Understanding Eliquis and Its Cost
Eliquis is a prescription blood thinner medication used to prevent blood clots and reduce the risk of stroke in people with atrial fibrillation, a common heart rhythm disorder. The medication is also prescribed after hip or knee replacement surgery and to treat deep vein thrombosis and pulmonary embolism. Like many specialty medications, Eliquis carries a significant price tag that affects many patients and their families.
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The cost of Eliquis varies depending on several factors, including your insurance coverage, pharmacy location, and dosage. Without insurance, a monthly supply of Eliquis can range from $400 to $600 or more, depending on the dose prescribed. A 30-day supply of 5 mg tablets (the most common dose) typically costs between $450 and $550 at retail prices. Patients taking the 2.5 mg dose may pay slightly less, while those requiring higher frequencies of dosing may pay more. These prices represent the cash price—what uninsured patients or those paying out-of-pocket would pay at most pharmacies.
Insurance coverage significantly impacts what you actually pay. If you have health insurance through an employer, Medicare, or Medicaid, your out-of-pocket cost depends on your specific plan's formulary—the list of covered medications. Some plans cover Eliquis with a standard copay of $10 to $50 per month, while others require higher copayments or coinsurance. Coinsurance means you pay a percentage of the drug's cost, such as 20 or 30 percent, which can be substantially more than a fixed copay.
Understanding the true cost of your medication is the first step toward finding ways to reduce your expenses. Knowing whether you have insurance, what your plan's formulary includes, and what your copay or coinsurance amount is will help you evaluate the options described throughout this guide.
Practical Takeaway: Contact your pharmacy or insurance company to learn your exact out-of-pocket cost for Eliquis. Ask whether the medication is covered on your plan's formulary and what your copay or coinsurance percentage is for brand-name drugs.
Manufacturer Assistance Programs and Patient Support
Bristol Myers Squibb, the manufacturer of Eliquis, offers a patient support program called the Eliquis Savings Program. This program is designed to help patients with both insured and uninsured status reduce their out-of-pocket medication costs. The program works differently depending on whether you have insurance coverage or not.
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For patients with commercial insurance, the Eliquis Savings Program typically offers a copay card that reduces copay amounts to $10 per month for most patients. This card is not a rebate or a loan—it's a copay reduction tool that covers the difference between your insurance's copay and the $10 amount. The copay card can usually be used for up to 24 months, though specific terms may vary. To use the copay card, you simply present it to your pharmacy when filling your prescription, along with your insurance information. The card is not meant for use with government insurance programs like Medicare or Medicaid, as those programs have specific rules about patient assistance.
For uninsured patients, Bristol Myers Squibb offers the Eliquis Patient Assistance Program. This program provides free medication to patients who meet certain income requirements. The income thresholds are typically set at or below 400 percent of the federal poverty level. For a single person in 2024, this would mean a household income of approximately $56,000 or less annually. For a family of four, the threshold would be around $115,000 annually. Patients in this program receive their Eliquis medication at no cost.
To learn about these programs or to obtain the copay card and program materials, you can contact the Eliquis support team by phone, visiting the official Eliquis website, or asking your healthcare provider's office for assistance. Many doctor's offices have staff members who are trained to help patients understand and navigate these programs.
Practical Takeaway: Contact the Eliquis Savings Program directly to request a copay card if you have commercial insurance. If you don't have insurance and your income meets the threshold, the Patient Assistance Program may provide medication at no cost. Ask your doctor's office for help connecting with these resources.
Medicare Coverage and Extra Help Programs
Medicare beneficiaries have several pathways to reduce their Eliquis costs, though the specific amount you pay depends on which part of Medicare you use and which plan you've selected. Medicare Part D is the prescription drug coverage component of Medicare, and most beneficiaries who want prescription drug coverage choose a Part D plan from a private insurance company. Different Part D plans cover Eliquis differently—some may cover it as a preferred brand-name drug with a moderate copay, while others may require prior authorization or place it in a higher cost tier.
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When you enroll in a Part D plan during the annual open enrollment period (typically October 15 through December 7 each year), you can compare plans based on their coverage of your specific medications. Medicare's official website provides a tool called the Plan Finder that shows which plans cover Eliquis and what your estimated costs would be under each plan. Using this tool to compare plans before enrollment can result in significant savings, as copays for Eliquis can vary from $15 to $75 per month depending on the plan selected.
Medicare also offers Extra Help, a program that assists people with limited income and resources in paying Medicare Part D premiums, deductibles, copays, and coinsurance. To qualify for Extra Help, your monthly income must generally be at or below 150 percent of the federal poverty level, and your resources (savings, investments, property other than your home) must be limited. For an individual in 2024, the income limit is approximately $1,968 per month, or $23,616 annually. If you receive Extra Help, your medication copay is typically reduced to just $2 to $8 per month for most drugs, including brand-name medications like Eliquis.
You can apply for Extra Help through Social Security, Medicare, or your State Health Insurance Assistance Program (SHIP). Each state has a SHIP office that provides free counseling about Medicare coverage options. These programs are particularly valuable for Medicare beneficiaries with limited income who must take costly medications for serious health conditions.
Practical Takeaway: If you're on Medicare, use the Plan Finder tool during open enrollment to compare Part D plans and their Eliquis coverage. If your income is limited, contact your State Health Insurance Assistance Program to learn whether you may be eligible for Extra Help.
Medicaid Coverage and State-Specific Programs
Medicaid is a joint federal and state health insurance program for people with limited income. Coverage for Eliquis under Medicaid varies significantly by state because each state designs its own Medicaid program within federal guidelines. Some states cover Eliquis readily, while others may require that patients first try and fail on less expensive blood thinners before covering Eliquis. This requirement is called a "prior authorization" or "step therapy" requirement.
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In states with stricter Medicaid formularies, patients may need to demonstrate that other blood thinners—such as warfarin (also called Coumadin), which is a much older and less expensive medication—did not work for them or caused side effects before Medicaid will cover Eliquis. Warfarin costs significantly less, sometimes under $20 per month, but requires regular blood tests and dietary restrictions. Some patients cannot tolerate warfarin or find these requirements impractical, making Eliquis medically necessary despite its higher cost.
If you're on Medicaid and your state's program doesn't immediately cover Eliquis, your doctor can request an exception or appeal by submitting medical documentation explaining why Eliquis is necessary for your specific situation. This process involves paperwork but can result in coverage approval. The appeals process typically takes 24 to 72 hours for urgent requests, though non-urgent appeals may take longer.
Some states also offer programs that bridge gaps in coverage. For example, some states have patient safety programs or pharmaceutical assistance programs that help cover medications not covered by Medicaid. Contacting your state's Medicaid office or your health plan directly can provide information about these options. Additionally, if you lose Medicaid coverage or have gaps in coverage, the manufacturer's patient assistance program mentioned earlier may provide temporary medication