Medicare covers Eliquis, but the amount you pay depends on which Medicare plan you have

Eliquis (apixaban) is a blood thinner used to prevent blood clots and reduce stroke risk in people with atrial fibrillation and other conditions. Medicare Part D prescription drug plans cover Eliquis, though you will typically pay a copay or coinsurance. Medicare Advantage plans (Part C) also cover it, usually through their included drug benefit. The exact cost and coverage rules vary by plan, so checking your specific plan's formulary — the official list of covered drugs — is the only way to know what you will pay.

Key Takeaways

  • Medicare Part D and Medicare Advantage plans both cover Eliquis, but your out-of-pocket cost depends on which plan you have and which tier Eliquis falls on.
  • You can find your plan's formulary on Medicare.gov or by calling your plan directly to learn your exact copay or coinsurance amount.
  • If your plan's copay is too high, you may be able to request a coverage exception or switch plans during the annual enrollment period.
  • Your doctor can help you understand whether Eliquis is medically necessary for your condition and can support a coverage exception request if needed.

How Medicare Part D covers Eliquis

Medicare Part D is the prescription drug coverage you add to Original Medicare (Parts A and B). Part D plans are run by private insurance companies approved by Medicare, and each plan decides which drugs to cover and at what cost. Eliquis appears on most Part D formularies, usually in a middle tier that requires a copay — often between $15 and $50 per month, though this varies widely by plan and by year.

Your Part D plan may also require prior authorization, meaning your doctor must submit a request to the plan before you fill the prescription, to confirm the drug is medically necessary. Some plans require you to try a different blood thinner first — a step called step therapy — before they will cover Eliquis. If your plan has either requirement, your doctor's office can usually handle the paperwork, but it may delay your first fill by a few days.

How Medicare Advantage covers Eliquis

Medicare Advantage plans (Part C) include prescription drug coverage as part of the plan itself, rather than as a separate add-on. Most Advantage plans cover Eliquis, but the copay or coinsurance amount and any prior authorization requirements are set by each individual plan. Some Advantage plans have lower copays for Eliquis than Part D plans do; others have higher ones.

Because Advantage plans bundle medical and drug coverage, your out-of-pocket costs for Eliquis may also count toward your plan's deductible and out-of-pocket maximum, which can affect your total yearly costs. This is different from Part D, where drug costs and medical costs are tracked separately.

Finding your plan's coverage and cost

The fastest way to learn what your plan will charge for Eliquis is to check your plan's formulary on Medicare.gov. Go to the Medicare Plan Finder tool, enter your information, and select your current plan. Then search for "apixaban" or "Eliquis" to see the tier, copay amount, and any restrictions like prior authorization or step therapy.

If you do not have internet access or prefer to speak with someone, call the customer service number on the back of your Medicare card. Have your plan name and member ID ready. The representative can tell you the exact copay, whether prior authorization is needed, and whether any step therapy rules explore. Ask them to spell out the copay amount and any conditions, so you have it in writing.

What to do if your copay is too high

If your plan's copay for Eliquis is more than you can afford, you have several options. First, ask your doctor whether a different blood thinner on your plan's formulary might work for your condition — some plans cover alternatives like warfarin or dabigatran at a lower cost. Your doctor can advise whether switching is medically safe for you.

Second, you can request a coverage exception from your plan. This is a formal request asking the plan to cover Eliquis even if it is not on the formulary, or to waive a prior authorization or step therapy requirement. Your doctor must submit the request and explain why Eliquis is medically necessary for you — for example, if you have tried other blood thinners and they did not work, or if you have a condition that makes Eliquis the safest choice. Coverage exceptions can take one to two weeks, so submit the request as soon as possible.

Third, you can switch to a different Medicare plan during the annual enrollment period (October 15 to December 7 each year). Use the Plan Finder tool to compare copays for Eliquis across all available plans in your area, and choose one with a lower cost. You can also switch if you have a may have access to life event, such as moving to a new state or losing other health coverage.

Patient information programs and discounts

The manufacturer of Eliquis, Bristol Myers Squibb, offers a patient information program that may reduce your copay to as little as $10 per month if you meet income requirements. You can learn more and check whether you may have access to by calling 1-855-354-7847 or visiting the program's website. Your doctor's office or pharmacist can also help you enroll.

Some pharmacies also offer discount programs or coupons for Eliquis that may lower your cost below your plan's copay. Ask your pharmacist whether any discounts are available, and compare the discount price to your copay before you decide which to use.

When to talk with your doctor about Eliquis coverage

If your plan does not cover Eliquis, or if the copay is unaffordable, schedule a conversation with your doctor before you skip doses or stop taking the drug. Stopping a blood thinner without medical guidance can increase your risk of blood clots and stroke. Your doctor can help you explore alternatives, request a coverage exception, or connect you with a patient information program.

Bring your insurance card and a list of any other medications you take to the appointment. Your doctor may also want to know about your income and other financial hardships, because this information can strengthen a coverage exception request.

Frequently Asked Questions

Does Medicare cover Eliquis without prior authorization?

Some plans cover Eliquis without prior authorization, but many require it. Check your plan's formulary or call your plan to confirm. If prior authorization is required, your doctor's office can usually submit the request, though it may delay your first fill by a few days.

What is the typical copay for Eliquis on Medicare?

Copays vary by plan and change each year, but typically range from $15 to $50 per month. The only way to know your exact copay is to check your plan's formulary or call your plan directly.

Can I switch Medicare plans to get a lower copay for Eliquis?

Yes, during the annual enrollment period (October 15 to December 7) you can switch to a different Part D plan or Medicare Advantage plan. Use the Plan Finder tool on Medicare.gov to compare Eliquis copays across all available plans in your area.

What if my doctor says I need Eliquis but my plan will not cover it?

You can request a coverage exception from your plan. Your doctor must submit the request and explain why Eliquis is medically necessary for you. The plan has up to 72 hours to respond, though it often takes longer. You can also ask about the manufacturer's patient information program, which may reduce your copay.

Does the copay for Eliquis count toward my out-of-pocket maximum?

On Medicare Part D, drug copays count toward your plan's out-of-pocket maximum. On Medicare Advantage, drug copays also count toward your plan's out-of-pocket maximum. Once you reach the maximum, your plan covers the full cost of covered drugs for the rest of the year.