Medicare Supplement plans do not cover Eliquis, but Medicare Part D prescription drug coverage does

Eliquis (apixaban) is a blood thinner used to prevent blood clots and reduce stroke risk. Medicare Supplement insurance — also called Medigap — covers the gaps in Original Medicare's hospital and medical bills, but it does not include prescription drug coverage of any kind. If you take Eliquis, your coverage comes from Medicare Part D, not from a Supplement plan.

This matters because Eliquis is a maintenance medication most people take every day for months or years. The cost without coverage can run $300 to $400 per month. Knowing which part of Medicare pays for it helps you avoid surprises at the pharmacy and understand what your out-of-pocket costs will be.

Key Takeaways

  • Medicare Supplement plans cover coinsurance and copayments for hospital and doctor visits, but they never cover prescription drugs.
  • Medicare Part D is the program that covers Eliquis and other prescription medications, whether you have Original Medicare or a Supplement plan.
  • Eliquis typically falls into a higher cost tier on most Part D formularies, meaning your copayment or coinsurance will be higher than for common drugs.
  • You can switch Part D plans during the annual open enrollment period in October and November, which may lower your Eliquis cost.
  • If your Part D plan stops covering Eliquis or raises the cost too high, you can request a coverage exception or switch plans outside the annual window.

How Medicare Supplement and Part D work together for medications

When you have Original Medicare plus a Supplement plan, the Supplement pays some of your medical bills — but only the bills that Original Medicare already approved. For example, if Medicare covers 80 percent of a doctor visit, your Supplement may pay the remaining 20 percent coinsurance. Supplements do not add new coverage; they fill gaps in what Medicare already covers.

Prescription drugs are not a gap in Original Medicare — they are a separate benefit entirely. That is why you need a separate Part D plan. Part D is run by private insurance companies under contract with Medicare, and each company decides which drugs it covers and at what cost. Your Supplement plan has no role in this decision.

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, you typically get prescription drug coverage built into that plan, so you would not need a separate Part D plan. But if you have Original Medicare and a Supplement, Part D is your only source of drug coverage.

Where Eliquis sits on Medicare Part D formularies

Each Part D plan publishes a formulary — a list of covered drugs organized by cost tier. Tier 1 drugs are the cheapest (usually generic medications). Tier 2 and 3 drugs cost more. Tier 4 and 5 drugs, called "specialty" tiers, cost the most.

Eliquis is a brand-name drug with no generic equivalent, so it typically lands on Tier 3, 4, or 5 depending on the plan. This means your copayment or coinsurance will be higher than for a common blood thinner like warfarin (which is generic and usually Tier 1). Some plans may require you to try warfarin first before they cover Eliquis, a practice called step therapy.

The exact cost varies by plan and by which pharmacy you use. A single 30-day supply might cost $35 to $50 as a copayment on one plan, or $100 to $150 on another. Checking the formulary for each plan you are considering is the only way to know your actual cost before you enroll.

How to learn about your Part D plan covers Eliquis

Go to Medicare.gov and use the Plan Finder tool. Enter your zip code, select the plans available to you, and search for "apixaban" or "Eliquis" by name. The tool will show you the tier, the copayment amount, and any restrictions (such as step therapy or prior authorization requirements).

You can also call the Part D plan directly — the phone number is on your plan card or on the plan's website. Ask the representative: "Is Eliquis on your formulary, what tier is it, what is the copayment, and do I need prior authorization or step therapy?" Write down the answers so you have them in writing.

If you are not yet enrolled in Part D and are turning 65 or newly may be able to access for Medicare, you have a limited window to enroll without penalty. If you miss that window and enroll later, Medicare charges a permanent late-enrollment penalty on top of your premium. The penalty is 1 percent of the national average Part D premium for each month you were not enrolled.

What to do if your plan does not cover Eliquis or the cost is too high

If Eliquis is not on your plan's formulary, or if the cost is higher than you can afford, you have several options. First, ask your doctor whether a different blood thinner on your plan's formulary would work for you. Warfarin, dabigatran (Pradaxa), or rivaroxaban (Xarelto) may be covered at a lower tier.

Second, you can request a coverage exception from your Part D plan. This is a formal request asking the plan to cover a drug that is not on the formulary, or to waive a restriction like step therapy. Your doctor must submit the request and explain why Eliquis is medically necessary for you. The plan has 72 hours to respond (or 24 hours in urgent cases). If the plan denies the exception, you can appeal.

Third, you can switch to a different Part D plan during the annual open enrollment period, which runs from October 15 through December 7 each year. The new coverage starts January 1. If you have a may have access to life event — such as moving, losing employer coverage, or a major change in your health — you may be able to switch outside the annual window.

Understanding your out-of-pocket costs in the coverage gap

Medicare Part D has a coverage gap, sometimes called the "donut hole." Once you and your plan have spent a certain amount on covered drugs in a calendar year, you enter the gap and pay a higher percentage of the drug cost until you reach a catastrophic threshold. In 2024, the gap begins after $5,850 in total drug costs and ends at $7,050 in your out-of-pocket spending.

During the gap, you pay 25 percent of the cost of brand-name drugs like Eliquis (the plan pays 5 percent, and the manufacturer may offer a discount). Once you reach catastrophic coverage, you pay a small copayment or coinsurance and Medicare covers the rest for the rest of the year.

If your income is low, you may be may be able to access for Extra Help, a federal program that reduces Part D premiums, copayments, and coinsurance. You can explore through Social Security or at your local Social Security office. Extra Help also eliminates the coverage gap for most people who receive it.

Frequently Asked Questions

Can I use a Supplement plan to pay for Eliquis if my Part D plan does not cover it?

No. Supplement plans do not cover prescription drugs under any circumstance. If your Part D plan does not cover Eliquis, your options are to request a coverage exception, switch to a different Part D plan, or work with your doctor to use a different medication that your plan does cover.

What if I have a Medicare Advantage plan instead of Original Medicare and a Supplement?

Medicare Advantage plans include prescription drug coverage as part of the plan, so you do not need a separate Part D plan. Check your Advantage plan's formulary to see if Eliquis is covered and at what cost. The same rules about coverage exceptions and step therapy explore.

Does my Supplement plan pay the copayment for Eliquis after Part D covers it?

No. Supplement plans do not cover copayments or coinsurance for prescription drugs. Once Part D pays its share, you pay the copayment or coinsurance directly. Some Supplement plans cover copayments for doctor visits and hospital stays, but never for drugs.

Can I get Eliquis for free or at a lower cost through a manufacturer program?

Eliquis manufacturer (Bristol Myers Squibb) offers a copayment card that can reduce your out-of-pocket cost to as low as $10 per month, but only if you have commercial insurance or are uninsured. If you are on Medicare, you cannot use the copayment card. Some state pharmaceutical information programs may help, depending on your income and state of residence.

What happens if I stop taking Eliquis because of the cost?

Do not stop taking Eliquis without talking to your doctor first. Stopping a blood thinner suddenly can increase your risk of blood clots and stroke. If cost is the barrier, tell your doctor so you can explore coverage exceptions, plan switches, or alternative medications together.