Table of Contents

In the US, Eliquis (apixaban) is one of the highest-spending drugs in Medicare, with $12.6 billion spent, more than any other medication.

Because of this financial strain, many patients are asking when a generic will become available to help lower costs. In 2024, generics made up 90% of all prescriptions but only 12% of total drug spending. Brand drugs were just 10% of prescriptions, yet accounted for 88% of all costs.

However, generic apixaban is still not available in US pharmacies, even though the FDA has already approved several generic versions.

Let’s look at why the delay happened, which companies are expected to manufacture generic apixaban, what pricing may look like, and what your options are until generics reach the market.

Key Takeaways

  • FDA-approved generic versions of apixaban already exist, but patents, settlements, and regulatory exclusivities prevent them from being sold in US pharmacies for now.
  • Based on court decisions and company settlements, generic Eliquis is unlikely to be broadly available in the US before 2028, with a more competitive multi-generic market probably emerging between 2028 and 2029.
  • Other countries, including Canada, already have generic versions of apixaban on the market.
  • Once generics finally launch in the US, historical experience with other drugs suggests that prices will fall, perhaps modestly at first and more sharply as multiple competitors enter.
  • Until then, you can talk to your clinician about other DOACs, generic dabigatran, or warfarin, or you can also look into assistance programs and Medicare updates that may help lower your Eliquis costs.

Is generic Eliquis available in the US right now?

There is no generic apixaban available in US retail pharmacies yet, even though the FDA has already approved generic apixaban tablets from at least two manufacturers.

Micro Labs Limited and Mylan Pharmaceuticals (now part of Viatris) received approvals in December 2019 after showing their tablets are bioequivalent and therapeutically equivalent to brand Eliquis.

Those approvals are either tentative or blocked from full effect because of active Eliquis patents and exclusivity. In one FDA approval letter for apixaban tablets, the agency states that the generic meets safety and effectiveness standards but can only receive tentative approval until patent issues are resolved.

Generic apixaban does exist in other countries

One of WHO’s major health targets this 2025 is improving access to direct oral anticoagulants (DOACs), like apixaban, to reduce early deaths from noncommunicable diseases by 25%. 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.

Why the FDA approval alone is not enough

FDA approval means the generic met the scientific standards for quality, safety, and equivalence. The generic must have the same active ingredient, strength, dosage form, and route.

It must pass bioequivalence testing that usually requires the 90% confidence interval for exposure measures to fall within the 80% to 125% range compared with the brand.

Patent and exclusivity rights are separate from that scientific decision. A company can hold patents on:

    • the active molecule
    • particular formulations
    • methods of use
    • regulatory exclusivities like pediatric exclusivity

These rights allow the brand to block sales of generics even after those generics earn FDA approval. That is exactly what is happening with Eliquis today.

When is generic Eliquis expected to be released in the US?

April 2028 is widely cited as the earliest generic entry date for apixaban tablets in the US.

In 2020, Eliquis’ manufacturers, Bristol-Myers Squibb (BMS) and Pfizer, won a patent case. Because they won, generic drug companies that were part of that lawsuit were not allowed to launch generic apixaban until 2031.

In 2021, a higher court, the Federal Circuit Court of Appeals, reviewed the 2020 decision and agreed with it. However, the court’s ruling clarified the enforceable patent expiry date more precisely.

The court stated:

    • The earliest a generic apixaban can legally launch is April 1, 2028.
    • This is still subject to additional appeals or future challenges.

The valid patents, specifically the “composition of matter” patent and the “formulation” patent, effectively protect Eliquis until 2028.

Some exclusivities related to pediatric indications and strengths extend into late 2028, so certain formulations may remain brand-only until those periods end.

How much will generic apixaban cost once released?

According to an analysis, generic drugs entering the market between 2011 and 2013 reduced prices much faster than those from earlier years. Prices dropped 74% within just 8 months and 90% within 2.5 years.

Recent oral generics became 46% cheaper in month one, while older generics (2002-2004) only became 36% cheaper in month one.

Why prices keep dropping

Generic prices fall depending on how many companies compete and how low they price their versions. Sometimes the first generic gets 180 days of exclusivity, where no other generics can launch. During this period, prices do not drop as fast, which is why the price curve flattens for the first six months.

After more generics enter, competition intensifies, and prices fall much faster.

In a 2021 US study, drug prices dropped more as additional generic manufacturers entered the market.

    • With about 3 competitors, prices fell 20% (paying about 80% of the old brand price).
    • With 10+ competitors (2 years after entry), prices fell 70% to 80% (paying 30% of the old brand price).
    • 3 years after entry, prices dropped even further, to about 20% of the original brand price.

The longer generics are on the market, the steeper the price drop.

    • At 2 years, the expected price is equal to 30% of the original brand price
    • At 3 years, the expected price is equal to 20% of the original brand price

This happens because more generics enter over time, increasing competition.

Why is Eliquis so expensive in the US compared to other countries

Unlike many high-income countries, the US does not have a single national body that negotiates drug prices for all residents. Historically, federal law even barred Medicare, the main insurer for older adults, from directly negotiating prices for most outpatient drugs, although the Inflation Reduction Act is now changing that for a small group of high-spend medications such as Eliquis.

Instead,

    • Manufacturers set list prices.
    • Pharmacy benefit managers and insurers negotiate confidential rebates and discounts.
    • Different plans pay different net prices.

This structure tends to keep list prices high. Manufacturers often argue that high US prices help fund research and development, while critics point out that Americans pay far more than patients in other wealthy countries for many of the same drugs.

How Canada and Europe control prices

Canada and most European countries structure pricing very differently. Public agencies or national health plans negotiate prices directly with manufacturers. Drug review bodies assess cost-effectiveness and can refuse to cover medicines that are not considered good value at a given price.

Some countries even use international reference pricing, which compares prices to what other countries pay.

In Canada, for example, the Patented Medicine Prices Review Board (PMPRB) monitors and limits the prices of patented drugs, and provincial drug plans negotiate further discounts for public formularies. As a result, many brand drugs, including Eliquis, are meaningfully cheaper there than in the US.

apixaban coupons and discounts

Starting from $89

Ready to Buy Apixaban Online?

Choose Pharma Giant for affordable medications and take control of your health today!

SAVE 10% with coupon code:

Are there cheaper alternatives to Eliquis until the generic arrives?

Here are some of the main alternatives often considered in the US:

1. Xarelto (rivaroxaban)

Xarelto is another DOAC used for atrial fibrillation and the treatment or prevention of venous thromboembolism. The large ROCKET AF trial in patients with atrial fibrillation found that rivaroxaban was non-inferior to warfarin for preventing stroke or systemic embolism and had similar rates of major bleeding, with less intracranial hemorrhage but more gastrointestinal bleeding.

On March 3, 2025, the FDA approved the first generic version of Xarelto, rivaroxaban 2.5 mg tablets. Other strengths may come later as additional patents or exclusivities expire and more generics are approved.

Generic rivaroxaban, across all major dosage strengths, is already authorized and available in certain markets outside the US, such as Canada.

Pros

    • Once-daily dosing for atrial fibrillation, which some people find easier than twice-daily schedules.
    • Extensive experience in real-world practice.

Cons

    • List prices are similar to Eliquis in the US, so switching does not always bring big savings unless a specific insurance plan favors rivaroxaban on its formulary.
    • Some studies suggest a higher rate of adverse events compared with apixaban, especially in older or frailer patients, although absolute risks depend on the individual.

2. Pradaxa (dabigatran)

Pradaxa was the first DOAC approved for stroke prevention in nonvalvular atrial fibrillation. The RE-LY trial showed that dabigatran 150 mg twice daily reduced stroke and systemic embolism more than warfarin, with similar or lower rates of major bleeding and lower intracranial bleeding.

Generic dabigatran is already available in the US. Generic capsules were first launched in 2022, and several manufacturers now sell them.

Pros

    • Generic status often makes dabigatran cheaper than Eliquis at cash prices and under some insurance plans.
    • A specific reversal agent, idarucizumab, is available for life-threatening bleeding or urgent surgery.

Cons

    • Twice-daily dosing.
    • Higher rates of gastrointestinal side effects, such as dyspepsia and, in some analyses, more gastrointestinal bleeding than warfarin.

3. Savaysa (edoxaban)

Edoxaban is another factor Xa inhibitor approved for stroke prevention in atrial fibrillation and for venous thromboembolism. The ENGAGE AF TIMI 48 trial found that edoxaban was non-inferior to warfarin for the prevention of stroke or systemic embolism and produced less major bleeding.

Savaysa is often chosen when there is a specific reason, such as intolerance to other DOACs.

Pros

    • Once-daily dosing.
    • Lower rates of major bleeding than warfarin in the pivotal trial.

Cons

    • No US generic yet, and list prices are usually similar to other brand DOACs.

4. Warfarin

Warfarin is the long-standing anticoagulant that predates DOACs. It remains widely used and very inexpensive because multiple generics exist. For some patients, especially those with mechanical heart valves or very severe kidney disease, warfarin remains the standard.

Pros

    • Very low generic cost, often just a few dollars per month with discount programs.
    • Reversal strategies, such as vitamin K and prothrombin complex concentrates, are well known and available.

Cons

    • Many food and drug interactions, including leafy green vegetables, some antibiotics, and other medicines.
    • In trials such as ARISTOTLE and others, DOACs, including apixaban, generally had lower risks of intracranial hemorrhage and similar or better protection against stroke compared with warfarin.

Other ways to save without switching medicines

Even before generic Eliquis becomes available, there are ways to reduce costs without changing drugs:

  • Manufacturer co-pay cards for commercially insured patients can reduce out-of-pocket costs to as little as about $10 per month for some individuals, up to specified yearly limits.
  • The Bristol Myers Squibb Patient Assistance Foundation may provide free medication to eligible uninsured or underinsured patients who meet income criteria.
  • Medicare beneficiaries with limited income can apply for Extra Help, which can markedly lower Part D premiums and co-pays.
  • The Eliquis 360 Support program now lets some cash-pay patients buy Eliquis directly at a discounted rate more than 40% lower than the list price, although eligibility rules apply.

A pharmacist can often review your insurance plan, discount cards, and assistance options to see whether any of these programs can bring down monthly costs while remaining on Eliquis.

Bottom Line

Right now, you still can’t buy generic apixaban in US pharmacies because Eliquis remains protected by patents until at least April 2028. Even though generics are already approved and sold in other countries, they can’t launch in the US yet. Once they do, prices should drop quickly as more manufacturers enter the market.

Until then, you may be able to save by considering other anticoagulants or using co-pay cards, assistance programs, or Medicare support. Understanding your options now can help you manage costs while you wait for true generics to become available.

Related Articles

Frequently Asked Questions

You may qualify for a manufacturer Co-Pay Card or discount program from the makers of Eliquis that can reduce the cost to as little as $10 per 30-day supply, but this applies only if you have commercial insurance (not Medicare/Medicaid).

Yes. Any generic that receives FDA approval must first pass strict bioequivalence studies, which confirm that it delivers the same amount of medication into the bloodstream and works the same way as the brand version. These studies follow FDA standards and are supported by extensive clinical literature showing that bioequivalent drugs produce the same therapeutic effect and safety profile as their brand counterparts.

With Medicare Part D or Medicare Advantage drug coverage, typical out-of-pocket costs for Eliquis average around $40-$54 per month, though the actual amount depends on your specific plan, deductible, and coverage tier. Some beneficiaries who qualify for Extra Help or low-income subsidies may pay as little as $0-$12.15 per month.

The duration of Eliquis therapy depends heavily on the condition being treated. For example, in chronic conditions such as non-valvular atrial fibrillation, many patients stay on it indefinitely or until a doctor advises otherwise. Clinical guidelines often recommend long-term anticoagulation when the risk of stroke or clot is ongoing. Because of bleeding risks, periodic re-evaluation is typical, but there’s no fixed standard duration that fits all patients.

If you are uninsured or underinsured, you may qualify for help from the charitable Bristol Myers Squibb Patient Assistance Foundation (BMSPAF) or other manufacturer-linked assistance programs. Eligibility typically requires proof of limited income/resources, though exact thresholds vary and are not always publicly specified. Patients interested in assistance must apply, often via their doctor or directly through the program.

Sources

Buchholz, K. (2023, August 29). The Ever-Increasing cost of Medicare drugs. Statista Daily Data. https://www.statista.com/chart/30695/expensive-medicare-drugs-price-increases/

Association for Accessible Medicines. (2025, September 5). 2025 Generic and Biosimilar Medicines Savings Report Highlights Value and Vulnerability | Association for Accessible Medicines. https://accessiblemeds.org/resources/blog/2025-generic-and-biosimilar-medicines-savings-report-highlights-value-and-vulnerability/

FDA. (2020, February 14). 2019 First generic drug approvals. U.S. Food And Drug Administration. https://www.fda.gov/drugs/first-generic-drug-approvals/2019-first-generic-drug-approvals

Neumann, I., Schünemann, H. J., Bero, L., Cooke, G., Magrini, N., & Moja, L. (2021). Global access to affordable direct oral anticoagulants. Bulletin of the World Health Organization, 99(9), 653–660. https://doi.org/10.2471/BLT.20.278473

The Bristol-Myers Squibb-Pfizer Alliance is pleased with the U.S. District Court decision to uphold both the composition of matter (COM) patent (US 6,967,208) and formulation patent (US 9,326,945) covering Eliquis®. | Pfizer. (n.d.). https://www.pfizer.com/news/press-release/press-release-detail/bristol-myers-squibb-pfizer-alliance-pleased-us-district

The Bristol-Myers Squibb-Pfizer Alliance is pleased with the decision by the U.S. Court of Appeals for the Federal Circuit upholding the Eliquis®Patents | Pfizer. (n.d.). https://www.pfizer.com/news/announcements/bristol-myers-squibb-pfizer-alliance-pleased-decision-us-court-appeals-federal

FDA. (2023, October 26). Small Business Assistance | 180-Day generic drug exclusivity. U.S. Food And Drug Administration. https://www.fda.gov/drugs/cder-small-business-industry-assistance-sbia/small-business-assistance-180-day-generic-drug-exclusivity

Nguyen, N. X., Sheingold, S. H., Tarazi, W., & Bosworth, A. (2021). Effect of competition on generic drug prices. Applied Health Economics and Health Policy, 20(2), 243–253. https://doi.org/10.1007/s40258-021-00705-w

Patel, M. R., Mahaffey, K. W., Garg, J., Pan, G., Singer, D. E., Hacke, W., Breithardt, G., Halperin, J. L., Hankey, G. J., Piccini, J. P., Becker, R. C., Nessel, C. C., Paolini, J. F., Berkowitz, S. D., Fox, K. A., & Califf, R. M. (2011). Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. New England Journal of Medicine, 365(10), 883–891. https://doi.org/10.1056/nejmoa1009638

FDA. (2025, October 23). First generic drug approvals. U.S. Food And Drug Administration. https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/first-generic-drug-approvals

Earwood, J. S., Wilkie, J. L., & Fernandez-Vasquez, J. L. (2022). Which anticoagulant is safest for frail elderly patients with nonvalvular A-fib?. The Journal of family practice, 71(9), 407–409. https://doi.org/10.12788/jfp.0509

Ezekowitz, M. D., Nagarakanti, R., Noack, H., Brueckmann, M., Litherland, C., Jacobs, M., Clemens, A., Reilly, P. A., Connolly, S. J., Yusuf, S., & Wallentin, L. (2016). Comparison of dabigatran and warfarin in patients with atrial fibrillation and valvular heart disease. Circulation, 134(8), 589–598. https://doi.org/10.1161/circulationaha.115.020950

Giugliano, R. P., Ruff, C. T., Braunwald, E., Murphy, S. A., Wiviott, S. D., Halperin, J. L., Waldo, A. L., Ezekowitz, M. D., Weitz, J. I., Špinar, J., Ruzyllo, W., Ruda, M., Koretsune, Y., Betcher, J., Shi, M., Grip, L. T., Patel, S. P., Patel, I., Hanyok, J. J., . . . Antman, E. M. (2013). Edoxaban versus Warfarin in Patients with Atrial Fibrillation. New England Journal of Medicine, 369(22), 2093–2104. https://doi.org/10.1056/nejmoa1310907

Yu, H. T., Yang, P., Kim, T., Jang, E., Kim, D., Uhm, J., Kim, J., Pak, H., Lee, M., Lip, G. Y., & Joung, B. (2018). Impact of renal function on outcomes with edoxaban in Real-World patients with atrial fibrillation. Stroke, 49(10), 2421–2429. https://doi.org/10.1161/strokeaha.118.021387

Granger, C. B., Alexander, J. H., McMurray, J. J., Lopes, R. D., Hylek, E. M., Hanna, M., Al-Khalidi, H. R., Ansell, J., Atar, D., Avezum, A., Bahit, M. C., Diaz, R., Easton, J. D., Ezekowitz, J. A., Flaker, G., Garcia, D., Geraldes, M., Gersh, B. J., Golitsyn, S., . . . Wallentin, L. (2011). Apixaban versus Warfarin in Patients with Atrial Fibrillation. New England Journal of Medicine, 365(11), 981–992. https://doi.org/10.1056/nejmoa1107039