Does Medicare Cover Eliquis?

Eliquis is a medication that is used to prevent blood from clotting. It is mainly used against certain medical conditions such as deep vein thrombosis (DVT) in the legs and pulmonary embolism (PE) in the lungs. However, it can be expensive and not everyone who needs it can easily afford it. 

So a common question many people have is, “does Medicare cover Eliquis?” In this article, we answer that question in clear, plain English. You will also find the average costs of Eliquis and other helpful info.

Does Medicare Cover Eliquis?

The short answer is no. In most cases, Medicare will not cover the cost of Eliquis. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your Eliquis. 

Original Medicare

Original Medicare (Medicare Part A and Part B) does not provide coverage for Eliquis. That is because Original Medicare mainly covers medically necessary services, equipment, and treatment rather than prescription drugs. Prescription drug coverage may be provided by either Medicare Advantage plans or by Medicare Part D. 

Part C and Part D Coverage for Eliquis

Some Medicare Advantage plans (Medicare Part C) provide coverage for Eliquis. Medicare Advantage plans cover everything Original Medicare covers as well as offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.

Medicare Part D plans also provide coverage for Eliquis. 99 percent of both Medicare Part C and Part D plans provide coverage for the medication Eliquis. 

Most Medicare plans restrict the amount of Eliquis you can purchase at one time. If you need to purchase a greater amount of Eliquis at one time, Medicare may not cover it. You can either wait until the period has passed before refilling or contact your plan provider and ask for an exception. 

Eliquis is listed as a Tier 3 drug in the Medicare drug formulary. Most of the time Tier 3 medications are preferred branded medications. Tier 3 medications are more expensive than Tier 1 and 2 medications. 

How Much Does Eliquis Cost?

The average cost of 60 tablets of 5mg Eliquis is around $585. This price varies from pharmacy to pharmacy. Eliquis usually costs around $9 per tablet.

What Are The Side Effects Of Eliquis?

Eliquis can cause mild and severe side effects. Some of these side effects are pretty rare. Eliquis side effects may include:

• Chest pain
• Red or brown urine
• Difficulty in breathing
• Swelling in the face or the tongue
• Excessive menstrual bleeding for women
• Dizziness 

If you experience these symptoms, it is recommended that you contact your doctor as soon as possible.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover cancer treatment after age 76?