Is Eliquis Covered by Medicare? – Overview
Federal law requires that Medicare cover certain medications, such as blood thinners. 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?
Since Eliquis is an expensive brand-name drug, your physician might have to forward the necessary paperwork to your Medicare provider before you get the drugs.
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.
Your Medicare provider might also require you to first try other types of medication prior to pursuing Eliquis Medicare coverage.
According to the CMA (Center for Medicare Advocacy), this process is known as step therapy.
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.
How Much Does Eliquis Cost?
As illustrated above, the cost of Eliquis is very high for a lot of people, coming in at over 500 bucks for a month’s supply.
However, most people don’t pay the full amount. If you find that the listed price is high, it’s no mistake but expects 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.
So, because Eliquis is such an expensive drug, ensure that your Medicare plan can cover 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 access prescription meds coverage via your Medicare Part D plan most of the time.
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. According to the Centre for Medicare and Medicaid Services, the deductible in 2023 is $1600.
On the other hand, Medicare Part B had a premium of $164.90.
Medicare Part C
Private insurance companies offer Medicare Advantage (Part C).
The federal government mandates that these insurance companies provide the same coverage as Medicare Part A & B, plus coverage for prescription medication.
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.
To sum it all up, Medicare Part C and D usually cover the cost of Eliquis because it’s a prescription drug.
However, original Medicare (Part A & B) only covers the costs of hospital costs (Part A) and medical services (Part B).