MedicareMay 23, 2026

Eliquis and the Medicare Part D Changes in 2025: What Patients Need to Know

The biggest change to Medicare Part D drug coverage in years took effect in 2025. Here's what changed, how it affects Eliquis costs, and what Medicare beneficiaries should do now.

Written by

J

Jacob Elich

Health Consulting & Business Operations

Jacob Elich is the founder of ClariMeds and an MBA-trained business operator with a background in health consulting and dealmaking. He started ClariMeds after watching family members struggle to afford medications they were prescribed but couldn't pay for — and realizing that the manufacturer assistance programs that could have helped them were largely invisible to the people who needed them most. His work focuses on closing that gap.

Eliquis and the Medicare Part D Changes in 2025: What Patients Need to Know

Medicare Part D underwent its most significant restructuring in years when the Inflation Reduction Act's drug pricing provisions took effect in 2025. For Eliquis patients on Medicare, the changes are largely positive — but understanding them matters for managing your costs effectively.

Here's what changed, what it means for your Eliquis costs, and what actions you should consider taking.

The Old Structure vs. the New Structure

Before 2025, Medicare Part D had four coverage phases:

  1. Deductible phase — you pay 100% until deductible is met
  2. Initial coverage phase — you pay a copay/coinsurance; plan pays the rest
  3. Coverage gap ("donut hole") — you paid 25% of drug costs; manufacturer and plan paid the rest
  4. Catastrophic coverage — you paid a small coinsurance or copay

The coverage gap was the most confusing and painful phase for many patients. Eliquis costs pushed patients into it relatively quickly, and the transition was sudden.

Starting in 2025:

  • The coverage gap phase was eliminated
  • A new $2,000 annual out-of-pocket cap was established
  • After you've paid $2,000 in covered drug costs, your plan pays 100% for the rest of the year
  • The cap resets every January 1

What This Means for Eliquis Patients Specifically

Eliquis is typically a Tier 3 or Tier 4 drug under Part D. Depending on your plan, your monthly cost-sharing might be $45–$150 or more.

Under the old structure, a patient paying $100/month for Eliquis might hit the donut hole around month 5–6 and suddenly face a different cost structure. The new cap simplifies this: you pay your normal cost-sharing until you've hit $2,000 total, then you pay nothing for the rest of the year.

Example: If your Eliquis copay is $90/month, you'd hit the $2,000 cap around month 22 — meaning your costs are capped at roughly $2,000 per year regardless of what happens with Eliquis pricing.

If you also take other Part D-covered medications, your costs accumulate faster toward the $2,000 cap.

The Medicare Prescription Payment Plan (M3P)

A new optional feature introduced in 2025 is the Medicare Prescription Payment Plan (also called the M3P or "smoothing" program).

Instead of paying higher costs early in the year (before hitting your deductible), you can now opt into the M3P and spread your estimated annual Part D costs evenly across monthly payments throughout the year.

This doesn't save money overall — but it prevents the cash-flow problem of large out-of-pocket costs in January and February when prescriptions refill.

To opt in, contact your Part D plan directly or call 1-800-MEDICARE.

Manufacturer Negotiated Prices

The Inflation Reduction Act also gave Medicare the authority to negotiate drug prices directly with manufacturers for certain high-cost drugs.

Eliquis was among the first 10 drugs subject to Medicare negotiation. The negotiated price for Eliquis takes effect in 2026. The negotiated price has not been disclosed publicly at this writing, but CMS has indicated negotiations resulted in significant reductions from current Medicare prices.

This will be the first time Medicare has ever directly negotiated Eliquis pricing. It represents a meaningful change for the program and for patients who depend on the drug.

Extra Help: Still the Best Option for Lower-Income Beneficiaries

The $2,000 cap helps everyone, but lower-income beneficiaries still have access to the most powerful Eliquis cost reduction: Medicare Extra Help (Low Income Subsidy).

Extra Help covers most or all of your Part D costs, including Eliquis. Patients on full Extra Help typically pay $0–$10 per month regardless of the drug's list price.

Income limits for Extra Help in 2025:

  • Individuals: roughly under $22,590/year
  • Married couples: roughly under $30,660/year

If you're close to these limits, it's worth applying — the savings can be thousands of dollars per year. Apply through Social Security (SSA.gov or 1-800-772-1213).

Should You Switch Part D Plans?

The 2025 changes don't make plan selection irrelevant — your monthly premium and the drug tier structure still affect total costs, especially for costs incurred before the $2,000 cap.

During Medicare Open Enrollment (October 15 – December 7), use the Medicare Plan Finder at Medicare.gov to compare plans based on your actual medications. Enter Eliquis (or apixaban if you're using the generic) and sort by total annual drug cost, not just premium.

Getting Help

Navigating Medicare drug coverage is legitimately complicated. If you're a Medicare beneficiary struggling to afford Eliquis, ClariMeds can help identify which programs apply to your situation — Extra Help, BMS Access Support, plan optimization — and handle the applications.

Tell us about your situation and we'll map out your options.

Paying too much for your medication?

ClariMeds connects you to free or low-cost medications through manufacturer assistance programs — and handles every step of the application for you.

See If You Qualify — Free
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