What Medicare covers for Eliquis and what you'll pay

Medicare Part D covers Eliquis (apixaban), a blood thinner used to prevent strokes and blood clots. Your out-of-pocket cost depends on which Part D plan you're on and where you are in the coverage year. Most plans place Eliquis on a higher tier — usually tier 3 or 4 — which means a higher copay than generic drugs. You might pay $15 to $50 per month in copays during the initial coverage phase, though some plans charge more.

The actual price Medicare pays the pharmacy is around $400 to $500 per month for a 30-day supply, but you won't see that number on your bill. What matters is your plan's formulary — the list of drugs it covers — and where Eliquis sits on that tier system. Once you hit the coverage gap (the "donut hole"), you pay 25% of the drug cost until you reach catastrophic coverage, where Medicare pays most of the cost.

Key Takeaways

  • Eliquis is usually a tier 3 or 4 drug on Medicare Part D plans, meaning higher copays than generic alternatives, but you can request a tier exception from your plan.
  • Switching to a different Part D plan during open enrollment (October 15 to December 7 each year) can lower your Eliquis copay by $10 to $30 per month depending on the plan.
  • Patient information programs run by Bristol Myers Squibb (the manufacturer) can reduce your copay to as low as $0 to $10 per month if your income qualifies.
  • Generic apixaban became available in 2023 and costs less than brand-name Eliquis, though some plans still charge higher copays for the brand name.
  • Asking your doctor for a prior authorization or step therapy override can move Eliquis to a lower tier if you've already tried other blood thinners without success.

Comparing Part D plans to find the lowest Eliquis copay

Not all Part D plans charge the same copay for Eliquis. One plan might charge $35 per month while another charges $50 for the same drug. You can compare plans using Medicare's Plan Finder tool on Medicare.gov, where you enter your current medications and it shows you the copay for each plan in your area. This is the most direct way to see which plans will cost you the least for Eliquis specifically.

The catch is that you can only switch plans during the annual open enrollment period, which runs from October 15 to December 7 each year. If you're outside that window, you're locked into your current plan unless you have a may have access to life event (moving, losing other coverage, marriage, or divorce). If you find a plan that saves you $20 or more per month on Eliquis, the switch is usually worth the paperwork.

When you compare, look at the total cost for the year, not just the copay. Some plans with lower copays have higher premiums, so you need to add both together. Medicare's Plan Finder does this math for you and shows the estimated annual cost for your specific medications.

Requesting a tier exception from your current plan

If you're happy with your current plan but the Eliquis copay is high, you can ask your plan to move it to a lower tier. This is called a tier exception or formulary exception. Your doctor submits the request, explaining why Eliquis is medically necessary for you — usually because you've already tried other blood thinners and they didn't work, or because you have a condition that makes Eliquis the best choice.

The plan has 72 hours to respond to an expedited request (if your doctor says it's urgent) or 30 days for a standard request. If they approve it, your copay drops to a lower tier, often saving you $10 to $20 per month. If they deny it, you can appeal, and your doctor can provide additional medical information to support the appeal.

To start this process, call your Part D plan's customer service number (on the back of your insurance card) and ask for the formulary exception form. Your doctor's office can usually submit it directly to the plan, so you don't have to handle the paperwork yourself.

Using manufacturer information programs to lower your copay

Bristol Myers Squibb, the company that makes Eliquis, runs a patient information program that can reduce your copay to $0 to $10 per month. The program is called the Eliquis Support Program, and it's available to people on Medicare Part D whose household income is below a certain threshold (usually around $50,000 to $60,000 per year for an individual, though this varies).

To enroll, you or your doctor can call 1-855-354-7847 or visit eliquissupport.com. You'll need to provide proof of income (tax return, pay stub, or benefit statement) and your insurance information. Once approved, you receive a copay card that you use at the pharmacy just like your insurance card. The program covers the difference between your copay and the actual cost of the drug, up to a limit.

The program is separate from Medicare, so it doesn't count against your coverage limits or affect your donut hole status. If your income is above the threshold, you may still be able to get a reduced copay — call to ask. Some people use both a tier exception and the copay card together to get the lowest possible out-of-pocket cost.

Switching to generic apixaban if your plan covers it

Generic apixaban became available in 2023 and costs significantly less than brand-name Eliquis. Some Medicare Part D plans now place generic apixaban on a lower tier (tier 1 or 2) with copays of $5 to $15 per month, while keeping brand-name Eliquis on a higher tier. If your plan offers this, switching to the generic can save you $20 to $40 per month.

Talk to your doctor about whether generic apixaban is appropriate for you. For most people with the same condition, the generic works identically to the brand name because it contains the same active ingredient. Your doctor can write a prescription for "apixaban" (generic) instead of "Eliquis" (brand), and the pharmacy will fill it with whichever version your plan covers at the lowest cost.

Some plans still charge the same copay for both the generic and brand-name versions, in which case the switch won't save you money. Check your plan's formulary or call your plan to confirm the copay for generic apixaban before asking your doctor to switch.

Understanding the coverage gap and catastrophic coverage

Once you've spent a certain amount on covered drugs in a calendar year, you enter the coverage gap (the "donut hole"). In 2024, this happens after you and your plan have spent $5,850 combined on covered drugs. In the gap, you pay 25% of the cost of brand-name drugs and generic drugs until your out-of-pocket spending reaches $8,550, at which point catastrophic coverage kicks in.

During catastrophic coverage, Medicare pays most of the cost and you pay a small copay (usually $5 to $10 per month for Eliquis). If you take Eliquis year-round, you'll likely hit catastrophic coverage by late fall or early winter, which means your copays drop significantly for the rest of the year.

To track where you are in the coverage year, check your Part D plan's website or call customer service. Some plans offer programs that help you get through the gap with lower costs, so ask your plan what's available.

Working with your doctor to reduce the cost of your prescription

Your doctor can help lower your Eliquis cost in several ways. First, they can submit a prior authorization request to your plan, explaining why you need Eliquis specifically. This can sometimes move the drug to a lower tier without you having to request it yourself. Second, they can document any previous blood thinners you've tried and why they didn't work, which strengthens a tier exception request.

Third, your doctor can prescribe a higher dose less frequently if medically appropriate. For example, instead of taking 5 mg twice daily, some patients can take 10 mg once daily. This reduces the number of pills you need per month and may lower your copay if your plan charges per-prescription rather than per-pill.

Finally, ask your doctor if there's a reason you specifically need Eliquis rather than a different blood thinner. Some alternatives like warfarin (generic, very cheap) or other newer anticoagulants might work for your condition and cost less on your plan. Your doctor can tell you whether switching is medically safe.

Frequently Asked Questions

Can I use the Eliquis copay card if I'm on Medicare?

Yes. The Eliquis Support Program copay card works with Medicare Part D. You present both your insurance card and the copay card at the pharmacy, and the copay card covers the difference between your copay and the actual cost. The program is designed specifically for people on Medicare.

What if I can't afford Eliquis even with a copay card?

Call your Part D plan and ask about their patient hardship program or low-income subsidy. If your income is below 150% of the federal poverty line, you may be may be able to access for Extra Help, a federal program that covers most of your Part D costs. You can explore through Social Security or your local Medicaid office.

Does switching to generic apixaban affect how well the drug works?

No. Generic apixaban contains the same active ingredient as brand-name Eliquis and works the same way in your body. The FDA requires generics to be bioequivalent to the brand name, meaning they perform identically. The only difference is the price and the appearance of the pill.

When should I request a tier exception instead of switching plans?

Request a tier exception if you're outside the open enrollment window or if your current plan is otherwise a good fit for you. If you're during open enrollment and another plan saves you significantly on Eliquis, switching plans is usually faster and simpler than going through the exception process.

Will my copay change if I move to a different state?

Yes. Part D plans are regional, so moving to a different state means you'll need to switch to a plan available in your new location. Your Eliquis copay may be higher or lower depending on which plans operate there. You can switch plans without waiting for open enrollment if you move, so update your address with Medicare and compare plans in your new area.