Medicare typically covers Eliquis through Medicare Advantage (Part C) or Medicare Part D prescription drug coverage plans.
Eliquis is a brand name for apixaban, a prescription oral anticoagulant tablet. Doctors commonly prescribe Eliquis to prevent strokes and blood clots in people with a particular type of irregular heartbeat called atrial fibrillation (AFib), or after certain types of surgery.
In this article, we describe Eliquis and some possible side effects of using the medication. We then discuss Medicare coverage for Eliquis, related medications that Medicare may cover, and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Eliquis is an anticoagulant that affects a natural protein found in a person’s body. The protein usually helps the blood to clot, and Eliquis interrupts that process.
When blood clots, it generally becomes less liquid and more like a gel, and forms into a lump, or clot. Blood clots can travel in the bloodstream to other areas of the body, causing serious health problems such as deep vein thrombosis (DVT) in the legs, pulmonary embolism (PE) in the lungs, or a stroke if the clot reaches the brain.
Doctors may prescribe Eliquis if a person has AFib, or after knee or hip replacement surgery. If someone has AFib, their heart does not beat correctly, which may lead to abnormal blood flow and blood clots.
If a person takes Eliquis regularly, their doctor may give them an anticoagulant alert card because Eliquis may increase the risk of bleeding during surgical, medical, or dental treatment.
In general, Eliquis may cause mild-to-severe side effects. A person can use
For example, some drugs may interact with Eliquis in ways that can negatively affect a person’s body and increase the risk of bleeding. If a person is taking Eliquis, they may want to talk to their doctor before also taking the following medications:
- medicine that contains heparin
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- selective norepinephrine reuptake inhibitors (SNRIs)
- selective serotonin reuptake inhibitors (SSRIs)
- other anticoagulants
Also, women who are planning a pregnancy or are pregnant may need to talk to their doctor before taking the drug.
In rare cases, Eliquis may cause bleeding in the brain, which may result in headaches, seizures, numbness, and tingling, especially in the arms and legs. The person may feel tired and nauseated. This situation may be a medical emergency, and the person should seek immediate medical help.
How to enroll
A person enrolled in original Medicare Part A (hospital insurance) and Part B (medical insurance) can enroll in a Medicare Part D prescription drug plan.
Medicare Advantage (Part C) plans are provided by private insurance companies and offer the same coverage as original Medicare, plus coverage for prescription drugs.
A person can use this tool to find a Medicare plan.
Medicare Part D plans have a drug formulary, which lists prescription drugs and the cost. The formulary lists the drugs in different tiers, with the lower levels containing medicines that cost less. Before enrolling in a plan, people can check the formulary to see whether it includes their medication and its cost.
If a doctor diagnoses a person with AFib, Medicare may cover additional treatments, such as surgery to have a stent. Surgeons implant the stent, which is basically a narrow tube, into blocked blood vessels to help blood flow.
Medicare Part A may also cover an individual’s stay in the hospital or a skilled nursing facility (SNF) because of an AFib diagnosis.
Following surgery, Medicare Part B may cover follow-up outpatient care, including:
- doctor appointments
- electrocardiograms and other diagnostic tests
- compression stockings, if a doctor declares them medically necessary
Some Medicare Advantage plans offer additional benefits, including over-the-counter medical supplies such as compression stockings.
Medicare Part D and Medicare Advantage generally cover the cost of medication such as Eliquis. Original Medicare may also cover related costs for hospital services (Part A) and medical services (Part B).
Premiums for Plan D vary depending on the plan, and a person can use this tool to help compare costs.
A person with Medicare Advantage must use in-network providers and pay the plan premium, which varies depending on the provider and the plan.
In 2020, the manufacturer’s website lists the price of Eliquis at $471 for 30 days. Eliquis has no associated laboratory monitoring costs. However, the amount a person pays for the medication depends on various factors, including:
- the type of Medicare coverage
- the formulary tier
- whether a person has reached their annual deductible amount
- copayments or coinsurance
Ways to save on costs
There are several possible ways to save on the cost of prescription drugs, including:
- switching to lower cost drugs or a generic version of the drug
- checking with state pharmaceutical assistance programs
- applying for Extra Help
- researching charitable programs that may help with the cost of medications
A person may also check with a pharmaceutical company to determine whether they can help with costs. For example, Bristol-Myers Squibb, the manufacturers of Eliquis, offer financial support programs. A person may qualify for financial assistance through these programs.
Medicare Advantage (Part C) or Medicare Part D (prescription drugs) typically covers the cost of Eliquis. However, original Medicare (parts A and B) may cover associated hospital costs and medical services.
Doctors generally prescribe Eliquis to those with atrial fibrillation or knee or hip replacements.