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Does Medicare Cover Eliquis?

Eliquis, or apixaban, is a medication that treats various health conditions. Eliquis is an anticoagulant or blood thinner that reduces the risk of blood clot formation due to pulmonary embolisms (blood clots in the lungs) and venous thromboembolisms (blood clots in the legs). It also helps to reduce the risk of stroke due to atrial fibrillation, a condition that can cause irregular heart rate and rhythm.

Key takeaways:

With the cost of Eliquis being about $561 out of pocket for a 30-day supply, many individuals are interested in Medicare coverage of Eliquis.

Is Eliquis covered by Medicare?

Medicare covers prescription drugs in two ways. Medicare can help cover the cost of your prescription drugs, including Eliquis, through a Medicare Part D plan or a Medicare Advantage plan, also known as Medicare Part C. Knowing the difference between a Medicare Advantage plan and a Medicare Part D plan is helpful when considering your Medicare coverage options. You should also be aware that additional insurance coverage might come with additional costs, such as yearly deductibles, copayments, and monthly premiums, common with most Medicare plans.

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Medicare Part D coverage

If you want to keep your Original Medicare coverage but need prescription drug coverage, you can enroll in a separate Medicare Part D drug plan. Medicare Part D plans provide prescription drug coverage not included in Original Medicare. To participate in a Medicare Part D plan, you must be enrolled in Medicare Parts A and B insurance plans. Various Medicare Part D plans are available, and you can enroll in the plan that best meets your coverage needs based on your medications.

Considerations for coverage with Medicare Advantage

If you want to have your healthcare and prescription drug coverage in one plan, consider enrolling in a Medicare Advantage plan. Medicare Advantage plans typically consist of Medicare Part A, Part B, and prescription drug coverage in one plan. Like Medicare Part D, you must already be covered by Medicare Part A and Part B to enroll in a Medicare Advantage plan. It's important to know that not all Medicare Advantage plans offer prescription drug coverage. Carefully review plan details to ensure you choose the right plan for all your healthcare needs.

How much does Eliquis cost with Medicare?

Your Medicare plan determines the amount you pay for Eliquis and other medications. Understanding certain plan elements can help you determine if the plan meets your drug coverage needs. Here are some core parts of drug plans that you should review:

  • Deductible. Your plan might include a deductible, the amount you must pay before your coverage starts. Your plan determines the specific deductible amount, and deductibles can differ among Medicare drug plans.
  • Plan Formulary. Your Medicare plan will have a list of covered drugs called a formulary. Formularies can include both brand-name drugs such as Eliquis and generic medications. Each plan has its unique formulary. Before selecting a plan, review the formulary carefully to ensure the plan covers Eliquis.
  • Drug Tiers. Formularies are often organized into tiers, and each tier is associated with different copayments (the amount paid after you meet your deductible). There is typically a separate tier for generic drugs, the plan preferred brand-name drugs, and non-preferred brand-name drugs. Commonly, drugs in lower tiers have lower copayments than those in higher tiers, but this may not always be the case.
  • Premium. You may have to pay a monthly fee to maintain your drug plan, and the cost of those premiums varies among plans.
  • Coverage Gaps. Coverage gaps, also called the “donut hole," are when your drug plan limits coverage. Coverage gaps occur after a specified dollar amount is spent on drugs by you and your drug plan.

Understanding these factors can help you manage the cost of Eliquis and other prescription medications included in your Medicare plan.

What is the best Medicare Part D plan for Eliquis?

Navigating Medicare drug coverage doesn’t have to be overwhelming, and understanding what’s valuable to you in an insurance plan will help you find the right plan. When searching for the best Medicare Part D drug plan that aligns with your needs and preferences, consider the following:

  • Look for drug plans that include Eliquis on the formulary list
  • Compare the costs of different plans to find the most affordable option
  • Explore drug plans covering expenses during the coverage gap, including your specific medications
  • Consider plans with no or low deductibles
  • Choose a plan with a low monthly premium

More information about Medicare Part D plans, options, and coverage can be found at Medicare.gov.

Eliquis is an essential medication used to help prevent strokes and to treat and prevent blood clots. Many factors determine Medicare coverage for Eliquis and other drugs. Some factors outlined in the details of your insurance plan include medication formularies, drug tiers, deductibles, and premiums. Whether you choose to enroll in a Medicare Advantage plan or a Medicare Part D plan, understanding these fundamentals will assist you with making informed decisions about your drug coverage.


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