Explore Medicare Coverage for Eliquis: A 2026 Guide
If you take Eliquis (apixaban), understanding how Medicare pays for it in 2026 can help you plan your annual prescription costs. This guide explains which parts of Medicare may cover Eliquis, how out‑of‑pocket costs are calculated, what changes from recent policy reforms mean, and where to look for lower‑cost options.
Many people rely on Eliquis (apixaban) to reduce the risk of stroke and blood clots. In Medicare, coverage and out‑of‑pocket costs vary by plan, pharmacy choice, and financial assistance status. With 2026 bringing ongoing Part D benefit changes and negotiated drug pricing rules taking effect, it’s useful to understand how coverage works and what to expect for budgeting.
This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.
Medicare coverage for Eliquis
Most people get Eliquis through Medicare Part D prescription drug coverage—either a standalone Part D plan paired with Original Medicare or a Medicare Advantage plan that includes drug coverage. Eliquis is commonly listed on plan formularies as a brand‑name anticoagulant and may require prior authorization or step therapy. Coverage details depend on the plan’s tier placement, network pharmacies, and utilization rules. In 2026, the standard Part D design continues to apply: you may face a plan deductible, then cost sharing in the initial coverage phase, and protection from very high spending due to the redesigned out‑of‑pocket limit.
Eliquis cost with Medicare
Your monthly cost typically depends on three factors: the plan’s tier and copay/coinsurance for Eliquis, whether you’ve met the annual deductible, and how far you are through the year’s spending. Many plans place Eliquis on a preferred or non‑preferred brand tier with either a flat copay (often seen as a dollar amount) or coinsurance (a percentage of the drug’s negotiated price). Under the Part D redesign implemented in 2025 and continuing in 2026, out‑of‑pocket prescription costs are capped for the year, with an option to spread payments monthly. People who qualify for Extra Help (the Low‑Income Subsidy) pay reduced amounts—often small, fixed copays—through the year. Using preferred network pharmacies and considering 90‑day supplies through plan mail‑order services can also influence your final price.
Part D drug coverage Eliquis
Plan formularies categorize drugs into tiers. Eliquis is typically on a brand tier, where cost sharing may be a copay (for example, a set dollar amount) or coinsurance (a percentage, frequently between about 25% and 33% in the initial coverage phase). A plan’s rules can include prior authorization to confirm medical need or step therapy asking you to try a different medication first if clinically appropriate. If your doctor prescribes Eliquis due to a specific medical reason—such as intolerance or contraindications to alternatives—your plan may review an exception request. Always confirm whether your regular pharmacy is in network and whether a preferred network offers lower copays for the same prescription.
Blood thinner covered by Medicare
Eliquis is one of several oral anticoagulants commonly covered by Medicare drug plans. Others often on formularies include rivaroxaban, dabigatran, and edoxaban, while warfarin is a long‑standing, lower‑cost alternative that requires regular INR monitoring and dietary considerations. Coverage does not mean identical pricing across drugs: tier placement and negotiated rates vary by plan. Your prescriber’s clinical judgment should guide any therapy changes. If you use a home delivery or specialty pharmacy, check whether your plan requires a specific channel for coverage and whether a 90‑day supply is allowed for maintenance therapy.
Eliquis generic alternative
Eliquis is the brand name for apixaban. While the U.S. Food and Drug Administration has approved generic versions of apixaban, market availability can depend on patent and exclusivity timelines as well as manufacturer agreements. If a generic becomes available through your plan, it would typically be placed on a lower tier and may reduce your copay compared with the brand. However, availability and pricing can change year to year. If a generic is not available on your plan’s formulary, discuss clinically appropriate alternatives with your prescriber; do not switch or stop anticoagulation on your own.
In 2026, you may see changes related to Medicare’s negotiated drug prices taking effect for selected medications, which can influence plan‑level pricing and member cost sharing; however, your actual out‑of‑pocket amount will still depend on your specific plan design, pharmacy choice, and benefit phase at the time of purchase.
| Product/Service | Provider | Cost Estimation |
|---|---|---|
| Eliquis 5 mg, 60 tablets (cash, no insurance) | GoodRx national average cash price | $500–$600/month |
| Eliquis in initial coverage (after deductible) | UnitedHealthcare (AARP MedicareRx plans) | $40–$100 copay or ~25%–33% coinsurance |
| Eliquis in initial coverage (after deductible) | Humana Part D plans | $40–$100 copay or ~25%–33% coinsurance |
| Eliquis in initial coverage (after deductible) | Aetna SilverScript (CVS Health) | $40–$100 copay or ~25%–33% coinsurance |
| Eliquis in initial coverage (after deductible) | Cigna Part D plans | $40–$100 copay or ~25%–33% coinsurance |
| Brand drug copay with Extra Help (LIS) | Medicare Low‑Income Subsidy | Low fixed copay (varies by eligibility) |
Prices, rates, or cost estimates mentioned in this article are based on the latest available information but may change over time. Independent research is advised before making financial decisions.
Practical cost factors to watch
- Deductible: Many plans apply the Part D deductible before copays/coinsurance start; the amount is set annually by Medicare and varies by plan adoption of the standard.
- Tier and network: A preferred brand tier and preferred pharmacies can lower your share versus non‑preferred tiers or out‑of‑network fills.
- Supply length: A 90‑day mail‑order fill may have a lower per‑pill cost than three 30‑day fills, depending on the plan.
- Assistance: Extra Help (LIS), manufacturer assistance for those without Part D, and state pharmacy assistance programs can substantially reduce costs if you qualify.
What 2026 changes may mean for you
The redesigned Part D benefit that began in 2025 continues in 2026, keeping a defined annual cap on what you pay out of pocket for covered drugs and enabling payment “smoothing” so you can spread costs evenly across the year. Separately, Medicare’s negotiated prices for certain high‑spend drugs begin applying in 2026. While negotiated prices can lower what plans pay and may translate into different member cost structures, your final copay or coinsurance for Eliquis will still be determined by your plan’s formulary tiering, the pharmacy you use, and where you are in the benefit timeline.
Bottom line
Eliquis is commonly covered under Medicare drug benefits, but your out‑of‑pocket cost in 2026 will reflect your plan’s formulary tier, deductible, and copay or coinsurance rules, along with any financial assistance you receive. With the Part D redesign continuing and negotiated prices taking effect, compare how your plan handles Eliquis, confirm your preferred pharmacy’s network status, and monitor formulary updates—especially if a generic becomes available—so you can budget with fewer surprises.
