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Is Eliquis Covered by Insurance? Understanding Your Options

If you’re prescribed Eliquis (apixaban), you’re probably wondering, “Is Eliquis covered by insurance?” This is a common and important question. Eliquis is a medication used to prevent blood clots and reduce the risk of stroke, especially in people with atrial fibrillation (an irregular heartbeat). Understanding your insurance coverage can help you manage your healthcare costs.

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In This Article

What is Eliquis (Apixaban)?

Eliquis (apixaban) is an anticoagulant, often called a blood thinner. It helps prevent blood clots from forming. Doctors prescribe it for conditions like:

It works by blocking a specific clotting protein in your blood. This makes it harder for clots to form, reducing your risk of serious health problems.

Factors Affecting Eliquis Insurance Coverage

Many factors determine if your insurance covers Eliquis.

Insurance Plan Type

  • Private Insurance: Coverage varies widely. What your employer offers or what you buy on your own determines your plan’s formulary (list of covered drugs).
  • Medicare: Medicare Part D plans usually cover Eliquis, but specific coverage rules and costs depend on your plan.
  • Medicaid: Coverage differs by state. Check your state’s Medicaid policies for details.

Plan Formulary

Insurers use a formulary, which is a list of drugs they cover. Formularies often have tiers. Each tier has different cost-sharing amounts. Eliquis is often on a higher tier, meaning you might pay more out-of-pocket.

Prior Authorization

Many insurance companies require prior authorization for Eliquis. This means your doctor needs to get approval from your insurance company before you can get the medication. They might want to make sure that Eliquis is medically necessary for you, so your doctor will need to provide documentation to support the use of Eliquis.

Step Therapy

Some plans use step therapy. This means you must first try a cheaper drug before they will cover Eliquis. If those drugs don’t work, they might then cover Eliquis.

How to Check Your Eliquis Coverage

Follow these steps to determine if your insurance covers Eliquis:

  1. Review Your Plan Documents: Check your insurance plan’s official documents. These provide detailed information about covered drugs and cost-sharing.
  2. Call Your Insurance Company: Call the member services number on your insurance card. Ask specifically if Eliquis is covered, what tier it’s on, and if you need prior authorization.
  3. Talk to Your Pharmacist: Ask your pharmacist to run a test claim. This can give you an idea of your copay or coinsurance cost.

Understanding Eliquis Costs with Insurance

Several factors influence how much you’ll pay for Eliquis with insurance.

Copay vs. Coinsurance

  • Copay: A fixed amount you pay for each prescription.
  • Coinsurance: A percentage of the drug cost you pay.

Your plan determines whether you have a copay or coinsurance for Eliquis.

Deductible

Some plans have a deductible. This is the amount you must pay out-of-pocket before your insurance starts to cover costs. If you have a high deductible, you might pay the full cost of Eliquis until you meet it.

Coverage Gap (Donut Hole)

If you have Medicare Part D, you might enter a coverage gap. This is also called a “donut hole.” During this gap, you’ll pay a higher share of your prescription costs.

What to Do If Eliquis Isn’t Covered

If your insurance doesn’t cover Eliquis, here are some steps you can take:

  • Appeal the Decision: You can appeal your insurance company’s decision. Ask your doctor to help you with the appeal by providing information on why Eliquis is medically necessary for you.
  • Ask for a Formulary Exception: Request a formulary exception. This is when your insurance company agrees to cover a drug even if it’s not on their list.
  • Consider Patient Assistance Programs: Some drug manufacturers have programs that help people who can’t afford their medications.
  • Look for Generic Alternatives: While there isn’t a direct generic for Eliquis yet, this could change in the future. Keep an eye out for updates, as generics are typically more affordable.

Affordable Options for Eliquis

Even with insurance, Eliquis can be expensive. Here are some ways to potentially save money:

  • Consider Universal Drugstore: You may find that purchasing Eliquis through Universal Drugstore offers a more affordable option. Our services can provide significant savings on your medications. Explore our website to learn how to order medications and discover the potential cost benefits.
  • Compare Prices: Prices can vary between pharmacies. Call a few to compare.
  • Use a Discount Card: Some discount cards can lower your prescription costs. However, be sure to compare the discount price with your insurance copay to see which is cheaper.

The Future of Eliquis Costs

Changes are coming to prescription drug pricing. The AARP reports that Medicare is now able to negotiate drug prices. This may lower costs for some medications in the future. According to the Centers for Medicare & Medicaid Services (CMS), negotiated prices take effect for certain drugs in 2026. This is something to watch if you’re concerned about medication costs.

Navigating insurance coverage for medications like Eliquis can be tricky. By understanding your plan, exploring cost-saving options, and staying informed, you can better manage your healthcare expenses. Whether through your insurance, discount programs, or services like Universal Drugstore, affordable solutions are available.

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