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Eliquis (apixaban) is a prescription anticoagulant used to prevent strokes and blood clots in people with atrial fibrillation and to treat or prevent deep vein thrombosis or pulmonary embolism. As a direct oral anticoagulant (DOAC), it offers advantages over warfarin because it does not require routine INR monitoring and has fewer food-drug interactions.

It is also one of Medicare’s highest-cost drugs. From June 2022 to May 2023, more than 3.7 million Medicare Part D enrollees used Eliquis, with total spending exceeding $16.4 billion.

Medicare Part D is undergoing major changes in 2026. The Inflation Reduction Act introduced an annual out-of-pocket cap and authorized Medicare to negotiate prices for high-cost drugs. The first negotiated prices, known as Maximum Fair Prices (MFPs), took effect on January 1, 2026, and include Eliquis.

This guide provides a comprehensive overview of Eliquis coverage under Medicare Part D for 2026.

Key Takeaways

  • Medicare Part D enrollees will pay no more than $2,100 for covered drugs in 2026, including Eliquis. Once this limit is reached, costs drop to $0 for the rest of the year.
  • Medicare negotiated the price of Eliquis. The maximum fair price is $231 for a 30-day supply starting January 1, 2026.
  • Most plans place Eliquis in the preferred brand (Tier 2 or 3) with quantity limits but no prior authorization or step therapy.
  • Manufacturer discounts cannot be used with Medicare due to the Anti-Kickback Statute. Using coupons while on Part D is illegal.
  • The Medicare Prescription Payment Plan allows you to spread drug costs over the year, but does not reduce overall spending. Enrollment is voluntary.
  • There are ways to save on Eliquis. If you have a prescription, you can get Eliquis for $157 per month or generic apixaban for $89. Plus, an additional 10% discount may be available.

Medicare Part D fundamentals

Medicare Part D is the prescription drug benefit offered through private insurers approved by Medicare. Beneficiaries can enroll in either a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage.

Plan structure

Part D plans use a standard benefit design, although insurers can offer enhanced coverage. Key features include:

  • Annual deductible: Plans may charge a deductible before coverage begins. The maximum allowed deductible rises to $615 in 2026.
  • Initial coverage phase: After meeting the deductible, you typically pay a copayment or coinsurance until your total drug costs (plan plus beneficiary payments) reach a specified limit. Many plans assign medications to tiers (generic, preferred brand, nonpreferred brand, specialty) that determine copayment amounts.
  • Out-of-pocket cap: In 2026, the law caps total out-of-pocket costs for covered prescription drugs at $2,100. Once you reach this limit, you pay nothing for covered drugs for the remainder of the year.
  • Negotiated prices (Maximum Fair Price or MFPs): For the first time, Medicare will negotiate prices for a small number of high-spend drugs. These MFPs become the maximum price Part D plans can pay in 2026. The first ten drugs selected include: For Eliquis, the negotiated price (MFP) will be $231 for a 30-day supply, down from a list price of over $500. Part D plans must offer the negotiated price or less. However, your out-of-pocket cost may not be exactly the MFP because plans still assign copayments or coinsurance.
  • Utilization management: Plans may impose prior authorization, quantity limits, or step therapy. Prior authorization requires your prescriber to prove medical necessity before coverage; quantity limits restrict how much you can fill at one time; step therapy requires trying a lower-cost drug first.

Costs under Part D in 2026

Medicare sets the national base beneficiary premium each year. For 2026, the base premium is $38.99, though actual premiums vary by plan. Deductibles may be lower than the maximum, and some plans have no deductible.

Beneficiary cost sharing depends on formulary tier placement and whether a generic exists. After your spending reaches the $2,100 cap, the plan covers 100% of drug costs for the remainder of the year.

Medicare Prescription Payment Plan (M3P)

A new feature for 2025 onward is the Medicare Prescription Payment Plan, also called the “cost-smoothing” program. This voluntary option allows you to spread your out-of-pocket drug costs across the year rather than paying large amounts up front.

Here’s how it works:

  • Who can enroll: Anyone with a Medicare Part D or Medicare Advantage plan with drug coverage can opt in. Enrollment is free, and all plans must offer it.
  • How it functions: When you fill a prescription, you no longer pay the pharmacy. Instead, the plan bills you monthly for your share. The bill is based on what you would have paid at the pharmacy plus any previous balance, divided by the remaining months in the year. As new prescriptions are added, the monthly payment may increase because fewer months remain to spread out the cost.
  • No cost savings: The payment plan does not reduce your overall spending. You still pay up to the $2,100 cap, but it helps smooth out expenses across the year.
  • Cap protection: Even under this plan, you will never pay more than the total you would have paid at the pharmacy or the $2,100 out-of-pocket maximum.

You might benefit if you have high drug costs early in the year. However, if you qualify for Extra Help or a state assistance program, the payment plan may not be advantageous. Enrolling late in the year (after September) could result in higher monthly bills because fewer months remain.

How much does Eliquis cost with Medicare?

According to Bristol Myers Squibb, patients with Medicare prescription drug coverage pay an average of about $51 per month for Eliquis, with half of patients paying $30 or less.

Those who qualify for the Low-Income Subsidy (LIS) may pay even less, typically between $0 and $12.65 per month, through the Social Security Administration’s Extra Help program.

Research from the USC Schaeffer Center for Health Policy & Economics, published in JAMA, found that average expected out-of-pocket costs for beneficiaries enrolled in stand-alone Part D plans more than doubled between 2020 and 2024, rising from $46.76 to $102.32.

This increase was largely driven by a shift toward coinsurance, with the share of plans using coinsurance for Eliquis increasing from 10.7% to 75%.

In contrast, beneficiaries in Medicare Advantage drug plans saw only a modest increase in out-of-pocket costs, from $44.57 to $46.93 during the same period. Notably, just 5% of Medicare Advantage plans used coinsurance for Eliquis in the most recent year.

How do Part D plans cover Eliquis?

Here’s how Medicare Part D plans typically cover Eliquis.

Formulary tiers and costs

Part D plans categorize drugs into tiers that determine copay amounts. Eliquis is typically placed in a preferred brand (Tier 2 or Tier 3) category, meaning copays are higher than for generics but lower than for nonpreferred brands or specialty medications.

Medicare Part D plan examples that cover Eliquis in 2026:

Plan Tier Placement Quantity Limits (QL) Prior Authorization / Step Therapy
Express Scripts Medicare (PDP) Tier 2 (preferred brand) 60 tabs / 30 days; 74 tabs / 180 days (DVT/PE starter pack) No prior auth or step therapy
Blue MedicareRx Premier Tier 3 (preferred brand) 60 tabs / 30 days (2.5 mg); 74 tabs / 30 days (5 mg) No prior auth or step therapy
Priority Health Medicare Tier 3 (preferred brand) 74 tabs / 30 days No prior auth or step therapy
Humana Value Rx Plan PDP Tier 3 (preferred brand) 60 tabs / 30 days (2.5 mg); 74 tabs / 30 days (5 mg) Step therapy required for suspension & sprinkle forms
Wellcare Value Script PDP Tier 3 (preferred brand) 60 tabs / 30 days (2.5 mg); 74 tabs / 30 days (5 mg); 74 tabs / 180 days (DVT/PE starter pack) No prior auth or step therapy
Kaiser Permanente Tier 3 (preferred brand) Not specified No prior auth or step therapy

These examples demonstrate that plan formularies often impose quantity limits on Eliquis but generally do not require prior authorization or step therapy. Quantity limits can be inconvenient for people who need higher doses or longer supply, but your prescriber can request an exception if medically necessary.

Cost-sharing examples

Because premium and copayment amounts vary, actual out-of-pocket costs differ widely among plans.

A KFF analysis found that in 2023, the median monthly copayment for Medicare Part D enrollees taking Eliquis was about $47. However, not all beneficiaries pay this amount. Roughly 13% of enrollees whose plans cover Eliquis face higher costs because the drug is placed on a non-preferred tier. Among them, about 9.5% are subject to coinsurance of up to 50%, while another 3% pay a flat copayment of around $100 per month.

These copays are expected to decline in 2026 when the negotiated MFP for Eliquis, set at $231 for a 30-day supply, takes effect.

Utilization management

Although the plans above did not list prior authorization for Eliquis, some insurers may impose it. The Medicare & You 2026 handbook notes that Part D plans may require your doctor to get prior authorization, set quantity limits, or enforce step therapy.

You should always check the plan’s formulary during open enrollment to confirm restrictions because they can change yearly. Quantity limits are the most common requirement for direct oral anticoagulants (DOACs), reflecting safety concerns about bleeding. If your prescriber believes the limit is insufficient, they can request an exception.

How to choose the best Medicare Part D plan for Eliquis in 2026

Choosing the right Part D plan involves balancing premiums, deductibles, formulary tiers, and utilization management. When focusing on Eliquis, consider the following factors:

1. Formulary placement and tier

Check whether Eliquis is a preferred brand or a non-preferred brand. Preferred brand placement (Tier 2 or 3) usually results in lower copays. Compare plan formularies using the Medicare Plan Finder or each insurer’s formulary PDF. For example, Express Scripts lists Eliquis in Tier 2, while Priority Health lists it in Tier 3.

Ask whether the plan anticipates moving Eliquis to a lower tier once the negotiated price takes effect.

2. Cost sharing and premiums

Compute your total annual costs by adding premiums, deductibles, and expected copays. Plans with low premiums may have higher copays, so evaluate which combination results in the lowest total cost.

Use last year’s usage to estimate your spending. Remember that once you hit the $2,100 cap, you pay nothing for covered drugs.

3. Utilization management policies

Review whether the plan requires prior authorization or step therapy for Eliquis. Even though many plans impose only quantity limits, some might require your physician to submit medical documentation.

Quantity limits can also vary. Look for a plan that offers a 90-day supply through mail order if you prefer fewer refills. If your plan has step therapy, ask whether you must try another DOAC like Xarelto or warfarin first.

4. Pharmacies and mail order options

Part D plans contract with networks of pharmacies. Using a preferred pharmacy or mail order can lower copays. For example, Express Scripts requires mail order for its Tier 2 drugs. Confirm whether your preferred pharmacy is in the plan’s network and whether mail order offers additional savings or convenience.

5. Premium support and Extra Help eligibility

If your income and resources are near the Extra Help limits, apply for the program because it can drastically reduce your Eliquis costs. Evaluate State Pharmaceutical Assistance Programs (SPAPs) available in your state and check whether they coordinate benefits with Part D.

Many low-income seniors automatically receive Extra Help but still pay standard premiums because they do not update their information, so ensure your data is accurate.

How to get Eliquis cheaper when you have Medicare?

Even with negotiated prices, Eliquis can still be expensive. Use these strategies to lower your costs:

  • Review plans during open enrollment (October 15 – December 7). Use the Medicare Plan Finder to compare premiums, deductibles, and copays. Plans change formularies annually, so the plan you used this year may not be the best next year.
  • Ask your doctor about dosing and supply options. If medically appropriate, using a 90-day mail-order supply may reduce copays per tablet. However, note that quantity limits may restrict this for Eliquis.
  • Consider alternative DOACs if clinically appropriate. Some plans may place rivaroxaban (Xarelto) or dabigatran (Pradaxa) on lower tiers. Your doctor can evaluate whether another DOAC is suitable.
  • Apply for Extra Help or SPAP assistance. Many seniors qualify for these programs but are unaware of them. Extra Help can reduce your cost per prescription to $12.65 for brand drugs, and SPAPs may cover part of your premium.
  • Use the Medicare Prescription Payment Plan if you have early-year expenses. This option spreads costs over the year and prevents large upfront payments.
  • Avoid coupons with Part D coverage. Using manufacturer coupons for Eliquis while on Part D is prohibited by the Anti-Kickback Statute. Paying cash with a coupon means the cost won’t count toward your deductible or out-of-pocket cap and may end up being higher in the long run.

Will a generic version of Eliquis be available in 2026?

No. April 2028 is widely cited as the earliest generic entry date for apixaban tablets in the US.

A generic version of apixaban has been approved by the FDA but is not commercially available due to active patents. Until these patents expire, generic manufacturers cannot launch a competing product.

When generics arrive, they will likely be placed in lower tiers (Tier 1 or 2), reducing copays. Keep this in mind when choosing plans for 2028 and beyond.

Outside the US, several companies already market generic apixaban. In Canada, for example, multiple generic products such as APO-Apixaban (Apotex) and JAMP-Apixaban (JAMP Pharma Corporation) are listed by provincial drug benefit programs as alternatives to Eliquis, at lower unit prices.

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Financial assistance programs for Eliquis

There are programs that can help lower the cost of Eliquis for those who qualify.

Extra Help (Low-Income Subsidy)

Extra Help is a federal program that lowers premiums, deductibles, and copayments for people with limited income and resources. In 2026, income limits are $23,940 for individuals and $32,460 for married couples, and resource limits are $18,090 and $36,100, respectively. Beneficiaries who qualify pay $0 for plan premiums and deductibles. Each prescription costs up to $5.10 for generics and $12.65 for brand-name drugs, and once their total drug costs reach $2,100, they pay nothing.

Many people qualify automatically if they also receive Medicaid, Supplemental Security Income, or help with Part B premiums. Others can apply via Social Security or their state health insurance assistance program.

State Pharmaceutical Assistance Programs (SPAPs)

Some states offer SPAPs that supplement Part D coverage for residents with limited income. These programs vary by state. They may pay some or all of your premiums, deductibles, or copays.

The Medicare & You handbook encourages contacting your state’s Medicaid office or State Health Insurance Assistance Program (SHIP) to find out whether a program is available. Because eligibility and benefits differ widely, you should call your SHIP or visit the plan website during open enrollment.

Manufacturer assistance programs

Manufacturers often provide coupons or co-pay cards for commercially insured patients. However, Medicare beneficiaries cannot use manufacturer drug coupons while using their Part D coverage.

The Social Security Amendments of 1972 include the federal Anti-Kickback Statute, which prohibits pharmaceutical companies from offering discounts or rebates to induce Medicare beneficiaries to use certain drugs. Using a coupon or rebate with Part D coverage could encourage the choice of more expensive drugs and increase Medicare costs. Patients enrolled in Original Medicare, a Part D plan, or a Medicare Advantage plan with drug coverage cannot apply manufacturer coupons.

You may choose to pay for a prescription out of pocket using a discount card or coupon instead of your Part D coverage, but the amount you pay won’t count toward your deductible or out-of-pocket limit, and you may miss out on plan negotiation benefits.

For brand medications like Eliquis, this option is rarely cheaper than using your Part D plan because the negotiated MFP sets a maximum price.

If you don’t have any insurance, Bristol-Myers Squibb offers a Direct-to-Patient program through Eliquis 360 Support. This program offers Eliquis directly to cash-paying patients for $345 per month, which is a 40% discount from the $606 list price. Patients with Medicare Part D coverage are not eligible for this program.

However, this discounted price remains significantly higher than what patients pay in other countries. For example, in Canada, a 30-day supply of Eliquis (2.5 mg or 5 mg) costs around $157, while generic apixaban is available for as little as $89 for the same amount.

Charity patient assistance

Independent charitable foundations sometimes assist with co-pays for high-cost drugs. The Bristol-Myers Squibb Patient Assistance Foundation is an independent charity that provides certain BMS medicines free of charge to eligible patients.

Eligibility generally requires low income and being uninsured or underinsured. Because federal law prohibits manufacturers from subsidizing Medicare co-pays, such charities operate independently to avoid anti-kickback violations.

If you struggle to afford Eliquis even after Extra Help, contact a charity like Patient Access Network Foundation or check benefitscheckup.org for available grants.

Bottom line

Eliquis is a life-saving anticoagulant, and the upcoming 2026 Medicare changes may make it more affordable. With a $2,100 out-of-pocket cap and a negotiated monthly price of $231, many beneficiaries could see lower costs. While most Part D plans cover Eliquis, quantity limits may apply.

Programs like Extra Help, SPAPs, and the Medicare Prescription Payment Plan can further reduce or spread out expenses. Reviewing your plan during open enrollment and exploring assistance options can help you manage costs while maintaining access to treatment.

Frequently Asked Questions

Most Part D and Medicare Advantage plans cover Eliquis because guidelines list DOACs as first-line therapy for atrial fibrillation and VTE treatment. However, coverage details (tier, copay, quantity limits) vary, and some plans may impose prior authorization or step therapy. Always check the plan’s formulary.

Your cost depends on the plan’s premium, deductible, and copay. With the negotiated price of $231 for a 30-day supply, copays are likely to decrease. Once your total spending on covered drugs reaches $2,100, you pay nothing for the rest of the year. If you qualify for Extra Help, your cost could be as low as $12.65 per refill.

Apply for Extra Help or a SPAP. If your income exceeds those limits, discuss alternative DOACs with your doctor, and compare Part D plans for better coverage. Charitable foundations may offer co-pay assistance. Uninsured or commercially insured patients can use the BMS Direct-to-Patient program, but Part D enrollees cannot participate.

No. You must opt into the Medicare Prescription Payment Plan by contacting your insurer. Negotiated prices automatically apply to your plan. You don’t need to do anything for the MFP to take effect.

No. The Anti-Kickback Statute forbids using manufacturer coupons with Medicare coverage. You may pay cash and use a coupon instead of insurance, but that cost will not count toward your Part D deductible or out-of-pocket cap.

Other DOACs may be covered on different tiers and may have different copays. Some plans might prefer one DOAC over another. Clinical trials show similar efficacy, but side effect profiles and dosing differ. Discuss options with your doctor and review your plan’s formulary.

Related Articles

Sources

Cubanski, J., & Neuman, T. (2026, March 11). Key facts about Medicare drug price negotiation. KFF. https://www.kff.org/medicare/key-facts-about-medicare-drug-price-negotiation/?entry=table-of-contents-cms-has-concluded-two-rounds-of-drug-price-negotiation-to-date-with-estimated-savings-of-several-billion-dollars-based-on-medicare-s-negotiated-prices-relative-to-existing-net-prices

Medicare& You 2026.https://www.medicare.gov/publications/10050-medicare-and-you.pdf

Centers for Medicare and Medicaid Services. (2026, March 3). Final CY 2026 Part D Redesign Program Instructions. CMS. https://www.cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions

How much does Medicare drug coverage cost? (n.d.). Medicare. https://www.medicare.gov/health-drug-plans/part-d/basics/costs

Express Scripts Medicare (PDP) 2026 Formulary. https://www.express-scripts.com/pdf/egwp/F0PA3P6A.pdf

Blue MedicareRxSM Premier (PDP) 2026 Formulary. https://www.rxmedicareplans.com/pdf/CY/Premier_Formulary.pdf

Priority Health Medicare 2026 Formulary. https://fm.formularynavigator.com/FBO/208/2026_Individual_Medicare_Formulary.pdf

Humana Value Rx Plan (PDP) 2026 Formulary. https://assets.humana.com/is/content/humana/20260003PDG2640026Cpdf

Wellcare Value Script (PDP) 2026 Formulary. https://fm.formularynavigator.com/FBO/67/2_6T_Enhanced_PDP_Comp_Form_26195.pdf

Kaiser Permanente2026 Comprehensive Formulary. https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/formularies/medicare/2025/comprehensive-formulary.pdf

Cubanski, J., Damico, A., & Neuman, T. (2025, August 9). How Medicare’s new drug price negotiation program could expand access to selected drugs. KFF. https://www.kff.org/medicare/how-medicares-new-drug-price-negotiation-program-could-expand-access-to-selected-drugs/

Bristol Myers Squibb and Pfizer Announce Direct-to-Patient Eliquis® (apixaban) Option. (n.d.). https://news.bms.com/news/details/2025/Bristol-Myers-Squibb-and-Pfizer-Announce-Direct-to-Patient-Eliquis-apixaban-Option/default.aspx

KFF. (2025, August 11). Eliquis’s New Lower Direct-to-Consumer Price is Still Higher Than Medicare’s Negotiated Price| KFF Quick Takes. https://www.kff.org/quick-take/eliquiss-new-lower-direct-to-consumer-price-is-still-higher-than-medicares-negotiated-price/

Zong, D. (2025, February 14). Medicare beneficiaries face much higher drug costs as plans quickly shift to Coinsurance. USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences. https://mann.usc.edu/news/medicare-beneficiaries-face-much-higher-drug-costs-as-plans-quickly-shift-to-coinsurance/

Trish, E., Blaylock, B., & Van Nuys, K. (2025). Cost sharing for preferred branded drugs in Medicare Part D. JAMA, 333(13), 1170. https://doi.org/10.1001/jama.2024.28092