Eliquis is prescribed to reduce the risk of blood clots in patients with atrial fibrillation, deep vein thrombosis, or pulmonary embolism. It may also be used after a major surgery.

If the use of Eliquis is delayed, blood clots can form internally and create life-threatening complications. Patients may suffer from stroke and die. 

Sadly, this important prescription drug is very expensive. The current price of Eliquis is $561 for a 30-day supply. That’s a lot of money, even for one-time users.

So, if your doctor has recommended it, you must be wondering whether Eliquis is covered by Medicare. The answer to this is a little complex. But worry not because we are here to guide you and make your Medicare journey easy.

Keep reading to learn more!

Does Medicare Part D cover Eliquis?

Yes, Eliquis is covered by Medicare Part D. It’s a commonly prescribed drug, and so Medicare has included it in the formulary. 

Formulary is the list of medications covered by Medicare. It categorizes medications into different tiers according to your needs and budget. 

However, please note that you can get Medicare Eliquis coverage through Part C too. Most Medicare Advantage plans offer coverage for prescription drugs. Talk to your insurance provider to confirm whether Eliquis is included in the list. 

How much does Eliquis cost with Medicare?

There’s no definite price for Eliquis with Medicare coverage. What you pay will depend on the following factors:

• Medicare Part D or C?

Whether you’re enrolled in Medicare Part D or C, you have to pay an annual deductible and agree to a co-payment or co-insurance for each drug. 

Part D is a stand-alone Original Medicare plan that is available through private companies. It has a fixed annual deductible limit for each year. In 2024, this amount can be no more than $545. 

However, Part C plans are a combination of Part A and B – with some companies offering Part D coverage too. These plans have lower deductibles, and some may even waive them completely.  

Knowing the amount your plan charges for prescription drug coverage is important because it will determine your Eliquis cost. If you have a Part D plan with a $545 deductible, you must spend this amount on drugs before receiving any coverage. 

So, if you haven’t spent anything on drugs this year, the first purchase of Eliquis will cost you $545 – with the remaining $16 paid by Medicare.

Once you’ve paid the annual deductible, the insurance will come into effect, and the medicine cost will be split according to the agreed co-insurance or co-payment.

• Your formulary

A formulary typically includes all types of generic and brand-name prescription drugs. But, different companies may choose to cover different medications.

CMS also allows people to make exceptions to their drug list. So, the only way to find the exact amount you will be paying for each drug is to get a plan. You should review the plan details to understand if the plan fits your needs and budget.

However, we know for a fact that all prescription drug plans (Part D or C) have a higher cost-sharing for brand-name medication than generic ones. And Eliquis is a brand-name drug, so you should expect to pay a higher co-payment.

• Additional insurances 

Medicare offers several other insurance programs to lift off financial burden from people. You can explore them and choose one that helps cover the co-insurance amount for Eliquis. 

For example, the Extra Help program is specially designed for low-income individuals who can’t afford medications with Medicare Part D. You can get Eliquis for $0 to $10 per month with both Medicare Part D and Extra Help. 

You can learn more about additional insurance right here. 

The average cost of Eliquis with Medicare

Medicare can’t cover the complete cost of Eliquis, but it can reduce it greatly. On average, patients with Medicare Part D Eliquis coverage pay $44 per month in 2024. And around 5 out of 10 patients pay $30.

This is an annual expense of $360 to $528. The price of Eliquis is revised every year, so you can expect small increments as time passes by.

Apart from that, Eliquis is on the list of drugs subject to price negotiations as announced recently by the Biden administration. Chances are the price will go down in 2026.

Why is Eliquis so expensive on Medicare?

Eliquis is generally an expensive brand name prescription drug with no generic alternative as of 2024. It is also protected by a patent. This is because the company spent years researching and experimenting to produce a blood thinner that prevents life-threatening situations successfully.

In 2019, the FDA approved a generic version of Eliquis (apixaban). It was supposed to be available for sale as soon as the Eliquis manufacturer’s patent expired. Although this patent was due to expire in Feb 2023, a court ruling allowed an extension. We’ll now probably see the generic version in the market by 2026 or 2028.

The manufacturer’s patent legally allows them to charge an amount that recovers the investment and makes them a profit. In 2024, the company charges $561 for a month’s worth of supply.

However, since Medicare can only cover up to 90% of this amount, some people may find it expensive even after insurance. You can apply for Extra Help in that case. 

What to do if you can’t afford Eliquis on Medicare?

While additional insurance is an amazing way to reduce Eliquis’s cost, most people don’t qualify for it. 

You may not have low income or limited resources to be eligible for Extra Help. Similarly, you may not be a veteran or a federal employee to get benefits from other insurance programs. You might just be a senior who doesn’t want to spend $$ annually on medication. 

In this case, there are other ways to afford Eliquis with or without Medicare:

1. Eliquis Patient Assistance Program Medicare

Bristol Myers Squibb Patient Assistance Foundation (BMSPAF) is a charitable organization founded by Eliquis manufacturers. Its assistance program provides a 12-month free supply of Eliquis for eligible Medicare patients. 

2. Eliquis copay card 

Eliquis copay card allows you to purchase a 30-day supply of medicine for $10. This card is valid for up to 24 months and gives you a benefit of up to $6,400. You can use it at any participating pharmacy. 

Also, please note that the Eliquis Copay Card for Medicare patients is not available yet. You can use the trial card to get a month’s worth of supply for free. But if you want to use the copay card, you need to shift to commercial insurance or drop insurance completely.

3. Eliquis alternatives

Another easy way is to use alternative medicines with blood-thinning effects. This includes Xarelto, Pradaxa, Savaysa, and warfarin. They are much cheaper than Eliquis and can save you thousands annually. 

Just make sure your doctor has approved its usage and your Medicare plan covers it.

Article updated on January 16, 2024.