How Much Does Eliquis Cost with Medicare?

How much does Eliquis cost with Medicare? For many Medicare beneficiaries, prescription drug costs are a major concern, especially for brand-name medications like Eliquis.

In this guide, we’ll explain how Medicare covers Eliquis, what you may pay out of pocket, and ways to reduce costs in 2026.

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Understanding Eliquis

Eliquis belongs to a class of anticoagulant drugs called direct factor Xa inhibitors, which work by neutralizing enzymes that form blood clots, thereby reducing the risk of life-threatening clot formation and stroke.

Medicare Coverage for Eliquis

Medicare provides coverage for Eliquis through different parts of its plans:

1. Medicare Part A: Covers Eliquis when administered in an inpatient setting during hospital stays.
2. Medicare Part B: Does not cover outpatient medications like Eliquis.
3. Medicare Part C (Medicare Advantage): Covers Eliquis if administered in an inpatient setting or included in the plan’s formulary.
4. Medicare Part D: Covers prescription medications like Eliquis for home use. Part D plans typically cover Eliquis, with individuals responsible for monthly premiums, deductibles, and copays.

Cost of Eliquis with Medicare

The cost of Eliquis with Medicare coverage varies based on several factors, including the type of Medicare plan, formulary tier, deductible, copayments, and coinsurance.

• Monthly Copay: On average, Medicare Part D beneficiaries pay around $30 to $44 per month for Eliquis, depending on their plan, deductible, and pharmacy.
• Deductible: The maximum deductible for Part D coverage is $545, which individuals must meet before coverage begins.
• Prior Authorization: Due to Eliquis’s cost and brand-name status, prior authorization from the insurance plan may be required before coverage. This process ensures approval before accessing the medication at a discounted price.
• Step Therapy: Some plans may require individuals to try alternative medications before covering Eliquis, known as step therapy, to ensure cost-effective treatment.

Strategies to Save on Eliquis

Despite its cost, several strategies can help individuals save on Eliquis:

1. Generic Alternatives: While a generic version of Eliquis (apixaban) was approved by the FDA, it may not be available until November 2026 due to patent disputes. Once available, the generic version is expected to reduce costs significantly.
2. Manufacturer Assistance: Bristol-Myers Squibb, the manufacturer of Eliquis, offers financial assistance programs, copay cards, and coupons to eligible patients.
3. Prescription Savings Programs: Platforms like SingleCare offer discounts on Eliquis and other medications, regardless of insurance or Medicare status. These savings can significantly reduce out-of-pocket costs.
4. Medicare Extra Help: Qualifying individuals with limited income and resources may be eligible for Medicare Extra Help, which provides substantial cost savings, including reduced or no copays for Eliquis.
5. Comparison Shopping: Comparing Eliquis prices at different pharmacies can help individuals find the most cost-effective option.
6. Consider Alternatives: Discussing alternative medications with healthcare providers, such as Xarelto, Pradaxa, Savaysa, or warfarin, can provide more affordable treatment options.

Related Resources

Medicare Part D prescription drug plans

How Medicare works

Blue Cross Medicare Advantage plans

Frequently Asked Questions About Eliquis and Medicare

Does Medicare cover Eliquis?
Yes. Eliquis is covered under Medicare Part D prescription drug plans for home use.

What Medicare plan covers Eliquis?
Eliquis is typically covered under Medicare Part D and some Medicare Advantage plans with prescription drug coverage.

How much does Eliquis cost with Medicare?
Most Medicare beneficiaries pay a monthly copay for Eliquis, which varies by plan, deductible, and pharmacy.

Is there a generic version of Eliquis?
A generic version of Eliquis (apixaban) has been approved but is not expected to be widely available until late 2026.

Conclusion

While Eliquis is an essential medication for managing various vascular conditions, its cost can be a concern, especially for Medicare beneficiaries. Understanding Medicare coverage options, copayments, and strategies to save on Eliquis can help individuals access necessary treatment while managing healthcare expenses effectively. By leveraging available resources, including manufacturer assistance programs and prescription savings, individuals can alleviate the financial burden associated with Eliquis and prioritize their health and well-being.

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