Does Medicare Cover Eliquis?
Original Medicare (Part A and Part B) does not cover prescription medications such as Eliquis; however, beneficiaries can purchase a Part D or Medicare Advantage Plan for drug coverage. While Eliquis is one of the most expensive medications of its kind on the market, the cost of Eliquis with Medicare Part D or Medicare Advantage may be more affordable for people in need.
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What Is Eliquis?
Eliquis is an anticoagulant medication commonly used to treat nonvascular atrial fibrillation in adults with a high risk of stroke. Blood thinners like Eliquis are generally recommended for any person over the age of 65 who suffers from atrial fibrillation, an irregular heartbeat, or frequent heart palpitations.
The high cost of Eliquis stems from its rank in the tiered pricing system of prescription drugs. Eliquis is considered a top-tier, brand-name drug, which means patients must pay its full price out of pocket to fill the prescription. While the FDA has approved a generic alternative to Eliquis to help lower costs, it is not yet widely available to all consumers on the open market.
Limitations on How Original Medicare Covers Eliquis
- Medicare Part A covers inpatient care, including hospital or nursing facility admission, home health, or hospice services.
- Medicare Part B covers outpatient care, including preventive medical services, diagnostic screenings, equipment, and supplies
Medicare enrollees who need Eliquis may be limited to these benefits unless they purchase a separate prescription drug plan.
How Medicare Part D Covers Eliquis
Beneficiaries of Original Medicare can purchase a Part D plan for prescription drug coverage. Since Original Medicare does not cover prescription medications, you should consider buying a standalone Part D plan separately from a private insurer to cover the medications you need. You must enroll in Part D when you first become eligible for Medicare to avoid late enrollment fees.
The private insurers that offer Part D plans are required to extend certain universal benefits to enrollees but can set their own prices for a tiered formulary of prescription drugs. Since Eliquis does not yet offer a generic alternative, it is typically listed among the most expensive, top-tier drugs, though specific prices vary by plan. Part D requires a separate monthly premium.
How Does Medicare Advantage Cover Eliquis?
Medicare Advantage offers enhanced coverage beyond Original Medicare, such as hearing, dental, and vision services. Medicare Advantage Plans also commonly include drug benefits. Most Medicare Advantage Plans with drug coverage specifically include Eliquis, among other medications primarily prescribed to adults over 65.
Like Part D, Medicare Advantage Plans assign drug prices according to their formulary. Eliquis typically costs even more than other top-tier drugs since there is no generic version; however, Medicare Advantage Plans are increasingly focused on staying competitive by lowering prices for this popular drug.
It’s important to note that you may not enroll in Part D and Medicare Advantage at the same time.
Medicare Advantage Coverage Limitations For Eliquis
Since Eliquis lives on the highest tier of most Medicare Advantage Plan drug formularies and is not available in generic form yet, some plans may require prior authorization for an Eliquis prescription. The prior authorization process requires physicians to exhaust all other options before approving the use of an expensive, brand-name medication to treat a specific condition.
How Much Does Eliquis Cost With Medicare?
For individuals without insurance coverage, a 30-day supply of Eliquis can cost more than $550. Beneficiaries of Original Medicare will not help cover those costs since Medicare Parts A and B only pay for inpatient and outpatient expenses. You can save on the cost of Eliquis by adding a separate Part D plan or buying Medicare Advantage coverage.
How Much Does Eliquis Cost With Medicare Part D Coverage?
Medicare Part D requires an additional monthly premium, on top of Original Medicare costs, to enjoy prescription drug benefits. Part D premium costs vary, based on income and other qualifiers, totaling less than $40 a month on average for most beneficiaries. Higher-income enrollees may require higher monthly premiums for Part D coverage. Part D coverage for Eliquis may vary according to each plan’s deductibles, copays, and coinsurance out-of-pocket costs.
How Much Does Eliquis Cost With Medicare Advantage?
Medicare Advantage also requires an additional monthly premium, since you must purchase a separate Medicare Advantage Plan from a private insurer. Medicare Advantage costs vary by state and insurer. Like Part D, Medicare Advantage lists Eliquis in its top tier of drugs but may charge as little as under $50 for the drug, after the deductible.
How to Manage Costs If Paying Out of Pocket
If your insurance does not cover Eliquis or still requires you to pay out of pocket for your prescription, you may be able to cut costs through one or more of the following methods:
- Generic medication: The FDA approved a generic version of Eliquis, called apixaban, in 2020; however, the drug is not expected to hit the market until at least 2026. Comparable prescription medications such as Warfarin or Xarelto may cost less than Eliquis. Talk to your doctor about more affordable alternatives.
- Manufacturer coupons or discounts: Coupons and prescription discount programs can help save money on medications like Eliquis, often without any strict qualifiers and independent of other coverage. Start by searching online for Rx cards and coupons to stack up the savings.
- Pharmacy shopping: Eliquis may come at a different cost depending on where you get your prescription filled. Ask your preferred pharmacy about discounts or coupons for returning customers and shop at other pharmacies, if necessary, to find the best rate.
All in All
Beneficiaries of Original Medicare need a separate Part D or Medicare Advantage Plan to cover Eliquis. While this coverage can help drastically lower all prescription drug expenses, the cost of Eliquis with Medicare depends on a plan’s individual formulary and policy expenses. Even with Part D or Medicare Advantage coverage, individuals may need to meet their deductible first or get pre-authorization to fill their Eliquis prescription.