Eliquis costs vary widely depending on your Medicare plan and pharmacy

There is no single price for Eliquis under Medicare. What you pay depends on which Medicare plan you have, which pharmacy you use, and whether you have reached your deductible or entered the coverage gap. A person with Original Medicare and a Part D plan might pay $10 to $50 per month at one pharmacy and $15 to $60 at another. Someone with a Medicare Advantage plan that includes drug coverage might pay nothing to $100 per month, depending on the plan's formulary — the list of drugs it covers and at what cost.

Eliquis (apixaban) is a blood thinner used to prevent blood clots and stroke. Medicare covers it, but the amount you pay out of pocket is determined by your specific coverage, not by Medicare itself. This means two people on Medicare can pay very different amounts for the same medication.

Key Takeaways

  • Your out-of-pocket cost for Eliquis depends on your Medicare plan type, your pharmacy, and where you are in the Part D coverage cycle.
  • Original Medicare with a Part D prescription plan typically costs $10 to $60 per month for Eliquis, but prices vary by plan and pharmacy.
  • Medicare Advantage plans with drug coverage may cover Eliquis at different costs, and some plans may require prior authorization before paying for it.
  • You can compare prices and coverage across plans during Open Enrollment (October 15 to December 7 each year) using Medicare.gov's plan finder tool.
  • Manufacturer discounts and patient information programs can lower your cost, but you must check whether they work with your specific Medicare plan.

How Original Medicare and Part D affect your Eliquis cost

If you have Original Medicare (Part A and Part B) plus a separate Part D prescription drug plan, your Eliquis cost moves through three stages each calendar year. First comes the deductible — the amount you pay out of pocket before your plan starts to help. Part D deductibles range from $0 to around $545 per year, depending on the plan you chose. If your plan has a $250 deductible and Eliquis costs $50 per month, you pay the full $50 until you have spent $250 total on prescriptions.

After you meet the deductible, you enter the initial coverage phase. Here, you and your plan split the cost. Your plan's formulary places Eliquis into a tier — usually Tier 3 or Tier 4 for brand-name blood thinners. Tier 3 copays often run $35 to $50 per month; Tier 4 can be $75 to $100 or more. You pay the copay, and your plan covers the rest of the drug's cost.

If your total drug spending reaches a certain threshold (around $5,100 in 2024, though this changes yearly), you enter the coverage gap, sometimes called the "donut hole." In the gap, you pay a larger share of the drug's cost — currently 25 percent of the price — until your out-of-pocket spending hits the catastrophic threshold (around $7,050 in 2024). Once you reach catastrophic coverage, your plan covers most of the cost and you pay only a small copay.

Medicare Advantage plans and Eliquis coverage

Medicare Advantage plans (Part C) combine hospital, medical, and usually prescription drug coverage into one plan run by a private insurance company. These plans must cover at least as much as Original Medicare, but they set their own rules for prescription drugs. Some Medicare Advantage plans cover Eliquis with no copay; others charge $10 to $50 per month; still others may not cover it at all or may require prior authorization — a step where your doctor must get the plan's permission before you fill the prescription.

The cost you pay also depends on the plan's formulary. Plans can move drugs between tiers or remove them from coverage entirely each year. A plan that covered Eliquis cheaply in 2024 might charge more in 2025, or a different plan might offer better coverage. This is why comparing plans during Open Enrollment is important — the cheapest plan for your other medications might be expensive for Eliquis.

If your Medicare Advantage plan does not cover Eliquis or requires prior authorization, your doctor can ask the plan to make an exception. This process, called a formulary exception request, can take a few days to a few weeks. If the plan denies the request, you have the right to appeal.

How to find the actual price at your pharmacy

The only way to know what you will pay is to check with your pharmacy and your plan. Call your pharmacy and give them your plan name and member ID. Ask for the copay or coinsurance amount for Eliquis at that location. Prices can differ between pharmacy chains and even between locations of the same chain, so it is worth calling more than one.

You can also use Medicare.gov's plan finder tool during Open Enrollment to compare drug costs across plans. Log in with your Medicare account, enter your current medications (including Eliquis), and the tool will show you the estimated out-of-pocket cost for each plan in your area. This tool is most accurate during Open Enrollment, when all plans are actively updating their information.

If you use a mail-order pharmacy through your plan, the cost may be different from a retail pharmacy. Some plans offer a 90-day supply by mail at a lower total cost than three 30-day fills at a retail location. Ask your plan whether mail-order is available and whether it would save you money.

Manufacturer discounts and patient information programs

Bristol Myers Squibb, the manufacturer of Eliquis, offers a copay card that can reduce your out-of-pocket cost to as little as $10 per month for up to 24 months. However, this card works only with certain Medicare plans and cannot be used if your plan is already in the coverage gap. You must check with your plan first to confirm the card is allowed.

The company also runs a patient information program for people who cannot afford Eliquis. This program may provide the drug free or at a reduced cost if your income falls below certain limits. You can learn more by calling 1-855-354-7847 or visiting the Bristol Myers Squibb website. Be aware that using a patient information program may affect your Medicare coverage in ways you should discuss with your plan before enrolling.

Some community health centers and pharmaceutical information organizations also help seniors pay for blood thinners. The Partnership for Prescription information (pparx.org) and NeedyMeds (needymeds.org) maintain searchable databases of programs by drug and location.

What to ask your doctor and plan

Before you fill an Eliquis prescription, ask your doctor whether there are generic or lower-cost alternatives that would work for your condition. Apixaban (the generic version of Eliquis) may be available at a lower cost than the brand name, depending on your plan's formulary. Your doctor can also help you understand whether the benefit of Eliquis over other blood thinners is worth the out-of-pocket cost in your situation.

Contact your Medicare plan directly and ask: Is Eliquis on your formulary? What tier is it on? Do you require prior authorization? What is the copay or coinsurance? Is there a mail-order option? Can I use the manufacturer's copay card? These questions will give you a clear picture of what you will pay before you pick up the prescription.

If the cost is too high, ask your doctor whether you can switch to a different blood thinner that your plan covers at a lower cost. Do not stop taking Eliquis on your own — stopping a blood thinner suddenly can cause serious harm. Work with your doctor and plan to find a solution.

When to review your coverage and make changes

Medicare's Open Enrollment period runs from October 15 to December 7 each year. During this time, you can switch to a different Part D plan or Medicare Advantage plan without penalty. If your current plan's cost for Eliquis is rising or if another plan in your area offers better coverage, Open Enrollment is when you can make the change. The new coverage starts January 1.

You can also switch plans if you experience a may have access to life event — such as moving to a new state, losing other insurance, or having a significant change in income. These changes allow you to switch outside of Open Enrollment. Contact Medicare at 1-800-MEDICARE to learn whether your situation qualifies.

Even if you do not switch plans, review your coverage each year. Drug formularies change, copays increase, and new programs become available. Spending 30 minutes comparing your options once a year can save you hundreds of dollars.

Frequently Asked Questions

Does Medicare cover Eliquis?

Yes, Medicare covers Eliquis through Part D prescription drug plans (if you have Original Medicare) or through Medicare Advantage plans that include drug coverage. However, your out-of-pocket cost depends on your specific plan and pharmacy.

Can I use a manufacturer copay card with Medicare?

It depends on your plan. Some Medicare plans allow copay cards; others do not. Call your plan before using the card to confirm it is permitted. Copay cards typically cannot be used once you enter the coverage gap.

What if my plan does not cover Eliquis?

Ask your doctor to request a formulary exception. Your doctor submits a letter explaining why Eliquis is medically necessary for you. The plan has a few days to respond. If denied, you can appeal or ask your doctor about switching to a blood thinner your plan does cover.

Is generic apixaban cheaper than brand-name Eliquis?

Often yes, but the difference depends on your plan's formulary. Some plans charge the same copay for both; others place generic apixaban on a lower tier. Ask your pharmacy to compare the copay for both versions before your doctor writes the prescription.

How do I know if I am in the coverage gap?

Your plan sends you a notice when you enter the gap, and you can check your coverage status anytime by logging into your plan's website or calling the member services number on your insurance card. Once you are in the gap, you pay 25 percent of the drug's cost until you reach catastrophic coverage.