Eliquis costs vary widely depending on which Medicare plan you have and your pharmacy

Eliquis (apixaban) is a blood thinner used to prevent blood clots and stroke. Under Medicare, what you pay depends on whether you have Original Medicare with a Part D plan, a Medicare Advantage plan, or no prescription coverage at all. Most people with Part D pay between $0 and $400 per month, but the exact amount shifts based on which plan covers the drug, what tier it sits on, and whether you've hit your deductible or entered the coverage gap.

The drug itself costs around $500 to $600 per month at full retail price. Medicare negotiates prices with pharmacies and drug manufacturers, so the amount your plan pays — and the amount you owe — is lower than that. But the split between what Medicare pays and what you pay is set by your specific plan, not by Medicare as a whole.

Key Takeaways

  • Eliquis costs between $0 and $400 per month for most Medicare beneficiaries, depending on their plan and where they are in the deductible and coverage gap cycle.
  • Original Medicare with Part D covers Eliquis on most formularies, usually at a higher tier that requires a copay or coinsurance rather than a flat copay.
  • Medicare Advantage plans cover Eliquis differently — some include it at low cost, others place it on a higher tier or require prior authorization from your doctor.
  • Switching pharmacies or using a manufacturer coupon can lower your out-of-pocket cost, but you must check with your plan first to make sure the savings count toward your deductible.
  • Your costs change three times a year: when you hit your deductible, when you enter the coverage gap, and when you reach catastrophic coverage.

How Part D plans cover Eliquis

Eliquis is a brand-name drug, and most Part D plans place it on Tier 3 or Tier 4, which means you pay coinsurance (a percentage of the cost) rather than a flat copay. On a Tier 3 plan, you might pay 25% of the cost; on Tier 4, you might pay 33% or more. This means your copay changes depending on what the pharmacy's price is that month — it is not a fixed $10 or $30.

Before your plan covers Eliquis, you must meet your deductible. Most Part D plans have a deductible between $505 and $550 in 2024, though some plans have no deductible. Until you meet it, you pay the full negotiated price at the pharmacy. Once you meet the deductible, your coinsurance kicks in.

After you and your plan spend $5,850 combined on covered drugs in 2024, you enter the coverage gap — sometimes called the "donut hole." In the gap, you pay 25% of the brand-name drug cost. Once your out-of-pocket spending reaches $8,000, catastrophic coverage begins and you pay only 5% of the cost for the rest of the year.

Medicare Advantage plans and Eliquis

Medicare Advantage plans (Part C) include prescription coverage, but each plan sets its own formulary and cost-sharing rules. Some Advantage plans cover Eliquis at a low copay — $10 to $50 per month — while others place it on a higher tier or require prior authorization, meaning your doctor must contact the plan and explain why you need this drug instead of a cheaper alternative.

Many Advantage plans prefer generic blood thinners like warfarin or apixaban generics (if available) before covering brand-name Eliquis. If your doctor prescribes Eliquis and your plan denies it without prior authorization, your doctor can request an exception. This process usually takes 24 to 72 hours.

Advantage plans also vary by region. Two plans with the same insurer may cover Eliquis differently depending on your ZIP code. Check your plan's formulary on its website or call the plan directly to find your exact copay before filling the prescription.

What happens if you have no Part D coverage

If you have Original Medicare without Part D, or if you let your Part D coverage lapse, you pay the full negotiated price for Eliquis at the pharmacy. This is typically $450 to $550 per month, depending on the pharmacy and any discounts they offer.

You can enroll in Part D during the annual enrollment period (October 15 to December 7) or during a special enrollment period if you lose coverage. If you miss the important date and enroll late, you may pay a permanent penalty on top of your plan premium for as long as you have Medicare.

Using manufacturer coupons and discount programs

Bristol Myers Squibb, the manufacturer of Eliquis, offers a copay card that can reduce your out-of-pocket cost to $10 per month for up to 24 months. However, this coupon works only if you have commercial insurance or Medicare Part D — not if you have Original Medicare without Part D or if you are uninsured.

Before using a manufacturer coupon, check with your Part D plan. Some plans do not count copay card savings toward your deductible or out-of-pocket maximum, which means the coupon saves you money now but may cost you more later when you hit the coverage gap. Your plan's customer service line can tell you whether the coupon counts.

GoodRx and similar discount programs offer prices that sometimes beat your copay, especially if you are in the coverage gap. Compare the GoodRx price to your plan copay at the pharmacy before you pay. Again, check whether the discount counts toward your deductible — most do not.

Switching to a generic or lower-cost alternative

Apixaban (the generic version of Eliquis) became available in late 2023 and costs significantly less — often $50 to $150 per month depending on your plan and pharmacy. If your plan covers apixaban at a lower tier than brand-name Eliquis, switching can cut your costs by half or more.

Talk to your doctor about whether apixaban works the same way for your condition. For most people taking Eliquis to prevent stroke from atrial fibrillation or to treat blood clots, apixaban is medically equivalent. Your doctor can write a new prescription, and you can fill it at any pharmacy.

Other blood thinners on most Part D formularies include warfarin (very cheap, but requires blood tests) and dabigatran (Pradaxa). Your doctor can discuss whether any of these are options for you and what your copay would be under your plan.

Timing your enrollment and plan changes

If you are not yet on Medicare, you can enroll in Part D when you turn 65 or within three months of losing other coverage. If you already have Part D but your plan's Eliquis copay is high, you can switch to a different Part D plan during the annual enrollment period (October 15 to December 7). The new plan takes effect January 1.

If you have a Medicare Advantage plan and your plan requires prior authorization or charges a high copay for Eliquis, you can switch to Original Medicare with Part D during the annual enrollment period. You can also switch Advantage plans to one that covers Eliquis at a lower cost.

Check your plan's formulary every October, even if you do not plan to switch. Formularies change yearly, and Eliquis may move to a different tier or require prior authorization starting January 1. If your costs are going up, you have until December 7 to enroll in a plan with better coverage.

Frequently Asked Questions

Does Medicare cover Eliquis at all?

Yes. Original Medicare Part D covers Eliquis on nearly all formularies, usually on Tier 3 or 4, which means you pay coinsurance rather than a flat copay. Medicare Advantage plans also cover it, though the copay and prior authorization rules vary by plan.

Why does my copay change month to month?

Eliquis is on a higher tier under most Part D plans, so you pay coinsurance — a percentage of the negotiated price — rather than a fixed copay. The negotiated price can shift slightly, so your copay does too. Once you enter the coverage gap, your coinsurance percentage changes to 25%.

Can I use the Eliquis copay card with Medicare?

Yes, if you have Part D. The copay card reduces your cost to $10 per month for up to 24 months. Check with your plan first to confirm the savings count toward your deductible and out-of-pocket maximum, because some plans do not count manufacturer coupons.

What if my Medicare Advantage plan requires prior authorization for Eliquis?

Your doctor must contact the plan and explain why you need Eliquis instead of a cheaper alternative. The plan usually responds within 24 to 72 hours. If the plan denies it, your doctor can request an exception, which may take longer but often succeeds.

Is the generic apixaban cheaper than brand-name Eliquis?

Usually yes. Apixaban typically costs $50 to $150 per month depending on your plan, compared to $200 to $400 for brand-name Eliquis. Ask your doctor whether apixaban is appropriate for your condition, and check your plan's copay for both drugs before deciding.