Eliquis (apixaban) is a widely prescribed anticoagulant used to treat various vascular conditions, including deep vein thrombosis (DVT), pulmonary embolism (PE), atrial fibrillation (AFib), and to prevent blood clots post-orthopedic procedures or ischemic stroke. While Eliquis is an effective medication, its cost can be a concern for individuals, especially those on Medicare. In this guide, we’ll explore the cost of Eliquis with Medicare coverage and strategies to save on this medication.
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:
- Medicare Part A: Covers Eliquis when administered in an inpatient setting during hospital stays.
- Medicare Part B: Does not cover outpatient medications like Eliquis.
- Medicare Part C (Medicare Advantage): Covers Eliquis if administered in an inpatient setting or included in the plan’s formulary.
- 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, individuals with Medicare Part D coverage pay around $44 per month for Eliquis. Approximately half of Medicare beneficiaries taking Eliquis pay $30 or less per month.
- Deductible: For 2024, 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:
- 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.
- Manufacturer Assistance: Bristol-Myers Squibb, the manufacturer of Eliquis, offers financial assistance programs, copay cards, and coupons to eligible patients.
- 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.
- 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.
- Comparison Shopping: Comparing Eliquis prices at different pharmacies can help individuals find the most cost-effective option.
- Consider Alternatives: Discussing alternative medications with healthcare providers, such as Xarelto, Pradaxa, Savaysa, or warfarin, can provide more affordable treatment options.
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.