Clinical Policy: Rifaximin (Xifaxan)
Clinical policy defining medical necessity criteria, initial and continuation approval requirements, dosing limits, approved indications (HE, IBS-D, Travelers' diarrhea), select off-label SIBO criteria, coverage exclusions and prior authorization documentation requirements for Health Net/Centene lines of business (Commercial, HIM, Medicaid).
Added requirement for concurrent lactulose and rifaximin to initial criteria for HE per guidelines.
Revised approval duration for Commercial line of business to 12 months or duration of request, whichever is less.
Deleted off-label Crohn's disease criteria as unsupported by guidelines.
Template changes to other diagnoses/indications and continued therapy sections.
Coverage Summary
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.