If you take Eliquis to prevent blood clots or stroke, the good news is simple: Medicare covers it. The bigger question most folks have is what it will actually cost — and in 2026, the answer is changing in your favor.
Yes, Medicare Part D covers Eliquis
Eliquis (the generic name is apixaban) is a widely used blood thinner, and it’s covered under Medicare Part D — your prescription drug coverage. You get Part D one of two ways: as a standalone drug plan that pairs with Original Medicare, or built into a Medicare Advantage plan.
Original Medicare (Part A and Part B) on its own does not cover drugs you pick up at the pharmacy, so having some form of Part D is what makes coverage for Eliquis possible. Nearly every Part D and Medicare Advantage plan in Utah includes Eliquis on its drug list, usually on a brand-name tier.
How your costs are decided
Two things shape what you pay for Eliquis: your plan’s formulary and its tiers.
A formulary is simply the list of drugs a plan covers. Plans sort those drugs into tiers, and the tier sets your copay or coinsurance:
| Tier | Typical drugs | What you usually pay |
|---|---|---|
| Lower tiers | Generic medications | Smaller copays |
| Brand tiers | Brand-name drugs like Eliquis | Higher copays or coinsurance |
| Specialty tier | High-cost specialty drugs | The largest share |
Because Eliquis is a brand-name drug, it most often sits on a brand tier, which means a somewhat higher copay than a generic. The exact dollar amount varies from plan to plan, so two neighbors can pay different prices for the same prescription. That’s why it pays to check the specifics before you choose a plan. Our Formulary Lookup lets you confirm Eliquis is covered and see which tier it lands on, and the Drug Cost Calculator helps you estimate your year of out-of-pocket spending.
The 2026 price negotiation
Here’s the part that’s genuinely new. Through Medicare Drug Price Negotiation, the government negotiated prices on the first 10 drugs, and Eliquis is on that list. Those negotiated prices took effect January 1, 2026.
This lowers the negotiated price of the drug itself, which is real progress. But I want to be straight with you about what it means at the pharmacy counter: the negotiation does not set a single fixed price that everyone pays. What you actually owe still depends on your plan’s tier for Eliquis and how much you’ve already spent toward your yearly cap. So the negotiation helps, but your own plan details still matter.
The $2,000 cap is the real protection
For anyone with ongoing drug costs, this is the most important change to know about. In 2026, Part D has a $2,000 out-of-pocket maximum for the year. The old “donut hole” coverage gap is gone.
Once your out-of-pocket spending on covered drugs reaches $2,000, you pay nothing more for your covered prescriptions for the rest of the calendar year. For someone on a steady brand-name medication like Eliquis — especially alongside other prescriptions — that cap can make a real difference and gives you a predictable ceiling to plan around. There’s also an option to spread that $2,000 into smoother monthly payments across the year if a big bill at the start would be hard to manage.
What to check before you pick a plan
A few quick steps go a long way:
- Confirm Eliquis is on the formulary of any plan you’re considering.
- Note the tier so you know roughly what your copay will be.
- Check the pharmacy network — using a preferred pharmacy often lowers your cost.
- Look at the whole picture, including your other prescriptions, not just one drug.
Plans change their formularies and pricing every year, so it’s worth a fresh look each fall during open enrollment rather than assuming last year’s plan is still the best fit.
If you’d like a second set of eyes, I’m happy to help. You can run the numbers yourself with the tools above or browse more guidance on the blog, and when you’re ready, reach out to me for a no-pressure conversation about which plan covers your medications best. No hard sell — just clear answers so you know what you’ll pay.
Medical & coverage disclaimer: This article is general education — not medical advice or a guarantee of coverage. Whether a specific drug is covered, and what you’ll pay, depends on your individual Part D or Medicare Advantage plan, its formulary, and the plan year, and can change. Always confirm with your plan or a licensed agent, and talk to your doctor about your treatment.