Is Eliquis Covered by Medicare? How Much Does It Cost?

Is Eliquis Covered by Medicare – Overview

Medicare coverage for medications, including blood thinners like Eliquis, is determined by the specifics of the individual’s Medicare Part D or Medicare Advantage plan. However, prices will vary according to your plan.

Eliquis is a brand-name drug, so its list price is exceptionally high. In fact, some people end up paying the total cost of the drug.

However, it can be challenging to find out how much you expect to pay for Eliquis when you have Medicare coverage.

Fortunately, we’ll discuss that in this review. We’ll also discuss what you need before Medicare covers your Eliquis costs and how the different parts of Medicare cover this drug.

What Do You Need Before Medicare Covers Your Eliquis Costs

Prior Authorization

For Eliquis coverage under Medicare, your Part D plan may require prior authorization, which involves your physician submitting documentation to prove the medical necessity of the medication.

This is known as prior authorization, and it requires that your Medicare provider approve the drugs you’re getting before you get them.

Once your Medicare provider gives the go-ahead, you can get Eliquis medication at a discounted price.

Step Therapy

Your Medicare provider might also require you to first try other types of medication prior to pursuing Eliquis Medicare coverage.

Step therapy may be required by your Medicare Part D plan, where you must try one or more cost-effective alternatives before the plan will cover Eliquis.

Step therapy acts as a buffer to your Medicare provider to ensure that you’ve tried cheaper alternative meds before seeking expensive meds such as Eliquis.

You can check whether your Medicare plan requires step therapy by checking the Medicare Plan Finder.

Generic Version Availability

As of 2024, generic apixaban is available in the U.S. market, potentially offering a more cost-effective alternative to brand-name Eliquis. Eliquis is typically placed in Tier 3 or 4 of Medicare Part D formularies as a brand-name drug, while generic apixaban may be available in lower tiers.

How Much Does Eliquis Cost?

As illustrated above, the average retail price for a 30-day supply of Eliquis (5mg, twice daily) is approximately $600-$700 as of 2024.

However, most people don’t pay the full amount. If you find that the listed price is high, it’s no mistake, but expect to pay considerably less.

The amount you pay for prescription meds varies based on:

Coinsurance or co-payments
The formulary
The type of Medicare coverage
Whether you’ve hit your yearly deductible sum

However, you can use other methods to save on the cost of prescription meds, including:

Applying for the ‘Extra Help’ program
Looking for charitable programs that can pay a portion of your drugs’ cost
Opting for a generic version of the drug or lower-cost meds
Seeking help from state pharmaceutical assistance programs

However, keep in mind that if the above options aren’t available, you might still need to pay the drug’s entire list price.

Because Eliquis is such an expensive drug, ensure that your Medicare plan covers as much of the costs as possible.

Which Parts of Medicare Cover Eliquis

Medicare Part A & B (Original Medicare)

If you have original Medicare (Part A & B) coverage, you can usually access prescription meds coverage through your Medicare Part D plan.

Original Medicare can also cover the associated costs of hospital services (Part A) and medical services (Part B).

Therefore, if you have original Medicare, Part A will cover the cost of the drugs provided while in the hospital.

Most people don’t pay premiums for Medicare Part A, but they might need to pay a deductible. For 2024, the Medicare Part A deductible is $1,632 per benefit period.

On the other hand, the standard Medicare Part B premium is $174.70 for 2024, up from $164.90 in 2023.

Medicare Part C

Private insurance companies offer Medicare Advantage (Part C).

Medicare Advantage plans (Part C) are required to cover all the services that Original Medicare covers, but they also offer additional benefits, including prescription drug coverage, which varies by plan.

What drugs a provider covers varies, so your plan might cover Eliquis or not.

What’s more, apart from the cost of drugs, if you have Medicare Part C coverage, you must use in-network pharmacies and pay your plan’s set premium.

The premium varies based on the plan and provider. However, you can use Medicare’s tool to identify a Medicare plan that offers coverage for current medication.

Medicare Part D

Meds in the formulary are placed in different tiers, with the lower ones occupied by cheap meds.

Before you enroll in any plan, check the formulary to see whether it includes Eliquis and the cost of the drug.

Also, note that premiums for Medicare Part D vary depending on your plan, but you can use Medicare’s plan comparison tool to compare prices.

Patients should be aware of the Medicare Part D coverage gap (‘donut hole’), where they may pay no more than 25% of the costs for covered brand-name drugs like Eliquis.

Final Thought

Medicare Part C and D usually cover the cost of Eliquis because it’s a prescription drug.

Original Medicare (Part A and Part B) covers hospital and medical services, respectively. Prescription drug coverage is primarily provided through Medicare Part D or Medicare Advantage plans.

Grants for Medical

Is Eliquis Covered by Medicare?