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). If someone has AFib, their heart does not beat correctly, which may lead to abnormal blood flow and blood clots.
Healthcare professionals may also prescribe Eliquis after certain types of surgery, such as knee or hip replacement surgery.
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.
In 2021, the manufacturer’s website listed the price of Eliquis as $499 for a 30-day supply. 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 (list of covered medications) tier
- whether a person has reached their annual deductible amount
- copayments or coinsurance
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 the Extra Help program
- 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.
Eliquis and original Medicare
Original Medicare may also cover related costs for hospital services (Part A) and medical services (Part B). For example, Part A may cover the costs of the medication provided while the person is in the hospital.
Most people do not pay a premium for Medicare Part A but may need to pay a deductible. In 2021, the deductible is $1,484, according to the Centers for Medicare & Medicaid Services. For Medicare Part B, the standard premium in 2021 is $148.50.
Eliquis and Medicare Advantage
Private insurance companies offer Medicare Advantage (Part C) plans. The law requires that they offer the same coverage as original Medicare, plus coverage for prescription drugs.
What a drug plan covers can vary. A person’s plan may cover the cost of Eliquis.
In addition to the cost of the medication, a person with Medicare Advantage must use in-network providers and pay the plan premium, which varies depending on the provider and the plan.
A person can use this tool to find a Medicare plan that can provide coverage for their current medications.
Eliquis and Part D
A person enrolled in original Medicare can enroll in a Medicare Part D prescription drug plan.
Medicare Part D provides a drug formulary, which lists prescription medications and their costs.
The list places the medications in different tiers, with the lower levels containing drugs that cost less. Before enrolling in a plan, people can check the formulary to see whether it includes their medication and its cost.
Premiums for Plan D vary depending on the plan, and a person can use this tool to help compare costs.
If a doctor diagnoses a person with AFib, a doctor may treat the condition with medications, surgical procedures, and lifestyle changes.
Medicare Part B covers cardiovascular behavioral therapy that can lower the risk of complications with a person’s heart. Part D will cover medications.
While Medicare may cover some surgical procedures, the program will likely determine coverage on a case-by-case basis.
For example, currently, Medicare has no national coverage policy for a catheter ablation procedure to restore a person’s irregular heartbeat to its usual rhythm. In this procedure, a healthcare professional will use radiofrequency energy to destroy the small area of heart tissue causing the irregular heartbeat.
Instead of a national coverage policy, local contractors make each coverage decision.
Medicare Part A may also cover an individual’s stay in the hospital or a skilled nursing facility because of an AFib diagnosis.
Following surgery, Medicare Part B may cover follow-up outpatient care, including:
- doctor’s 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.
Doctors generally prescribe Eliquis to people with atrial fibrillation or knee or hip replacements.
Medicare Advantage (Part C) and Medicare Part D (prescription drugs) typically cover the cost of Eliquis. However, original Medicare (parts A and B) may cover only the associated hospital costs and medical services.