only one available. If you order from Canada you can get the generic version which is Rifaximin for cheap. I got a 10 day supply 550mg x 3/day for $38.00.

    1. May I ask where you got this prescription? I can’t believe I’m just finding this blog post. I’ve been living with Sibo for 2 years plus because I can’t afford the drug.

  10. Why Rifaximin (and several other drugs) are so expensive. First, I take Rifaximin for the hepatic encephalopathy due to liver failure caused by an infection, so I have an interest. I also grew up as a “Lilly brat” (son of an Eli Lilly executive) and I know how and why these drugs cost so much. It won’t help much to know this, but at least you’ll know.

    The problem involves patent law, but there’s more to it. When a new compound/biologic/formula is discovered to have the potential to treat a condition, it must be patented immediately, lest a competitor undercut the discovering manufacturer. This starts a 17 year timer, after which the patent expires and it becomes available for generic manufacturers. However, this is just the very beginning of the process. These molecules are passed to research, where a large team of expensive PhD biochemists filter through the molecules, eliminating most from consideration. Then you start years of animal tests, human tests, filtering for side effects, manufacturing design, FDA approvals. More molecules are eliminated at every step, and the patent ticks away.

    By the time it’s ready to be brought to market, the manufacturer has only a few years of those 17 left to recover development costs, cover themselves for liability in case something gets through and starts killing people (this has happened), make some corporate profit, and reward stockholders, keeping the stock value up. Some of the time, especially when the market is kind of small, they have to charge what seem like abusive prices just to pay off those obligations.

    Why can you get it cheaper from other countries? They don’t have to abide by our patent laws. They can capture the formula and go straight to generic. It’s just the way capitalism works. Think the government could do it better? What’s their motivation to be competitive? What amazing new drugs are coming out of, say, England? Perhaps some adjustments could be made to the patent law, but this is the best way it gets done. In case you wonder, the patent protection for Rifaximin expires in 2024.

  11. I have a phenomenal new doctor who works in a our community clinic. Because the clinic has patients with no insurance or on Medicaid in addition to patients like me with insurance, I was able to get Rifaximin at no cost through a local pharmacy with a 340b grant. It is not income based for patients. The downside is having to change providers but I had already wanted to find a new doctor with more expertise.

  12. I went to a traditional western medicine GI . My out of pocket for a 2 week course of Rifaximin was less than $40. Unfortunately, it didn’t work for me, but I loved being on it. Absolutely no GI issues, rosacea cleared up, but I still tested positive for SIBO and was put on metronidazole, which wrecked my digestive system. Am now working with a Functional medicine Dr. To restore gut health

    1. Hi Elizabeth – Yes, that makes sense – at a traditional doctor, 2 weeks or less is usually covered. But that’s exactly the problem – many times 2 weeks is not nearly enough (which could be the only reason it didn’t work for you). I hope you get some answers and relief!

  13. What I think is interesting is my health insurance wouldn’t cover the SIBO breathe test as they said it was “experimental and that there is no evidence of it being beneficial”. However, they had no problem prescribing me Rifaximin to treat my stomach as if I had SIBO. Thankfully, I found an Integrative place that took my health insurance and is treating me for the correct form of SIBO instead of guessing.

    It does make me curious if the SIBO test becomes a test covered by health insurance if suddenly Rifaximin would suddenly be covered or at least at a discounted rate.

  14. What are the alternative options for those who can’t afford the drug even with ins?
    My pharmacy said it is now $2000 and my portion is $500+..
    I’m a Lyme sufferer on disability recently diagnosed with SiBo. It’s wrong that people can’t afford these these drugs even with ins.

  15. I was wondering why it is so high. That’s what led me to this page. Luckily my BCBS of Alabama pays 100% of my Xifaxin.. I’ve been on it for two years , I have Late stage Cirrhosis
    If the Liver, with Hepatic Encephalopathy snd portal hypertension. I will always have to take Xifaxin. Without insurance mine would have run $2,300 a month. A friend of mines son in law had a tough time getting his filled. His insurance finally started paying after weeks of waiting and I think it pays $1,100 now.
    I’m thankful my insurance pays it all. But I too, wonder why it’s so expensive .

  16. I live in Australia. Rifaximin is classified as a Schedule 4 drug. It costs the government AUD444 (~USD300) for a 56 day course. [The subsidised patient price is AUD40]. The only approved uses is to treat Hepatic Encepholpathy It must be prescribed by a gastroenterologist or hepatologist.

  17. . we finally was able to get the GI doc to prescribe Xifaxin. Been in a flare for almost 3 years and diagnosed with UC…read about a overgrowth of bacteria in the gut so thought this drug would help. After taking this drug for a few days all symptoms were gone(blood, diarrhea, pain, urgency,  fatigue)… only thing was pockets of gas and took digest gold enzyme and that was eliminated. Reduced prednisone to 5mg and still taking a probiotic, and huge amounts of vitamins and omegas. Only was given a 2 week dose of this and insurance will not pay again for another 4 weeks…. just wondering what results others had on this drug. History-tried Lialda, sulfalazine, entyvio, humira nothing touched until Flagyl gave 85% relief….Xifaxin cleared almost all symptoms…. also able to eat anything:)…. just hoping it will last:). Or will try to get script and email. Thank you so much for all the information…

  18. Hi, how long were you on xiafaxin? My dr. Wants to put me on a 3 week course 3 times a day. Mine was likely caused from h.pylori.

  19. Just got results of “GI-Map” DNA fecal testing … positive for “E.Colo Shiga-Like Toxin Stx2”

    I am a veteran who became disabled by 2018, military refused stool testing and ignored dysbiosis results I obtained from private German Dr.

    +H.Pylori apparently has also survived multiple rounds of antibiotics (despite negative gastroscopy!)

    I came across research about Cipro and Shiga toxins. Also learned Rifaxamin US Patent in effect until 2029.

    (I have no faith in Veterans Affairs treatment who would rather perform Colonoscopies/endoscopies than order COMPLETE stool testing)

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