Does Medicare cover Eliquis?

Does Medicare Part D cover Eliquis?

Yes. Eliquis is one of the drugs covered under Medicare Part D that CMS selected for the first cycle of Medicare drug price negotiation. CMS says that, as required by law, Medicare prescription drug plans, including standalone Part D plans and Medicare Advantage plans with drug coverage, must include on their formularies the selected drugs for which CMS and the drug company have agreed to a negotiated price. CMS says it will use its comprehensive formulary review process to assess any practices that may undermine access to selected drugs.

Your plan may still have rules for the drugs you take, such as prior authorization, step therapy or quantity limits, so check with your plan to find out its specific coverage rules.

What does Medicare's negotiated price for Eliquis mean for me?

Medicare's negotiated price for Eliquis, which the law calls a maximum fair price, took effect January 1, 2026. The drug company must make the negotiated price available to people eligible for it and to the pharmacies, mail-order services and other entities that dispense the drug. Medicare.gov says to contact your plan for details on how negotiated prices might affect you.

The negotiated price applies as long as Eliquis remains in the Medicare Drug Price Negotiation Program. For each year after the first, CMS publishes an updated negotiated price equal to the previous year's price increased by the yearly percentage increase in the Consumer Price Index for all urban consumers (CPI-U). See which drugs have Medicare negotiated prices.

What do I pay for Eliquis with a Medicare drug plan?

What you pay depends on your plan's premium, deductible and the copayment or coinsurance for the tier the plan puts Eliquis on. No Medicare drug plan may have a deductible more than $615 in 2026 ($700 in 2027), and some plans have no deductible.

Generally, after the deductible you pay 25% of the cost as coinsurance for generic and brand-name drugs until your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027). Then you won't have to pay out of pocket for covered Part D drugs for the rest of the calendar year.

Can I get help paying for Eliquis?

Extra Help is a Medicare program that helps pay drug costs. You automatically qualify for Extra Help if you qualify for Medicaid, one of the Medicare Savings Programs, or Supplemental Security Income (SSI); if you don't automatically qualify, you can apply. See how to get help paying for Medicare.

The Medicare Prescription Payment Plan works with your Medicare drug coverage to spread your out-of-pocket costs for covered drugs across the calendar year. It might help you manage monthly expenses, but it doesn't save you money or lower your drug costs.

Does Medicare Advantage or Medigap change Eliquis coverage?

Most Medicare Advantage plans include Medicare drug coverage (Part D), and CMS's formulary rule for negotiated drugs applies to Medicare Advantage plans with drug coverage as well as standalone drug plans. Medicare Advantage plans with drug coverage generally have the same Part D coverage stages; other rules and costs vary by plan.

Medigap plans sold after 2005 don't include prescription drug coverage. With Original Medicare, you can join a separate Medicare drug plan (Part D) to get drug coverage. Drugs you get as a hospital inpatient during a covered stay are generally covered by Part A as part of your inpatient treatment.

What if my plan limits my Eliquis prescription?

You or your prescriber can ask your plan for an exception to a rule like prior authorization, step therapy or a quantity limit; for prior authorization and step therapy exceptions, your prescriber must provide a supporting statement. When you're in a plan, you have the right to a coverage determination to see if a drug is covered, and if you disagree with the plan's decision, you, your representative or your prescriber can appeal within 65 days from the date on the plan's denial notice. See how to appeal a Medicare decision.