MedicareApril 8, 2026

Eliquis on Medicare: What Part D Covers and How to Cut Your Costs

Medicare covers Eliquis through Part D, but out-of-pocket costs can still be significant. Here's how the coverage works, what changed in 2025, and how to pay as little as possible.

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 on Medicare: What Part D Covers and How to Cut Your Costs

Eliquis is one of the most common medications among Medicare beneficiaries — and one of the most frustrating to afford. Medicare covers it through Part D, but the coverage structure means many patients still face hundreds or thousands of dollars in out-of-pocket costs.

Here's how the coverage works, what changed significantly in 2025, and what steps you can take to lower your costs.

How Medicare Part D Covers Eliquis

Medicare Part D covers prescription drugs, but coverage varies by plan. Eliquis is typically placed on Tier 3 or Tier 4 in most Part D formularies — meaning it's considered a "preferred brand" or "non-preferred brand" drug. Tier placement determines your copay or coinsurance.

Your actual cost depends on:

  • Which Part D plan you're enrolled in
  • Which coverage phase you're in (deductible, initial coverage, or catastrophic)
  • Whether you qualify for Extra Help

The 2025 Part D Changes: A Major Win for Patients

Before 2025, Medicare Part D had a coverage gap — the "donut hole" — where patients temporarily paid a much larger share of drug costs. Many Eliquis patients hit this gap and faced significantly higher costs for part of the year.

Starting January 1, 2025, the donut hole was eliminated and replaced with a $2,000 annual out-of-pocket cap.

This means once you've paid $2,000 in covered drug costs in a calendar year, your Part D plan covers 100% of your remaining drug costs for the rest of the year. For Eliquis patients who previously paid $3,000–$5,000 annually, this is a substantial improvement.

The cap resets every January 1.

What Eliquis Typically Costs Under Part D

Costs vary by plan, but here are rough ranges for common scenarios:

| Situation | Typical Monthly Cost | |-----------|---------------------| | Tier 3 copay, pre-deductible | $100–$200 | | Tier 3 copay, post-deductible | $45–$90 | | Extra Help (full subsidy) | $0–$10 | | Extra Help (partial subsidy) | $10–$35 |

These are estimates — your actual cost depends entirely on your specific Part D plan.

The Medicare Donut Hole and the $2,000 Cap: Month-by-Month Reality

Even with the cap, costs are front-loaded in the year. If your Eliquis copay is $90/month, you could spend $1,080 in the first year before hitting the $2,000 cap. But if you're also taking other expensive medications, you could hit the cap sooner.

Tip: If you take multiple Part D-covered medications, track your cumulative out-of-pocket spending on Medicare.gov or through your plan's app. Once you hit $2,000, document it and call your plan to confirm you're in the catastrophic phase.

Medicare Extra Help: The Program Most Patients Don't Know About

Extra Help (also called the Low Income Subsidy or LIS) is a federal program that drastically reduces what Medicare beneficiaries pay for Part D drugs. Eliquis patients on full Extra Help typically pay $0–$10 per month.

Who qualifies: Individuals with limited income and resources. In 2025, rough eligibility is:

  • Income below ~$22,590/year for individuals
  • Income below ~$30,660/year for married couples
  • Limited savings/assets (excludes home, one car, retirement accounts)

How to apply: Contact your local Social Security office or call 1-800-MEDICARE. You can also apply online at SSA.gov.

Many patients who qualify never apply because they don't know the program exists. If you're on Medicare and struggling to afford Eliquis, this should be your first call.

Why Copay Cards Don't Work on Medicare

Commercial copay cards — including the Eliquis copay card offered by BMS — cannot be used by Medicare beneficiaries. This is federal law under the anti-kickback statute.

Pharmacies cannot accept copay cards for Medicare patients, and using one (even unknowingly) creates compliance problems. This surprises many patients who used a copay card before turning 65 and enrolling in Medicare.

The good news: the BMS Access Support patient assistance program (the free medication program) is distinct from the copay card and may be available to Medicare patients in certain situations.

Switching Part D Plans During Open Enrollment

If your current Part D plan has Eliquis on a high tier with high cost-sharing, you may be able to switch to a plan with better Eliquis coverage during Medicare Open Enrollment (October 15 – December 7) each year.

Use the Medicare Plan Finder at Medicare.gov to compare plans by your specific medications. Sort by total annual drug cost, not just premium — a plan with a slightly higher premium but lower Eliquis tiers may save you significantly.

Getting Additional Help Through ClariMeds

ClariMeds helps Medicare beneficiaries navigate Eliquis coverage, identify Extra Help eligibility, and apply for the BMS Access Support program when applicable.

Tell us about your situation and we'll map out your best 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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