How Much Does Eliquis Cost with Medicare?

Summary: Eliquis is a popular blood thinner that helps many seniors to lower their risk of blood clots and stroke. It is also pretty costly. Learn how much your Eliquis prescription will cost with Medicare and how you can get coverage for this important drug. Estimated Read Time: 7 mins

Table of Contents:

1. Does Medicare Cover Eliquis?
2. How Much Does Eliquis Cost with Medicare Part D?
3. Eliquis Under Medicare Part D Drug Negotiations
4. How Much Does Eliquis Cost with Medicare Advantage?
5. Medicare Prior Authorization for Eliquis
6. Medicare Step Therapy for Eliquis
7. Can I Receive Help Paying for Eliquis with Medicare?
8. How to Receive Coverage for Eliquis with Medicare

Eliquis is one of many FDA-approved drugs that can help reduce the risk of major blood clots and lower your risk of stroke. It is a direct factor Xa inhibitor drug that sees wide use by seniors in the United States. If you are one of the many Medicare enrollees with an Eliquis prescription, it is essential to understand how your coverage will affect what you pay each month for drug coverage.

Does Medicare Cover Eliquis?

If you are on Original Medicare, you might wonder how your plan covers the popular drug Eliquis. This drug is prescribed to treat and prevent vascular conditions that are common in seniors. These conditions include:

• Atrial Fibrillation (AFib)
• Pulmonary embolism
• Deep vein thrombosis
• Blood clots
• Ischemic stroke

Your Medicare drug coverage for Eliquis will depend on the Medicare prescription drug plan you choose. When it comes to drug coverage, Medicare has several different options available.

Medicare Part A will cover Eliquis when it is prescribed as part of an inpatient hospital stay and is administered by a physician. Medicare Part D prescription drug coverage will cover Eliquis if it’s on your Part D plan’s formulary, which is the list of the plan’s covered drugs. Medicare Advantage (Medicare Part C) plans may also have drug coverage that includes Eliquis. However, keep in mind not all Medicare Advantage plans offer drug coverage, so you’ll want to be sure your plan offers drug benefits and that Eliquis is under the plan’s formulary.

When prescribed, you are often instructed to take Eliquis twice daily. Taking a double dose of medication can lead to higher costs, which can in turn, create a financial burden for patients – especially those on a fixed income.

To combat these high prescription costs, several options are available through Medicare and outside resources to help you cover the cost of Eliquis and other Xa inhibitor medications.

How Much Does Eliquis Cost with Medicare Part D?

The average Medicare Part D enrollee will have an average of nine private insurance companies and close to 24 individual plans to choose from in 2023. All 24 Medicare Part D plans offer coverage for the popular drug, Eliquis. However, the copayment, deductible, and monthly premium you will have to pay differs from plan to plan.

Thus, the plan you choose can make a huge difference in what you pay for your drugs. When enrolling in any insurance coverage, it is essential to review all your options and compare your total out-of-pocket costs before making assumptions and hastily enrolling in a plan.

Eliquis Under Medicare Part D Drug Negotiations

The Inflation Reduction Act was signed into law by President Joe Biden in 2022. The law is meant to help ease the financial burden caused by inflation for millions of Americans. One major way the Inflation Reduction Act is going to help you save money is through Medicare Part D price negotiations. The law gives Medicare the power to negotiate and lower prices for costly, widely used drugs that many Medicare beneficiaries need.

In September 2023, the Centers for Medicare and Medicaid (CMS) announced the first ten drugs up for price negotiation, and one of them is Eliquis.

Of the ten medications up for negotiation so far, Eliquis is the most used among Medicare Part D enrollees. Eliquis alone costs Medicare billions of dollars each year, so if the high cost can be negotiated down, it will reduce spending for the Medicare program and for you.

It’s still undetermined how much the cost of Eliquis will come down. Price negotiations for Eliquis will continue until August 1, 2024, and CMS will publish the final negotiated prices by September 1 of that same year. However, the new pricing won’t go into effect until January 1, 2026.

How Much Does Eliquis Cost with Medicare Advantage?

If you decide a Medicare Advantage plan is the best option for your insurance coverage, you should review your plan’s drug benefits as well as health benefits.

Not all Medicare Advantage plans offer drug benefits, and the ones that do each have a unique drug formulary. In 2023, the average Medicare recipient has 35 Medicare Advantage prescription drug plans from which to choose. Finding the right plan is essential when you require specialty drugs like Eliquis.

Like Medicare Part D plans, the option you choose will greatly impact your annual costs. However, with a Medicare Advantage plan, you also must factor in the health insurance benefits and costs as well.

Medicare Prior Authorization for Eliquis

Eliquis is a brand-name drug. This means it lives in a higher drug tier on all Medicare prescription drug plans and has a higher out-of-pocket cost than other drugs. Because of this, your insurance carrier may require you to go through prior authorization before you can receive coverage for the prescription.

Prior authorization allows the insurance company to audit the medical necessity of treatment before you receive the care to ensure acceptance of your claim after the bill’s creation. This helps save you time and out-of-pocket costs in the event of a claim denial. Essentially, prior authorization allows you to know your costs before your claim exists.

When it comes time for the approval of your prior authorization, you can pick up your medication and begin treatment.

Medicare Step Therapy for Eliquis

In some cases, once your claim goes through the prior authorization process, your insurance company may ask you to try step therapy before using higher-tier drugs like Eliquis. Step therapy allows you to try similar drugs at lower price points.

Certain plans require step therapy before you are eligible for coverage for brand-name drugs. You can see if your plan requires this by using the Medicare Part D Plan Finder Tool. If necessary, your physician will submit the proper paperwork to your pharmacy, and your step therapy process will begin.

Can I Receive Help Paying for Eliquis with Medicare?

Unfortunately, brand-name drugs like Eliquis can become expensive. For many, this is the only drug option available to treat their conditions. Thus, the high cost can become a burden to those who require treatment.

To save money on prescription drug costs, many people prefer to take the generic versions of medications. To become FDA-approved, generic medications must provide the same results and use the same or similar formula as their brand-name counterpart. In 2019, the U.S. Food and Drug Administration (FDA) approved Apixaban as a generic form of Eliquis. However, Apixaban will not hit the market for consumers until 2026.

Current ways to lower your costs for Eliquis include coupons, manufacturer rebates, free samples, and the Medicare Extra Help program for those who qualify.

If you are struggling to cover your monthly Eliquis costs, your healthcare provider or pharmacist may be able to help find options to cover those costs.

Medicare Coverage of Eliquis FAQs

How to Receive Medicare Coverage for Eliquis

If you are receiving Medicare benefits and require Eliquis, you may be scrambling to find coverage or need help with your out-of-pocket responsibility. This is where the agents at MedicareFAQ come in to help. Our agents are well-versed in reviewing coverage options and will help you find the best plan for your needs in your area.

We are here to help you find the right plan. To begin your free side-by-side Medicare plan comparison, complete our no-obligation online rate form or give us a call today at the number above.

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