Does Medicare Cover Eliquis?

For a long time, the Eliquis question was a simple one: yes, Medicare covers it, and it’s expensive. The expensive part was the punchline. A blood thinner that costs $530+ per month felt out of step with what a daily prescription should cost a 75-year-old on a fixed income, but for years that was the deal.

Starting in January 2026, the deal changed. Eliquis became one of the first ten drugs whose price Medicare directly negotiated under the authority granted by the 2022 Inflation Reduction Act. The negotiated price — known as the Maximum Fair Price — is meaningfully lower than the prior list price. Whether you’ll feel that change in your monthly out-of-pocket cost depends on your plan, but for the system as a whole, this is the biggest structural change to anticoagulant coverage in two decades.

What Eliquis is for, and why nearly half of all Medicare patients with AFib end up on it

Eliquis is the brand name for apixaban, a direct oral anticoagulant — DOAC for short — manufactured by a Bristol-Myers Squibb / Pfizer collaboration. It’s prescribed to:

• Reduce the risk of stroke and systemic embolism in adults with non-valvular atrial fibrillation
• Treat deep vein thrombosis and pulmonary embolism
• Reduce the risk of recurrent DVT and PE following initial therapy
• Prevent DVT in patients undergoing hip or knee replacement surgery

Atrial fibrillation is the most common reason Medicare patients are on Eliquis. Roughly one in nine adults over 65 has AFib, and current clinical guidelines strongly favor DOACs over warfarin for stroke prevention in most AFib patients. Eliquis specifically has a track record of slightly fewer major bleeding events compared with other DOACs, which is why many cardiologists default to it.

If you’re newly diagnosed with AFib at 70 and your cardiologist starts you on a blood thinner, statistically there’s a high chance the prescription is for Eliquis.

Coverage under Part D — the basic structure

Every standalone Medicare prescription drug plan and every Medicare Advantage plan with drug coverage includes Eliquis on its formulary. It’s almost always on Tier 3 — preferred brand. Prior authorization is uncommon for Eliquis (unlike specialty drugs); plans generally let prescribers prescribe it without requiring a PA form.

Your monthly cost depends on:

• Plan deductible: Most 2026 Part D plans have a deductible up to $590. Eliquis usually counts toward the deductible at full negotiated price for the first fill.
• Tier 3 cost-sharing: After the deductible, you pay a Tier 3 copay or coinsurance. Typical flat copay: $40–$50/month. Typical coinsurance: 25% of the negotiated price.
• Annual out-of-pocket cap: $2,000/year on covered Part D drugs starting in 2025. Once you hit it, you pay $0 for the rest of the year.

For a typical AFib patient on Eliquis as their only major brand medication, monthly out-of-pocket usually settles around $40–$50 after the deductible, with the cap rarely being hit on Eliquis alone.

What changes in 2026 with the negotiated price

This is the part that’s actually new.

In August 2024, CMS announced negotiated prices for ten drugs as part of the first round of Medicare Drug Price Negotiation. Those prices took effect on January 1, 2026. Eliquis was on the list. The negotiated price (CMS’s “Maximum Fair Price”) is approximately $231 per 30-day supply, down from a prior list price north of $521.

Here’s what that means in practice:

• Plans that use coinsurance: If your Part D plan charges 25% coinsurance for Eliquis on Tier 3, your monthly cost drops from roughly $130 to about $58.
• Plans that use flat copays: Your $45 monthly copay probably doesn’t change. The savings flow to the plan and, indirectly, to all beneficiaries through reduced premiums.
• Plans without your Tier 3 coverage: Some niche or low-premium plans don’t cover Eliquis on Tier 3 at all; for those, the negotiated price will only kick in if the plan adopts it.

The negotiated price also matters more if you fall into the deductible phase. During the deductible, you pay the full negotiated price, so the $231 figure replaces the $521 figure for that period.

How the IRA reshaped Eliquis economics overall

Beyond the negotiated price, the broader Inflation Reduction Act changes have reshaped the economic experience for Medicare Eliquis users:

• 2024: 5% catastrophic coinsurance was eliminated.
• 2025: $2,000 annual out-of-pocket cap took effect. Prescription Payment Plan option launched (you can spread the $2,000 across the year as monthly installments).
• 2026: First negotiated prices kick in for Eliquis and nine other drugs.

Stacking those changes: a typical Eliquis patient in 2024 might have spent $1,200 per year out of pocket. The same patient in 2026 might spend $400. That’s not marketing copy; it’s the actual structural impact of layered IRA changes on a 30-day fill of the same prescription.

Generic apixaban — the next thing to watch

Eliquis is on patent. There’s been ongoing patent litigation between Bristol-Myers Squibb and several generic manufacturers, and the patent expiration timeline shifts based on how that litigation resolves. As of mid-2026, no generic apixaban is approved for the U.S. market.

When generic apixaban does launch — likely in late 2028 or 2029 — expect a meaningful drop in costs across all Part D plans. Generics are typically priced at 30–50% of the brand price within months of launch, and as competition increases that drops further. Generic apixaban will likely sit on Tier 2 of Part D formularies, with copays in the $5–$15 range for most patients.

Practical tips for Eliquis on Medicare in 2026

A few things that come up regularly:

• Use your plan’s preferred pharmacy. The preferred pharmacy network discount on Eliquis is real — typically $10–$20 per fill cheaper than a non-preferred pharmacy.
• Consider 90-day supplies. Many Part D plans offer 90-day supplies through mail order at a discount. For a maintenance medication you’ll be on long-term, this usually saves money.
• Ask about the Prescription Payment Plan. Started in 2025, this lets you spread the $2,000 annual cap across monthly payments instead of paying it all up front. Useful if your Q1 deductible-plus-Tier 3 costs strain your budget.
• Confirm dose adjustment for kidney function. Particularly relevant for patients 75+ — the standard 5 mg twice-daily dose drops to 2.5 mg twice-daily if you meet two of three criteria. Wrong dosing increases bleeding risk and is a common error.

Bottom line

Eliquis is fully covered by Medicare Part D for AFib stroke prevention and venous thromboembolism. Starting in January 2026, the negotiated price reduces what Medicare and many beneficiaries pay for it, with the practical impact varying by plan structure. Combined with the new $2,000 annual cap, Eliquis is more affordable on Medicare in 2026 than it has been at any point since launch — though the brand’s patent status means the truly low generic prices are still a couple years away.