How Much Does Eliquis Cost with Medicare? (2024)

Eliquis is a popular blood thinner that helps many seniors to lower their risk of blood clots and stroke. It is also pretty costly. Learn how much your Eliquis prescription will cost with Medicare and how you can get coverage for this important drug.Estimated Read Time: 7 mins

Table of Contents:

1. Does Medicare Cover Eliquis?
2. How Much Does Eliquis Cost with Medicare Part D?
3. Eliquis Under Medicare Part D Drug Negotiations
4. How Much Does Eliquis Cost with Medicare Advantage?
5. Medicare Prior Authorization for Eliquis
6. Medicare Step Therapy for Eliquis
7. Can I Receive Help Paying for Eliquis with Medicare?
8. How to Receive Coverage for Eliquis with Medicare

Does Medicare Cover Eliquis?

If you are on Original Medicare, you might wonder how your plan covers the popular drug Eliquis. This drug is prescribed to treat and prevent vascular conditions that are common in seniors. These conditions include:

• Atrial Fibrillation (AFib)
• Pulmonary embolism
• Deep vein thrombosis
• Blood clots
• Ischemic stroke

Your Medicare drug coverage for Eliquis will depend on the Medicare prescription drug plan you choose. When it comes to drug coverage, Medicare has several different options available.

Medicare Part Awill cover Eliquis when it is prescribed as part of an inpatient hospital stay and is administered by a physician. Medicare Part Dprescription drug coverage will cover Eliquis if it’s on your Part D plan’s formulary, which is the list of the plan’s covered drugs. The good news is that several Medicare Part D plans do provide coverage for Eliquis. However, it is important to find the plan that best covers the drug in your area at the lowest cost for you.

Medicare Advantage (Medicare Part C) plans may also have drug coverage that includes Eliquis. However, keep in mind not all Medicare Advantage plans offer drug coverage, so you’ll want to be sure your plan offers drug benefits and that Eliquis is covered in the plan’s formulary.

When prescribed, you are often instructed to take Eliquis twice daily. Taking a double dose of medication can lead to higher costs, which can in turn create a financial burden for patients – especially those on a fixed income.

To combat these high prescription costs, several options are available through Medicare and outside resources to help you cover the cost of Eliquis and other Xa inhibitor medications.

How Much Does Eliquis Cost with Medicare Part D?

The average Medicare Part D enrollee will have an average of nine private insurance companies and close to 24 individual plans to choose from in 2024. Most Medicare Part D plans offer coverage for the popular drug, Eliquis. However, the copayment, deductible, and monthly premium you will have to pay differs from plan to plan.

Thus, the plan you choose can make a huge difference in what you pay for your drugs. When enrolling in any insurance coverage, it is essential to review all your options and compare your total out-of-pocket costs before making assumptions and hastily enrolling in a plan.

If you are struggling financially to cover the cost of your Eliquis prescription, one of the most common resources to look into is Medicare Part D Extra Help. This program can help cover the out-of-pocket costs for prescription medications for qualified beneficiaries.

Eliquis Under Medicare Part D Drug Negotiations

The Inflation Reduction Act was signed into law by President Joe Biden in 2022. The law is meant to help ease the financial burden caused by inflation for millions of Americans. One major way the Inflation Reduction Act is going to help you save money is through Medicare Part D price negotiations.The law gives Medicare the power to negotiate and lower prices for costly, widely used drugs that many Medicare beneficiaries need.

In September 2023, the Centers for Medicare and Medicaid (CMS) announced the first ten drugs up for price negotiation, and one of them is Eliquis.

Of the ten medications up for negotiation so far, Eliquis is the most used among Medicare Part D enrollees. Eliquis alone costs Medicare billions of dollars each year, so if the high cost can be negotiated down, it will reduce spending for the Medicare program and for you.

It’s still undetermined how much the cost of Eliquis will come down. Price negotiations for Eliquis will continue until August 1, 2024, and CMS will publish the final negotiated prices by September 1. However, the new pricing won’t go into effect until January 1, 2026.

How Much Does Eliquis Cost with Medicare Advantage?

If you decide a Medicare Advantage plan is the best option for your insurance coverage, you should review your plan’s drug benefits as well as health benefits.

Not all Medicare Advantage plans offer drug benefits, and the ones that do each have a unique drug formulary. In 2023, the average Medicare recipient has 35 Medicare Advantage prescription drug plans from which to choose. Finding the right plan is essential when you require specialty drugs like Eliquis.

Like Medicare Part D plans, the option you choose will greatly impact your annual costs. However, with a Medicare Advantage plan, you also must factor in the health insurance benefits and costs as well.

Medicare Prior Authorization for Eliquis

Eliquis is a brand-name drug. This means it lives in a higher drug tier on all Medicare prescription drug plans and has a higher out-of-pocket cost than other drugs. Because of this, your insurance carrier may require you to go throughprior authorizationbefore you can receive coverage for the prescription.

Prior authorization allows the insurance company to audit the medical necessity of treatment before you receive the care to ensure acceptance of your claim after the bill’s creation. This helps save you time and out-of-pocket costs in the event of a claim denial. Essentially, prior authorization allows you to know your costs before your claim exists.

When it comes time for the approval of your prior authorization, you can pick up your medication and begin treatment.

Medicare Step Therapy for Eliquis

In some cases, if your claim requires prior authorization process, your insurance company may ask you to try step therapy before using higher-tier drugs like Eliquis. Step therapy allows you to try similar drugs at lower price points.

Certain plans require step therapy before you are eligible for coverage for brand-name drugs. You can see if your plan requires this by using theMedicare Part D Plan Finder Tool. If necessary, your physician will submit the proper paperwork to your plan, and your step therapy process will begin.

Can I Receive Help Paying for Eliquis with Medicare?

Unfortunately, brand-name drugs like Eliquis can become expensive. For many, this is the only drug option available to treat their conditions. Thus, the high cost can become a burden to those who require treatment.

To save money on prescription drug costs, many people prefer to take the generic versions of medications. To become FDA-approved, generic medications must provide the same results and use the same or similar formula as their brand-name counterpart. In 2019, the U.S. Food and Drug Administration (FDA) approved Apixaban as a generic form of Eliquis. However, Apixaban will not hit the market for consumers until 2026.

Current ways to lower your costs for Eliquis include coupons, manufacturer rebates, free samples, and theMedicare Extra Helpprogram for those who qualify. Often, manufactures of drugs will provide coupons to help lower the cost of prescription drugs. If you have an Eliquis coupon Medicare will not all you to use both your Medicare Part D benefits and the coupon. You must choose to use the coupon on its own and opt out of using your Part D coverage or use your Part D coverage and not use the coupon.

If you choose to use the coupon only, any costs you pay out-of-pocket will not go towards your Plans Maximum out-of-pocket limit.

If you are struggling to cover your monthly Eliquis costs, your healthcare provider or pharmacist may be able to help find options to cover those costs.

Medicare Coverage of Eliquis FAQs

What is the best Medicare Part D plan for Eliquis Coverage?

Medicare Part D plans can have different out-of-pocket costs depending on your location. The best Medicare Part D plan for Eliquis coverage will be the plan that offers the lowest combined monthly premium and copayments for your drug annually.

How much does Eliquis cost out-of-pocket?

If you do not have insurance, the current price of a month’s supply of Eliquis can be nearly $650.00. However, with insurance, that cost can be reduced drastically.

What blood thinner will Medicare pay for?

Medicare Part D and Medicare Advantage plans cover several blood thinner medications, including Eliquis. Other blood thinners include Xarelto, Coumadin, and Warfarin.

Is there a Coupon to help cover Eliquis costs?

Paying for Eliquis can be tough for seniors on a fixed income. To help cover your costs, you can utilize manufacturers’ coupons, free trial offers, or payment assistance services.

Do Medicare Supplement Plans Cover Eliquis?

Medicare Supplement plans do not cover the cost of prescription drugs. Thus, you will need to enroll in a Medicare Part D plan alongside your Medigap plan to receive coverage for Eliquis.