How much does Eliquis cost with insurance?

How much does Eliquis cost with Medicare?

In 2022, the manufacturer’s (Bristol-Myers Squibb) website listed the price of Eliquis as $522 for a 30-day supply without insurance.  Patients who have prescription insurance through Medicare pay $37 on average for Eliquis, according to the manufacturer of Eliquis. The manufacturer also states that some Medicare patients with Part D coverage may pay as little as $10 per month for Eliquis through the use of a Medicare Part D prescription drug plan or a Medicare Advantage Prescription Drug (MAPD) plan that includes prescription drug coverage.

The amount an individual pays for Eliquis depends on various factors such as:

  • the type of Medicare coverage
  • the formulary tier (list of covered drugs)
  • whether the individual has reached their annual deductible amount
  • coinsurance or copayments

What is Eliquis?

Eliquis (apixaban) is an anticoagulant (blood thinner) medication used to prevent strokes and blood clots in people with atrial fibrillation (afib, a heart rhythm disorder). Eliquis is also used to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), two types of blood clots that can occur in the legs or lungs.

Eliquis works by inhibiting a protein called factor Xa. Factor Xa is involved in the clotting process. By inhibiting factor Xa, Eliquis decreases the formation of clots.

What about generic Eliquis?

There is no generic version of Eliquis currently available. The earliest possible date that a generic version could become available is December 2023, when the patent for Eliquis expires.

What’s the cheapest way to get Eliquis?

There are a few ways to save on the cost of your Eliquis prescription. One way is to use a prescription discount card, such as the ones offered by manufacturer assistance programs or independent organizations. Manufacturer assistance programs provide discounts for eligible individuals. Other ways to save include using a mail-order pharmacy or looking for an Eliquis coupon or other special offers.

Some insurance plans may help to reduce the cost of Eliquis, but may have higher copays, deductibles or higher premium fees. You may be able to save money by switching to a Medicare Advantage Prescription Drug (MAPD) plan that includes prescription drug coverage, or by enrolling in a Medicare Part D prescription drug plan.

You can also ask your healthcare provider about the possibility of getting a sample pack of Eliquis from the manufacturer. This could help you decide if Eliquis is the right medication for you before you commit to paying for a full month’s supply.

Eliquis costs are high, but there are ways to reduce the cost. Talk to your healthcare provider about your options and compare costs between different pharmacies to find the best price.

Does Medicare cover Eliquis?

Medicare Part A (hospital insurance) does not cover Eliquis because it is not a hospital-administered medication.

Medicare Part B (medical insurance) does not cover Eliquis because it is considered an outpatient medication.

However, Medicare Part D plans (prescription drug plans) and Medicare Advantage plans with prescription drug coverage (MAPDs) may cover Eliquis.

If an individual has Original Medicare and they would like coverage for Eliquis, they will need to enroll in a stand-alone Part D plan or a Medicare Advantage Prescription Drug (MAPD) plan that includes prescription drug coverage.

Medicare Part D plans and Eliquis coverage

Medicare Part D plans (PDPs) and Medicare Advantage Prescription Drug (MAPD) plans are required to cover all FDA-approved drugs. Since Eliquis is an FDA-approved drug, it must be covered by all PDPs and MAPDs that offer prescription drug coverage.

However, each plan has its own rules about how much it will cover for each type of drug in its formulary (list of covered drugs). Some plans may place Eliquis on a higher tier of their formulary (list of covered drugs), which means that patients will have to pay a higher coinsurance or copayment for the medication. Other plans may exempt Eliquis from the annual deductible amount.

If an individual has a Medicare Part D prescription drug plan or a Medicare Advantage Prescription Drug (MAPD) plan, they will likely pay a monthly premium, an annual deductible, and coinsurance or copayments for their Eliquis medication. The average monthly premium for a Medicare Part D prescription drug plan in 2022 is $33, according to CMS.  No Medicare drug plan may have a deductible of more than $480 in 2022 which means that you are responsible for the first $480 of out of pocket costs for your prescription drugs before your coverage commences.

Medicare Part D prescription drugs are the most common way of obtaining coverage from Medicare for prescription drugs such as Eliquis. If an individual has Medicare Part D, also called prescription drug coverage, they may be able to get Eliquis at a lower cost. Part D plans have a list of covered drugs (formulary drug list) and use tiered formularies. The cost of Eliquis depends on which tier the drug is placed in.

There are four tiers:

  • Preferred or Generic (lower-cost drugs)
  • Non-preferred or Brand-name (higher-cost drugs)
  • Specialty (very high-cost drugs)
  • Not Covered Drugs

If an individual has Medicare Part B, they may be able to get help with the costs of Eliquis through the Eliquis Access Program. The Eliquis Access Program offers free or low-cost medications to eligible patients. To see if you qualify for this program, visit the manufacturer’s website or speak with your doctor.

Eliquis and Medicare Advantage

Medicare Advantage plans (Medicare Part C) are an alternative to the Original Medicare. These plans are offered by private insurance companies and must cover all the same benefits as Original Medicare Some Medicare Advantage plans also offer prescription drug coverage. If an individual has a Medicare Advantage plan that includes prescription drug coverage, they may be able to get Eliquis at a lower cost. Like with Part D plans, the cost of Eliquis depends on which tier the drug is placed in and whether the individual has met their deductible. To see what your specific plan covers, you can view your plan’s formulary or contact your plan’s customer service department.

You can also compare Medicare Advantage plans that include prescription drug coverage on the Medicare website. When you compare plans, be sure to look at the total cost of the plan, not just the monthly premium. You should also consider whether the plan covers your preferred pharmacies and doctors.

Can Medigap plans help me save money on Eliquis?

No, Medigap plans cannot be used to help pay for prescription drugs. Medigap plans are supplemental insurance plans that can help cover some of the costs that Original Medicare does not cover, such as copayments, coinsurance, and deductibles. While Medigap plans cannot help with the cost of Eliquis specifically, they can help with some of the other costs associated with Medicare.

How much does Eliquis cost with Medicare?

Medicare patients with Part D coverage pay on average $37 for Eliquis while some Medicare Part D patients may as low as $10 for Eliquis, according to the manufacturer of Eliquis.

Eliquis assistance for Medicare patients

If you have Medicare and need help paying for Eliquis, there are a few options that may be able to help.

  • The Eliquis Access Program offers free or low-cost medications to eligible patients. To see if you qualify for this program, visit the manufacturer’s website or speak with your doctor.
  • Patient Assistance Programs (PAPs) are programs offered by pharmaceutical companies to help people who cannot afford their medication. Eligible patients may be able to get Eliquis for free or at a reduced cost.
  • You may also be eligible for Extra Help. Extra Help is a program that helps people with limited income and resources pay for their prescription drugs. To see if you qualify for Extra Help, visit the Social Security Administration website or call 1-800-772-1213.
  • If you cannot afford your medication, your doctor may be able to give you samples of Eliquis to try. Doctors sometimes receive free samples from pharmaceutical companies. These samples can then be given to patients who cannot afford their medication.
  • There are also alternative medications available including Xarelto, Pradaxa and Savaysa.

 

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The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.
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