sorry about late response. ive been taking care of my brother, who has liver cancer and ESLD. we have the same problem with xifaxin. Medicaid approves it, then deny it. your correct, lactulose alone is not very efficient.
He now has a social worker, who has helped getting his xifaxin reapproved, for now. Yes writing letters, from you and your dr can help. im a little surprised medicare is denying this important medication.
my brother and I, both got hep c in the 60s. I finally passed the virus in 2013, and was lucky enough to improve my liver.. he was not so lucky.
let me know how your appeals are doing. much respect to you.. I know how heartbreaking this process can be. stay strong..