Does Medicare cover Eliquis?
Atrial fibrillation, or AFib, happens when a person has an irregular heartbeat. There are various treatment options for AFib, like taking medications and cardiac ablation. One medication that doctors often prescribe for AFib is a blood thinner called Eliquis. Eliquis is the brand name for apixaban.
Medicare Part D (prescription drug coverage) helps cover most AFib medications, including Eliquis. If you have a Medicare Advantage (Medicare Part C) plan that includes Part D coverage, Eliquis is likely covered by your plan.
We’ll explain how Eliquis works, how Medicare Part D works, and what other blood thinners you may find on your plan’s list of covered drugs.
Key takeaways:
Medicare Part D helps cover the cost of Eliquis, a blood-thinning medication that doctors often prescribe for treating AFib.
Your prescription drug coverage should cover most medications for AFib, but it’s a good idea to check your plan’s drug list (also called a formulary) to make sure Eliquis is on it.
What is Eliquis?
Eliquis is an anticoagulant, or blood thinner, that people use to manage AFib, a condition that occurs when your heart beats abnormally. When your heart beats irregularly, it affects your heart’s ability to pump blood, which can lead to symptoms like:
Dizziness
Shortness of breath
Heart palpitations
Fatigue
People with AFib have an increased risk of stroke, heart failure, and other heart-related complications. Eliquis helps to reduce these risks by preventing blood clots.
Does Medicare cover Eliquis?
Without insurance, Eliquis can cost almost $500 for a month’s supply! Fortunately, most Medicare prescription drug plans help cover Eliquis. Generally, most AFib medications are covered by Medicare Part D because they’re common prescriptions among older adults. Though highly unlikely, in the event that your plan doesn’t cover Eliquis (or another drug you need), you have a few options:
Talk to your doctor and see if there’s a similar blood thinner that your plan covers for AFib treatment.
Request a formulary exception. This is a formal request to add a drug to your plan’s list. Your healthcare provider has to approve a formulary exception.
Switch plans during the Annual Enrollment Period. You can choose a drug plan that better fits your needs during this enrollment period. If you need help picking the best one for you, our team of dedicated Advisors would be happy to guide you through your options with free, personalized advice. Call today at 855-900-2427 or schedule an appointment to talk.
It’s always a good idea to familiarize yourself with your plan’s formulary once you choose and enroll in a Medicare Part D plan or Medicare Advantage plan.
Though all Part D plans vary in pricing and coverage, you can generally expect to pay between $2 and $18 for a 30-day supply of the drug.
Medicare Part D
Medicare Part D is an optional, but recommended, prescription drug plan beneficiaries can purchase. You can get Part D coverage through either a Medicare Advantage plan that includes it or with a standalone Part D plan.
Each Part D plan has a formulary, which is a list of covered drugs. The formulary categorizes drugs into tiers, which help determine your copay for different prescriptions.
If you have AFib, make sure that you choose a plan that covers prescriptions for Eliquis or other relevant blood thinners. The good news is that it should be easy to find one that does!
Original Medicare
Original Medicare, sometimes referred to as Traditional Medicare, includes Part A and Part B and covers roughly 80% of healthcare costs. When you first enroll in Medicare, you enroll in Original Medicare. Unfortunately, prescription drug costs aren’t typically covered by Original Medicare coverage alone.
You must enroll in Original Medicare before switching to a Medicare Advantage plan or adding a Part D or Medicare Supplement plan to your coverage. Only Medicare Advantage plans with Part D included (MAPD plans) and Part D plans may help cover the cost of prescription drugs like Eliquis or other AFib medications.
Medicare Advantage
Roughly 54% of Medicare enrollees choose to switch their coverage to a Medicare Advantage, also called Medicare Part C, plan. Medicare Advantage plans are offered by private insurance companies in place of Original Medicare.
Medicare Advantage plans offer more benefits when compared with Original Medicare, including prescription medication coverage (most Medicare Advantage plans include Part D). For this reason, most Medicare Advantage plans cover the cost of Eliquis. However, there are some disadvantages to choosing a Medicare Advantage plan, including limited provider networks and prior authorization requirements. To get a better understanding of the pros and cons of Medicare Advantage, check out this article.
Regardless of which Medicare plan or combination of plans you choose, make sure to research your plan to ensure that Eliquis or another AFib medication your provider recommends is covered.
What other blood thinners are covered by Medicare?
Most Medicare prescription drug insurance (including standalone Part D plans and Medicare Advantage plans) covers another common blood thinner called Xarelto. Like Eliquis, healthcare providers consider Xarelto a preferred medication to treat AFib. It works similarly to Eliquis by preventing blood clots from forming.
Most Medicare Part D and Medicare Advantage plans cover the cost of other common blood-thinning medications, like Warfarin. Be sure to check your plan’s formulary to ensure that the medication you need is covered.
Bottom line
Though Original Medicare coverage on its own won’t cover the cost of AFib prescription medications, there are other plans you can choose to help cover the cost of these drugs.
In order to understand which prescription drug coverage is right for you, consult with your healthcare provider about what medications are best for your AFib. Everyone’s healthcare needs are unique, and choosing between medications like Eliquis and Xarelto will depend on your individual AFib needs.
If you have any questions about Medicare or need help determining if your prescription is covered by your Medicare plan, we’re here to help. Call today at 855-900-2427 or schedule an appointment to get help understanding and using your Medicare coverage.