What payment options exist for Eliquis

Eliquis (apixaban) is a blood thinner that costs around $400 to $500 per month without insurance, so most seniors use Medicare, Medicaid, or private insurance to cover it. If you have coverage, your out-of-pocket cost depends on your plan's formulary (the list of drugs it covers), your deductible, and whether you hit the coverage gap in Part D. The manufacturer also offers a copay card that can reduce your share to as little as $10 per month, though this works differently depending on your insurance type.

If you have no insurance or your plan doesn't cover Eliquis well, you have several routes: the manufacturer's patient information program, state pharmaceutical information programs, or negotiating a lower price directly with your pharmacy. The fastest way to find your lowest cost is to call your pharmacy with your insurance information and ask them to run the numbers for each option.

Key Takeaways

  • Medicare Part D covers Eliquis on most formularies, but your copay depends on which tier your plan places it on and whether you've hit the coverage gap.
  • The Eliquis copay card (made by the manufacturer) can lower your copay to $10 per month if you have commercial insurance or Medicare Part D.
  • If you have no insurance or high out-of-pocket costs, Bristol Myers Squibb's patient information program covers the full cost for those who meet income limits.
  • Medicaid covers Eliquis in all states, though some states require prior authorization before your doctor can prescribe it.
  • Asking your pharmacy to compare prices across different insurance plans and discount programs takes minutes and can save hundreds of dollars per month.

How Medicare Part D covers Eliquis

Eliquis appears on the formulary of most Medicare Part D plans, meaning Medicare will help pay for it. Your actual cost depends on which tier your specific plan places Eliquis on — typically tier 3 or tier 4 — and where you are in the yearly benefit cycle. Early in the year, before you meet your deductible, you pay the full price. Once you meet your deductible, you pay a copay (often $35 to $75 per month for Eliquis). After you and Medicare together spend $5,100 in 2024 (this amount changes yearly), you enter the coverage gap and pay 25 percent of the drug cost until you reach catastrophic coverage.

The coverage gap is where costs spike. At that point, the manufacturer's copay card becomes crucial — it covers the 25 percent gap payment, bringing your cost back down. You can use the copay card and Medicare together; they are not mutually exclusive. Check your plan's formulary on Medicare.gov or call your plan directly to confirm Eliquis is covered and what tier it's on, because plans vary.

Using the Eliquis copay card to lower your cost

Bristol Myers Squibb (the manufacturer) offers a copay card that reduces your copay to $10 per month for up to 24 months. You can get the card by calling 1-855-354-7847, visiting the Eliquis website, or asking your doctor's office to order one for you. The card works with Medicare Part D, commercial insurance, and TRICARE. It does not work with Medicaid or Medicare Part A or B alone.

When you use the card at the pharmacy, it pays the difference between your insurance copay and $10. If your copay is already $10 or less, the card doesn't help. The card has a maximum benefit cap (currently around $300 per month), so if your insurance copay is very high, the card covers part but not all of the difference. The card is free and requires no paperwork beyond showing it at the pharmacy.

Medicaid coverage for Eliquis

All 50 states cover Eliquis through Medicaid, but the process and your copay vary by state. Some states place Eliquis on a preferred tier with a low or zero copay; others require your doctor to request prior authorization before the prescription can be filled. Prior authorization typically takes 24 to 72 hours. A few states limit how many months of Eliquis you can receive per year, though this is uncommon.

To find out your state's specific rules, call your Medicaid office or ask your pharmacy to check your coverage before your doctor writes the prescription. Your pharmacy can also tell you whether prior authorization is needed and can contact your doctor on your behalf to request it. This saves you a phone call and speeds up the process.

Bristol Myers Squibb patient information program

If you have no insurance or your insurance doesn't cover Eliquis, Bristol Myers Squibb's patient information program covers the full cost of the drug at no charge. You must meet income limits: generally, your household income must be at or below 400 percent of the federal poverty line (about $55,000 per year for a single person in 2024, though this changes yearly). You also cannot have insurance that covers Eliquis, even if your copay is high.

To enroll, call 1-855-354-7847 or visit the Eliquis website and select "Patient information." You'll need to provide proof of income (a recent tax return, pay stub, or benefit statement) and proof of citizenship or legal residency. Approval usually takes 5 to 10 business days. Once approved, the program sends your prescription directly to your pharmacy at no cost to you, and you renew your enrollment once per year.

State pharmaceutical information programs

Many states run their own programs that help uninsured or underinsured seniors pay for prescription drugs. These programs vary widely by state in terms of income limits, copays, and which drugs they cover. Some states cover Eliquis; others do not. Income limits range from 100 percent to 400 percent of the federal poverty line depending on the state.

To find your state's program, visit the National Association of State Pharmaceutical information Programs (ASPPAP) website at pparx.org, which lists every state program with a direct link and phone number. You can also call 211 (a free referral line) and ask for your state's pharmaceutical information program. Have your income information and proof of citizenship ready when you call.

Negotiating a lower price at the pharmacy

If you have no insurance or your copay is very high, ask your pharmacy to quote you the cash price for Eliquis — the price you would pay if you bought it without using insurance. This price is often lower than your insurance copay, especially if your plan places Eliquis on a high tier. Some pharmacies also offer their own discount programs (like GoodRx or SingleCare) that can reduce the cash price further.

Before you decide to pay cash instead of using insurance, check whether paying cash will affect your ability to use the manufacturer's copay card later in the year. In most cases, you can switch between insurance and cash payment month to month, but some plans have rules about this. Ask your pharmacy and your insurance plan before you commit. Comparing all three options — your insurance copay, the copay card, and the cash price — takes 10 minutes and can save you hundreds of dollars per month.

Frequently Asked Questions

Can I use the Eliquis copay card if I'm on Medicare?

Yes, the copay card works with Medicare Part D. It reduces your copay to $10 per month for up to 24 months. The card does not work with Medicaid or if you have Medicare Part A or B only (without Part D). Call 1-855-354-7847 to request a card.

What happens to my Eliquis cost if I enter the Medicare Part D coverage gap?

In the coverage gap, you pay 25 percent of the drug cost instead of a fixed copay. The Eliquis copay card covers this 25 percent gap payment, bringing your cost back down to $10 per month. You can use the copay card and Medicare together without any conflict.

Do I have to choose between the copay card and my insurance?

No. The copay card works alongside your insurance. Your insurance pays its share, and the copay card covers the difference up to $10. You show both your insurance card and the copay card at the pharmacy.

What if my state's Medicaid program requires prior authorization for Eliquis?

Prior authorization means your doctor must request approval from Medicaid before the prescription can be filled. This usually takes 24 to 72 hours. Ask your pharmacy to request it on your behalf — they can contact your doctor directly, which speeds up the process and saves you a phone call.

Can I use the patient information program if I have insurance but my copay is too high?

No. The Bristol Myers Squibb patient information program requires that you have no insurance covering Eliquis. If your copay is high, try the copay card first, or ask your pharmacy to compare the cash price and discount programs like GoodRx.