Does Medicare Cover Eliquis? Part D Coverage and 2026 Costs

Which part of Medicare covers Eliquis?

Eliquis (the brand name for apixaban) is a blood thinner you take by mouth at home, usually twice a day. Medicare treats drugs you take yourself at home differently from drugs a doctor or nurse gives you. Self-administered pills like Eliquis are covered under Medicare Part D — your prescription drug coverage — not under Original Medicare Part A or Part B.

You get Part D coverage one of two ways: through a standalone Part D plan that you add to Original Medicare, or through a Medicare Advantage plan that bundles drug coverage in. Original Medicare by itself (Part A and Part B) does not cover most outpatient prescription drugs taken at home, so it will not pay for your everyday Eliquis.

There is one exception worth knowing. While you are admitted to a hospital as an inpatient (Part A) or getting certain hospital outpatient care (Part B), any Eliquis the staff gives you is bundled into that hospital benefit rather than billed to your drug plan. But for the daily Eliquis you take at home, Part D is the coverage that matters.

• Part D (or Medicare Advantage with drugs): covers your at-home daily Eliquis.
• Part A: covers Eliquis given to you while you are a hospital inpatient (bundled into the stay).
• Part B: does not cover at-home blood thinners like Eliquis.

Will my specific plan cover Eliquis — and with restrictions?

Each Part D and Medicare Advantage drug plan keeps its own formulary — the list of drugs it covers — and decides which cost tier to place each drug on. That means coverage and cost for Eliquis are not the same from plan to plan. Always check your own plan's formulary before assuming you are covered, and recheck each year during Open Enrollment because formularies can change.

Eliquis is not in one of Medicare's six protected drug classes. Plans must cover essentially all drugs in those protected classes, but blood thinners are not among them. As a result, a plan may apply restrictions to Eliquis — such as prior authorization (your doctor must justify it first) or step therapy (you may have to try another drug first). If your plan adds a hurdle, your prescriber can request an exception.

You can confirm coverage and any restrictions by looking up your plan on the Medicare Plan Finder at Medicare.gov, calling your plan, or reading the plan's drug list (formulary) document.

How much does Eliquis cost with Medicare in 2026?

Eliquis is sold as a brand-name drug. There is currently no FDA-approved generic apixaban widely available through Part D plans, which is one reason brand-name copays and higher tiers often apply. Your out-of-pocket cost is built from three things: your plan's monthly premium, an annual deductible set by your plan, and the copays or coinsurance you pay at the pharmacy.

Two 2026 changes help a lot. First, under the Medicare Drug Price Negotiation Program (part of the Inflation Reduction Act), Eliquis has a negotiated Maximum Fair Price of $231 for a 30-day-equivalent supply — down from its $521 2023 list price — effective January 1, 2026. This negotiated price applies automatically through your Part D plan; you do not have to sign up for anything. Keep in mind that what you actually pay at the pharmacy still depends on your plan's copay or coinsurance, which your plan sets.

Second, beginning in 2026 your total out-of-pocket spending for covered Part D drugs is capped at $2,100 for the year. Once your spending reaches that cap, you pay $0 for covered drugs (including Eliquis) for the rest of the year. The $2,100 cap counts spending across all your covered drugs, not Eliquis alone.

• 2026 Medicare-negotiated price: $231 for a 30-day supply (down from the $521 2023 list price).
• 2026 out-of-pocket cap: $2,100 per year across all covered Part D drugs; $0 after the cap.
• Your share each month = plan premium + any deductible + copay/coinsurance, until you hit the cap.
• 2026 national base Part D premium: $38.99/month (your plan's premium may be higher or lower).

How can I lower my Eliquis costs?

If you have limited income and savings, the biggest help is the Part D Low-Income Subsidy, also called Extra Help. With full Extra Help in 2026, your copays are capped at about $12.65 for a brand-name drug like Eliquis (and about $5.10 for generics), and you pay $0 once your total drug costs reach the catastrophic threshold.

For 2026, you may qualify for Extra Help with income up to $23,475 a year for an individual or $31,725 for a married couple, and resources (savings and certain assets) up to $18,090 for an individual or $36,100 for a couple — those resource limits include a $1,500-per-person burial allowance. You can apply through Social Security at no cost.

Beyond Extra Help, you can compare plans each year on the Medicare Plan Finder to find the one that covers Eliquis at the lowest total cost for you (weighing premium, deductible, and copays together). Choosing the cheapest plan for your exact drug list often saves more than any single trick.

Late enrollment, Medigap, and other things to know

If you put off joining Part D and later need Eliquis, watch out for the late enrollment penalty. The penalty is 1% of the national base beneficiary premium ($38.99 in 2026) times the number of full months you went without creditable drug coverage, rounded to the nearest 10 cents. It is added to your Part D premium for as long as you have Part D — so the cost of delaying lasts a lifetime.

Medigap (Medicare Supplement) policies do not pay for Eliquis. Medigap helps with Original Medicare's deductibles and coinsurance for medical care; it does not cover prescription drugs. For drug costs you need Part D, either as a standalone plan alongside Medigap or built into a Medicare Advantage plan.

Medicare Advantage and standalone Part D plans both must follow Medicare's drug rules, but they can have different formularies, tiers, and restrictions. So a Medicare Advantage plan may cover Eliquis at a different cost than a standalone Part D plan — another reason to check the specific plan before you enroll.