Medicare's coverage for Eliquis: A yes or no answer?
For individuals living with atrial fibrillation (AFib), understanding the cost of their medication, Eliquis (apixaban), under Medicare Part C (Medicare Advantage) and Part D (prescription drug plans) is crucial.
Medicare Part D enrollment is available for those enrolled in Original Medicare, and Eliquis is a brand-name drug covered by these plans. However, the cost of Eliquis varies significantly depending on factors such as the type of Medicare coverage, formulary tier, annual deductible amount, copayments, and coinsurance.
Under Medicare Part D, average copays for Eliquis are approximately $55 per month, but many pay $40 or less due to negotiated rates and coverage. Some plans may require prior authorization or step therapy, which can delay access or necessitate trials of cheaper drugs first.
Medicare Part C plans often include prescription drug coverage, but costs still depend on the specific Medicare Advantage plan's formulary. Copays for Eliquis can vary by plan design, drug tier, and pharmacy network.
The plan formulary and drug tier play a significant role in determining copay levels. Eliquis is likely listed as a preferred or non-preferred brand or specialty drug, with placement affecting copay levels.
Beneficiaries are advised to review their specific Medicare Part C/D plan formularies and cost-sharing details carefully and consult their prescriber and pharmacist regarding authorization processes.
It's worth noting that Original Medicare may cover related costs for hospital services (Part A) and medical services (Part B) when Eliquis is administered. Medicare Part B may cover doctor's appointments, electrocardiograms, other diagnostic tests, and compression stockings if medically necessary.
For more resources on medical insurance, visit the Medicare hub. Remember, a tool can help compare costs of Medicare Part D plans, and some Medicare Advantage plans offer additional benefits, such as over-the-counter medical supplies like compression stockings.
Eliquis helps prevent blood clots by blocking Factor Xa, which triggers proteins in the body responsible for clotting. The drug can also be prescribed after certain types of surgery, such as knee or hip replacement surgery.
In 2024, the manufacturer's website listed the price of Eliquis as $594 for a 30-day supply. However, beneficiaries may save on the cost of prescription drugs by switching to lower cost drugs, checking with state pharmaceutical assistance programs, applying for the Extra Help program, researching charitable programs, or contacting the drug manufacturer for financial support.
[1] Medicare.gov [2] AARP Medicare Guide [3] MedicareAdvantage.com [4] MedicareInteractive.org [5] Medicare Rights Center
- For those living with atrial fibrillation (AFib), it's essential to understand the costs of medications like Eliquis (apixaban) under Medicare Part C (Medicare Advantage) and Part D (prescription drug plans).
- Under Medicare Part D, average copays for Eliquis are around $55 per month, but many people pay $40 or less due to negotiation and coverage terms.
- Medicare Part D enrollment is accessible for individuals enrolled in Original Medicare, with Eliquis being a brand-name drug covered by these plans.
- In Medicare Part C plans, the cost of Eliquis varies based on the specific Medicare Advantage plan's formulary, plan design, drug tier, and pharmacy network.
- The Medicare Rights Center serves as a valuable resource for understanding medical insurance, offering resources and tools for comparing costs of Medicare Part D plans.
- Eliquis is a drug that helps prevent blood clots by blocking Factor Xa, which triggers proteins in the body responsible for clotting.
- Patients may require prior authorization or step therapy for Eliquis under certain Medicare Part D plans, potentially delaying access or necessitating trials of cheaper drugs first.
- Skin conditions, neurological disorders, respiratory conditions like asthma, cancer, and cardiovascular health are among the numerous medical-conditions influencing an individual's need for health insurance and health-and-wellness maintenance.
- In addition to Medicare, researching charitable programs, applying for the Extra Help program, or contacting the drug manufacturer for financial support can help beneficiaries save on the cost of prescription drugs like Eliquis.
- AQ (Avenzoar Quinolone) and PSA (Prostate-Specific Antigen) are also essential medical-conditions and screenings for health assessment and care management, particularly in men's health.
