What to do if Eliquis costs too much on your Medicare plan

Eliquis (apixaban) is a blood thinner that prevents blood clots and stroke, often prescribed after heart procedures or for atrial fibrillation. On Medicare, your out-of-pocket cost depends on which plan you have and which pharmacy you use — but there are concrete steps to lower what you pay before you skip doses or stop taking it.

The fastest move is to ask your doctor whether a generic blood thinner might work instead. If Eliquis is the right drug for you, the manufacturer offers a copay card that caps your cost at $10 per month for most Medicare patients. If that does not help, Medicare's coverage rules include a formal appeal process, and your state has programs that may cover the gap between what Medicare pays and what the drug actually costs.

Key Takeaways

  • Eliquis has a manufacturer copay card that limits your cost to $10 per month for most Medicare beneficiaries, even if your plan's copay is higher.
  • Switching to a generic blood thinner like apixaban (the generic form of Eliquis) or warfarin may lower your cost if your doctor agrees it is medically appropriate.
  • If your plan puts Eliquis in a high cost tier or requires prior authorization, you can ask your doctor to request a coverage exception through your plan.
  • State pharmaceutical information programs and the Medicare Extra Help program may cover costs if your income is below certain thresholds.
  • Never stop or reduce doses of a blood thinner without talking to your doctor first, even if cost is the reason.

Using the Eliquis copay card

Bristol Myers Squibb, the manufacturer of Eliquis, runs a copay information program that works with most Medicare plans. The card reduces your copay to $10 per month for a 30-day supply, regardless of what your plan normally charges. You do not pay the card directly — you show it at the pharmacy when you fill the prescription.

To get the card, visit the Eliquis website (eliquis.com) or call 1-855-354-7847. You will need your Medicare number and your pharmacy information. The card arrives by mail in about one week. If your plan charges more than $10 per month, the manufacturer's program covers the difference — your plan still pays its share, and you pay $10.

This card works at most major pharmacies, including CVS, Walgreens, Rite Aid, and Kroger. Some mail-order pharmacies also accept it. If your pharmacy says it cannot process the card, call the Eliquis support line and they can help troubleshoot or find a participating pharmacy near you.

Asking your doctor about generic alternatives

The generic version of Eliquis, called apixaban, costs significantly less at most pharmacies. It is the same medication in the same dose — the only difference is the brand name and the price. If your doctor prescribed Eliquis by brand name, ask whether apixaban would work for your condition.

Other blood thinners in the same class include rivaroxaban (Xarelto) and dabigatran (Pradaxa), which also have generic versions. Warfarin is an older blood thinner that has been generic for decades and is often the cheapest option, though it requires regular blood tests and diet consistency. Your doctor can tell you whether any of these would be appropriate for your specific diagnosis.

When you talk to your doctor, bring your pharmacy's price list or a printout from GoodRx or your plan's formulary showing the cost difference. Doctors often do not know the actual prices patients pay, and concrete numbers help them make the right recommendation.

Understanding your Medicare plan's coverage rules

Eliquis appears on the formulary (covered drug list) of most Medicare Part D plans, but the cost tier varies. Some plans place it in Tier 3 or 4, meaning higher copays. Others require prior authorization — your doctor must request permission from the plan before the pharmacy will fill it.

To find out your plan's rules, call the customer service number on your Medicare card. Ask: (1) What tier is Eliquis on? (2) What is my copay? (3) Does the plan require prior authorization? (4) Can the plan make an exception if the copay is too high?

If your plan's copay is very high and the manufacturer's copay card does not bring it down enough, your doctor can request a formulary exception. This is a formal request asking the plan to cover the drug at a lower cost tier or without prior authorization. The plan must respond within 72 hours for urgent requests. Your doctor's office handles the paperwork — you do not file it yourself.

State pharmaceutical information programs

Most states run pharmaceutical information programs (PAPs) that help people with Medicare pay for drugs they cannot afford. These programs are separate from Medicare and have their own income limits and rules. Some cover the gap between what Medicare pays and what you owe; others pay copays directly.

To find your state's program, visit the National Association of State Pharmaceutical information Programs (ASAP) at pparx.org. Enter your state, and you will see a list of programs with phone numbers and income thresholds. Each state's program has different rules — some cover brand-name drugs only, others cover generics, and some cover both.

You will need to provide proof of income (recent tax return or pay stub), proof of citizenship or legal residency, and proof of Medicare enrollment. Processing takes one to four weeks. Some programs mail you a debit card; others send payment directly to your pharmacy.

Medicare Extra Help for low-income beneficiaries

If your income is below 150% of the federal poverty level (roughly $1,500 per month for a single person, though this varies by state), you may be may be able to access for Extra Help, a federal program that pays Part D premiums and reduces copays and deductibles.

Extra Help is administered by Social Security. You can explore online at ssa.gov/benefits/medicare, by phone at 1-800-772-1213, or in person at your local Social Security office. You will need proof of income, citizenship, and current Medicare enrollment. If you are approved, your copay for most drugs drops to $1 to $5 per prescription.

If you already receive Supplemental Security Income (SSI) or Medicaid, you are automatically enrolled in Extra Help. Otherwise, you must explore. The process takes about 15 minutes online.

What to do if you have already missed doses

If cost has caused you to skip doses or take less than prescribed, tell your doctor at your next appointment — do not wait for a scheduled checkup. Blood thinners work only if taken consistently, and gaps in coverage increase your risk of blood clots or stroke.

Your doctor may adjust your dose, switch you to a different drug, or refer you to a social worker who can help you find financial resources. Some hospitals and clinics have patient information coordinators who know about programs specific to your area. Do not assume your doctor knows you are struggling with cost unless you say so directly.

Comparing pharmacy prices

The same prescription can cost very different amounts at different pharmacies. Before you fill Eliquis or apixaban, check prices at several pharmacies using free tools like GoodRx, SingleCare, or your Medicare plan's pharmacy finder.

Enter your zip code, the drug name, and the dose. The tool will show you prices at nearby pharmacies and discount codes you can use. Some discount cards work better at certain chains — for example, GoodRx often has lower prices at independent pharmacies, while SingleCare may be cheaper at large chains. You can use these discount cards even if you have Medicare, as long as you do not submit the claim to Medicare at the same time.

If you use mail-order pharmacy through your Medicare plan, compare that price to local pharmacies. Mail-order is sometimes cheaper for 90-day supplies but not always.

Frequently Asked Questions

Can I use the Eliquis copay card if I am on Medicare?

Yes. The copay card works with Medicare Part D plans and reduces your copay to $10 per month. You show the card at the pharmacy when you fill the prescription. The manufacturer covers the difference between your plan's copay and $10.

What if my doctor says I need Eliquis and not a generic blood thinner?

Use the manufacturer's copay card first — it brings the cost to $10 per month for most people. If that is still too high, ask your doctor to request a formulary exception from your Medicare plan. You can also look into state pharmaceutical information programs or Extra Help if your income qualifies.

How long does it take to get approved for a formulary exception?

Medicare plans must respond to standard requests within 72 hours and to urgent requests within 24 hours. Your doctor's office submits the request, and the plan contacts your doctor with the decision. If denied, you have the right to appeal.

Will switching pharmacies really save me money on Eliquis?

Yes. Prices vary significantly — sometimes by $50 or more per month for the same drug and dose. Use GoodRx or your plan's pharmacy finder to compare before you fill. The savings are real and worth five minutes of checking.

What happens if I cannot afford Eliquis even with the copay card?

Tell your doctor when ready. Ask about generic blood thinners, state pharmaceutical information programs, and whether you may have access to for Extra Help. Your doctor's office may also have a social worker or patient advocate who can help you find local resources or negotiate with your pharmacy.