Medicare 2026

Eliquis and Xarelto Under Medicare in 2027: What the Negotiated Prices Mean for You

Blood thinners like Eliquis (apixaban) and Xarelto (rivaroxaban) are among the most widely used prescription drugs in Medicare. If you or someone you care for takes one of them, there's meaningful news to understand heading into 2027: both drugs now have a Medicare "negotiated price," and the Part D out-of-pocket cap is going up to $2,400. Here's what that actually means at the pharmacy counter, and how coverage works.

What the negotiated prices are

Under Medicare's drug price negotiation program, Eliquis and Xarelto each have a "maximum fair price" that took effect January 1, 2026. For a 30-day supply, that price is $231 for Eliquis (down from a 2023 list price of $521) and $197 for Xarelto (down from $517). These two drugs reach a lot of people: about 3.9 million Part D enrollees used Eliquis in 2023, and about 1.3 million used Xarelto.

A negotiated price stays in place as long as the drug remains in the program. After the first year, it is adjusted annually by the change in the Consumer Price Index (CPI-U), and CMS publishes the updated figures.

What the negotiated price is — and isn't

This is the point most worth understanding: the negotiated price is the price the manufacturer must make the drug available at to Medicare and to the pharmacies that dispense it. It is not your copay.

What you actually pay at the pharmacy still depends on your specific Part D plan:

• Whether you've met the plan's deductible (no Part D plan may charge more than $700 as a deductible in 2027).
• What tier the drug sits on in your plan's formulary.
• The cost sharing (copay or coinsurance) your plan assigns to that tier.
• Whether you qualify for Extra Help (the low-income subsidy).

Because of this, two people on the same medication can pay different amounts depending on the plan they're enrolled in. The negotiated price pulls down the underlying cost of the drug, which generally helps, but the member experience will vary plan by plan.

By law, both stand-alone Part D plans and Medicare Advantage plans that include drug coverage must list the drugs with negotiated prices on their formularies. So you can expect Eliquis and Xarelto to be covered — but check the tier and any rules (like prior authorization or step therapy) in your specific plan.

The 2027 out-of-pocket cap

Part D now has a hard annual ceiling on what you pay out of pocket for covered Part D drugs. For 2027, that cap is $2,400 (up from $2,100 in 2026). Once your own spending on covered drugs reaches $2,400, you pay nothing more for covered Part D drugs for the rest of the calendar year.

For people on long-term anticoagulants, this cap can be a significant financial guardrail — especially combined with the lower negotiated prices.

Separately, the Part D base beneficiary premium for 2027 is $41.33. That's a national figure used in calculating the late-enrollment penalty; actual plan premiums are set by each plan and vary.

Original Medicare + Medigap vs. Medicare Advantage

Both paths cover these drugs through Part D, but they work differently, and neither is "better" in the abstract:

• Original Medicare + a stand-alone Part D plan (often with Medigap): You generally see any provider that accepts Medicare, and Medigap can help with Part A and B cost sharing. Drug coverage is a separate Part D plan you pick.
• Medicare Advantage with drug coverage: Medical and drug coverage are bundled, often with extra benefits, but you typically use the plan's provider network and follow its rules.

Trade-offs include network flexibility, monthly premiums, out-of-pocket exposure, extra benefits, and how prior authorization is handled. The right fit depends on your doctors, your medications, your budget and your preferences.

If you have Medicaid or Extra Help

Since 2025, people with Medicaid or Extra Help have a monthly Special Enrollment Period to move to Original Medicare with a stand-alone Part D plan — or to switch from one stand-alone Part D plan to another. If you're a full-benefit dual-eligible, you can join an integrated D-SNP in any month. You don't have to wait for a specific window.

What to do before January 1, 2027

• Read your Annual Notice of Change (ANOC). Your current plan sends it in the fall. It shows your 2027 formulary tier for Eliquis or Xarelto, deductible, cost sharing and any rule changes.
• Compare plans during Open Enrollment, October 15 – December 7, 2026. Changes take effect January 1, 2027. The Plan Finder at Medicare.gov lets you enter your drugs and pharmacy and see estimated annual costs.
• Confirm Part B figures when announced. CMS publishes the 2027 Part B standard premium and deductible, along with the IRMAA income brackets, in the fall — usually November. For context on benefit amounts, the Social Security Administration announced a 3.6 percent COLA for benefits payable beginning January 2027.

Where to go for help

For official plan details, formularies and enrollment, use Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24/7. Your plan's member services line can confirm the 2027 tier and cost sharing for your specific medication.