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Eliquis is an anticoagulant used to lower the chance of stroke in people with atrial fibrillation. Most Medicare prescription drug plans cover Eliquis.
Eliquis (apixaban) is covered by most Medicare prescription drug coverage plans.
Eliquis is an anticoagulant used to lower the chance of stroke in people with atrial fibrillation (AFib), a common type of irregular heartbeat (arrhythmia). It’s also used to prevent or treat blood clots in the legs, also known as deep vein thrombosis, and blood clots in your lungs, or pulmonary embolisms.
Keep reading to learn more about Medicare coverage for Eliquis and other AFib treatments.
Does Medicare cover Eliquis?
Yes, Medicare plans cover Eliquis. For Medicare to cover your Eliquis (apixaban) prescription, you must have either Medicare Part D or a Medicare Advantage plan (Medicare Part C). Both options are sold by private insurance companies approved by Medicare.
Medicare Prescription Drug Plan (Part D) adds prescription drug coverage to Original Medicare (Part A hospital insurance and Part B medical insurance).
Medicare Advantage plans (Part C) provide your Part A and Part B coverage. Many Part C plans also offer Part D plus coverage for extra benefits not covered by Medicare, such as dental, vision, and hearing.
Most Part D and Part C plans come with:
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a premium (what you pay for your coverage)
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a yearly deductible (what you pay for the drugs/healthcare before your plan starts paying a share)
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copayments/coinsurance (after your deductible is met, your plan pays a share of the cost, and you pay a share of the cost)
Before committing to a Part D or Part C plan, review the availability. Plans vary in cost and drug availability. Each plan will have its own list of covered prescription drugs and vaccines called a formulary.
How much does Eliquis cost with Medicare?
According to the manufacturer of Eliquis, in 2024, the list price for a 30-day supply of Eliquis is $594, but people on Medicare pay, on average, $55 per month. And 5 out of 10 people on Medicare who take Eliquis pay $40 or less. The Medicare drug plan you select will determine your exact cost.
Medicare has a program for low-income individuals called the Extra Help program. Individuals on this program may pay $0 to $11.20 per month for Eliquis in 2024. If you qualify for Extra Help in 2024, you could pay no more than $4.50 for each generic covered drug and $11.20 for each brand-name covered drug.
Beginning in 2026, Medicare will negotiate the cost of 10 drugs for Medicare recipients. Eliquis is one of these 10 medications. In the future, Medicare enrollees may expect to pay less for this medication.
Your deductible and copay will be the primary determining factors in the amount you pay for Eliquis.
Does Medicare cover AFib treatment?
Beyond prescription drugs like Eliquis covered by Medicare Part D and Medicare Advantage plans, Medicare may cover other treatments for AFib.
If you’re hospitalized as a result of your AFib, Medicare Part A may cover inpatient hospital and skilled nursing facility care.
Medicare Part B generally covers AFib-related outpatient care, such as
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doctor visits
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diagnostic tests, such as EKG (electrocardiogram)
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certain preventive benefits, such as screenings
For eligible beneficiaries with certain heart conditions, Medicare often covers cardiac rehabilitation programs, such as:
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counseling
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education
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exercise therapy
Takeaway
Medicare will cover Eliquis if you have Medicare prescription drug coverage.
You can get Medicare prescription drug coverage from Medicare-approved private insurance companies. The two programs are Medicare Part D, an add-on coverage to Medicare Parts A and B, and Medicare Advantage Plan (Part C), which provides your Part A and B coverage plus your Part D coverage.
Eliquis is used to treat atrial fibrillation. Medicare may cover other care and treatments for people with AFib.
View the original article on Healthline
