Rifaximin Shortage: What Providers and Prescribers Need to Know in 2026

Provider Briefing: Rifaximin Availability in 2026

If your patients have been reporting difficulty filling Rifaximin (Xifaxan) prescriptions, their experience is consistent with a nationwide pattern. While Rifaximin is not listed on the FDA's official drug shortage database, intermittent stock-outs at retail pharmacies have become a persistent issue since 2023 — and the situation remains largely unchanged heading into 2026.

This briefing provides prescribers with an up-to-date overview of the supply landscape, prescribing implications, cost and access barriers, and practical tools to support patient access.

Supply Timeline

Rifaximin availability issues have evolved gradually rather than emerging from a single supply disruption:

• 2015: FDA approval for IBS-D significantly expanded the prescribing base beyond hepatic encephalopathy and traveler's diarrhea.
• 2018: Patent settlement between Salix Pharmaceuticals and Teva pushed generic entry to 2029, ensuring Xifaxan remains the sole US formulation.
• 2023–present: Growing off-label use for SIBO, combined with steady increases in IBS-D and hepatic encephalopathy prescribing, has created demand that intermittently exceeds retail pharmacy supply at the local level.

The core issue is structural: single-source brand manufacturing combined with a medication that many pharmacies under-stock due to its high acquisition cost.

Prescribing Implications

From a clinical standpoint, there are several considerations when prescribing Rifaximin in the current environment:

Anticipate Fill Delays

Patients may need 1 to 3 days for their pharmacy to order Rifaximin from the wholesaler. For patients on chronic Rifaximin therapy for hepatic encephalopathy, consider authorizing refills 5 to 7 days before the expected run-out date to build in a buffer.

Prior Authorization Is Common

Most commercial and Medicare plans place Rifaximin on Tier 3 or specialty tier, requiring prior authorization. Many plans also mandate step therapy — typically requiring a trial of Lactulose before approving Rifaximin for hepatic encephalopathy. Be prepared to submit clinical documentation supporting medical necessity, particularly for patients with documented Lactulose intolerance or treatment failure.

Off-Label Prescribing Considerations

Rifaximin's use for SIBO remains off-label. Insurance coverage for off-label use varies significantly. When prescribing for SIBO, document the clinical rationale thoroughly, as many denials can be overturned on appeal with appropriate supporting evidence (e.g., positive breath test results, symptom documentation).

Current Availability Picture

The availability situation varies by pharmacy type and geography:

• Large chain pharmacies (CVS, Walgreens, Rite Aid) frequently have limited or no Rifaximin stock. These pharmacies typically order on demand rather than maintaining standing inventory for high-cost medications.
• Independent pharmacies often have more flexible ordering and may maintain stock for established patients.
• Specialty pharmacies focused on gastroenterology or hepatology patients are the most reliable source for consistent Rifaximin supply.
• Mail-order pharmacies through insurance plans may offer more reliable access but require longer lead times.

Medfinder for Providers offers real-time pharmacy availability data that can help your practice direct patients to pharmacies with current stock.

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Cost and Access Barriers

Cost remains the single largest barrier to Rifaximin access for patients:

• Cash price: $1,800 to $2,400 for 60 tablets of 550 mg (30-day hepatic encephalopathy supply)
• Insured copay range: $50 to $200+ per fill depending on plan and tier
• Uninsured/underinsured patients: Often unable to access the medication without assistance

Available Cost-Reduction Programs

• Xifaxan Savings Card: Bausch Health offers a manufacturer copay card that can reduce commercially insured patients' out-of-pocket cost to as low as $0 to $75 per fill. Not valid for government insurance (Medicare, Medicaid, Tricare).
• Bausch Health Patient Assistance Program: Provides Rifaximin at no cost to qualifying uninsured or underinsured patients based on income criteria.
• Discount card programs: SingleCare, GoodRx, and other discount platforms may offer modest savings, though discounts on brand-only medications are typically limited.

For a patient-facing resource on cost savings, direct patients to: How to Save Money on Rifaximin in 2026.

Tools and Resources for Your Practice

Several resources can help your practice support patients navigating Rifaximin access challenges:

• Medfinder for Providers: Real-time pharmacy stock lookup — direct patients here or use it within your practice workflow to identify pharmacies with current Rifaximin inventory.
• Prior authorization templates: Maintain a standardized PA letter for Rifaximin that includes diagnosis, clinical history, previous treatments tried, and medical necessity justification. This reduces turnaround time on approvals.
• Manufacturer support: Bausch Health's provider support line can assist with locating supply, PA support, and connecting patients with assistance programs.
• Alternative therapy protocols: Have a documented protocol for transitioning patients to Lactulose, Neomycin, or Metronidazole when Rifaximin is unavailable. For a clinical overview, see our provider guide: How to Help Your Patients Find Rifaximin in Stock.

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Looking Ahead

The Rifaximin supply situation is unlikely to change substantially before 2029, when the first generic formulations may enter the US market. Until then:

• Demand will continue to grow as evidence for Rifaximin in IBS-D and SIBO accumulates
• The brand-only status means prices will remain elevated
• Proactive refill management and use of availability tools will be essential for patient continuity

Providers who build Rifaximin access planning into their workflow — including early refill authorization, PA preparedness, and patient education on pharmacy options — will be best positioned to keep their patients on therapy.

Final Thoughts

Rifaximin remains a cornerstone of treatment for hepatic encephalopathy and IBS-D, and its role in SIBO management continues to expand. The current supply challenges are driven by structural factors (single-source manufacturing, patent protection through 2029, high acquisition cost) rather than a traditional manufacturing shortage.

By leveraging tools like Medfinder for Providers, proactively managing prior authorizations, and connecting patients with cost-reduction programs, prescribers can mitigate the impact of these challenges and help ensure treatment continuity for their patients.