How To Get Eliquis Cheaper On Medicare
How To Get Eliquis Cheaper On Medicare: Your Complete Guide
If you or a loved one relies on Eliquis (apixaban) to manage blood clots or atrial fibrillation, you know just how life-changing this medication is. However, you also know the staggering price tag that often comes with it. Facing hundreds, sometimes thousands, of dollars per month for a necessary prescription can feel overwhelming.
The good news? If you are enrolled in Medicare, there are effective, proven strategies you can use to drastically reduce the cost of Eliquis. This guide is designed to walk you through exactly how to get Eliquis cheaper on Medicare, step by step, using friendly and clear advice.
Understanding Your Medicare Coverage Options for Eliquis
Before you can save money, you need to understand where your coverage stands. Medicare is complex, but knowing which parts cover prescriptions is essential for lowering your Eliquis bill.
The Role of Medicare Part D (The Key to Prescription Savings)
Eliquis is nearly always covered under Medicare Part D, which is specifically designed for prescription drug coverage. You can get Part D coverage in two primary ways:
- Standalone Prescription Drug Plans (PDPs): These are insurance plans you purchase separately if you have Original Medicare (Parts A and B).
- Medicare Advantage Plans (Part C): Many Part C plans include drug coverage (MA-PDs).
It's crucial to know that Eliquis is often considered a Tier 3 (Non-Preferred Brand) or Tier 4 (Preferred Brand) drug on plan formularies. This designation heavily impacts your copayments, often making it quite expensive until you hit certain spending limits.
Navigating the Coverage Phases (Deductibles, Initial Coverage, and the Donut Hole)
Medicare Part D coverage operates in four distinct phases. If you need to get Eliquis cheaper on Medicare, understanding these phases is vital, as the cost changes dramatically between them.
- Deductible Phase: You pay 100% of the drug cost until you meet your plan's annual deductible (this amount varies by plan, up to a set maximum).
- Initial Coverage Phase: After meeting the deductible, you pay a copay or coinsurance (e.g., 25% of the cost), and your plan pays the rest. This phase lasts until the total retail cost paid by you and your plan reaches the initial coverage limit.
- Coverage Gap (Donut Hole): Historically, this was the most dreaded phase. Fortunately, due to recent legislation, your cost for brand-name drugs like Eliquis is capped at 25% of the price while you are in the Donut Hole.
- Catastrophic Coverage Phase: Once your out-of-pocket costs (TrOOP) reach a certain threshold, you only pay a small copay or coinsurance for the rest of the year. This is where most people find the deepest relief for high-cost drugs like Eliquis.
The goal is often to get into the Catastrophic Phase as quickly and affordably as possible, or better yet, avoid high costs altogether.
Proven Strategies to Lower Your Eliquis Costs Significantly
The key to making Eliquis affordable is leveraging federal and manufacturer assistance programs. Don't assume you don't qualify—it's always worth checking.
Check Eligibility for the Extra Help Program (Low-Income Subsidy - LIS)
Extra Help, or the Low-Income Subsidy (LIS), is Medicare's most powerful tool for reducing prescription costs. If you qualify for LIS, your costs will dramatically decrease, essentially eliminating the coverage gap and capping your copays.
LIS recipients pay no deductible, have fixed, low copays for all medications (including high-cost items like Eliquis), and typically don't have a coverage gap. This is the single best way to get Eliquis cheaper on Medicare.
You may automatically qualify if you receive Medicaid, Supplemental Security Income (SSI), or help from your state paying Medicare premiums. If not, you can apply directly through the Social Security Administration.
Utilizing Pharmaceutical Assistance Programs (PAPs)
If your income is slightly too high for LIS, don't worry—manufacturer assistance programs are often the next best bet. Bristol Myers Squibb (BMS), the maker of Eliquis, offers patient assistance programs (PAPs).
These programs are generally aimed at low-income, uninsured individuals. However, if you are a Medicare beneficiary who is struggling financially and does not qualify for LIS, it is absolutely worth calling the manufacturer to see if their program can help cover your cost or provide the drug for free.
Important Note: Medicare beneficiaries generally cannot use manufacturer copay cards or coupons to reduce their costs. These cards are illegal to use with federal health programs. You must apply for a full Patient Assistance Program, which covers the entire cost, not just the copay.
Using Mail-Order Pharmacies and 90-Day Supplies
Many Part D plans offer better pricing for medications filled through their preferred mail-order pharmacy. Switching from a 30-day supply at your local drugstore to a 90-day supply delivered to your home can provide significant savings.
By filling a 90-day supply, you only pay one copay (or a slightly higher one), but you get three months of medication. This is an efficient way to stretch your spending and potentially reach the Catastrophic Coverage phase faster.
Choosing the Right Medicare Part D Plan
Perhaps the single most important action you can take to get Eliquis cheaper on Medicare is choosing the *right* Part D plan during the Annual Enrollment Period (AEP) or during initial enrollment.
Plans change their formularies and pricing every single year. A plan that was excellent for Eliquis last year might be terrible this year. You must review your plan annually.
Essential Steps for Plan Comparison
When comparing Part D options, focus specifically on how each plan treats Eliquis:
- Check the Formulary Tier: Confirm that Eliquis (apixaban) is on the plan's list of covered drugs (the formulary). The lower the tier, the lower your copay.
- Calculate Estimated Annual Cost (EAC): Use the Medicare Plan Finder Tool. Enter all your medications, especially Eliquis, and the tool will estimate your total annual cost, including premiums, deductibles, and copays, for every plan available in your area. This estimate is far more accurate than just looking at the monthly premium.
- Review Preferred Pharmacies: Check if your current pharmacy is part of the plan's preferred network. Filling prescriptions at a non-preferred pharmacy can significantly increase your copay for drugs like Eliquis.
- Evaluate Deductibles: Since Eliquis is expensive, choosing a plan with a $0 deductible might mean you start receiving coverage sooner, even if the monthly premium is slightly higher.
Remember that even a small difference in the coinsurance percentage for Eliquis can save you hundreds of dollars quickly, especially if you spend time in the coverage gap.
Conclusion: Taking Action to Afford Eliquis
Don't let the high list price of Eliquis deter you from necessary treatment. As a Medicare beneficiary, you have strong avenues to pursue substantial cost reductions. To successfully get Eliquis cheaper on Medicare, your primary action items should be:
- Reviewing your Part D plan annually using the Medicare Plan Finder.
- Applying for the Extra Help (LIS) program if you meet the income requirements.
- Investigating the manufacturer's Patient Assistance Program if you are ineligible for LIS but still facing financial hardship.
- Opting for 90-day supplies via mail-order to maximize your coverage benefits.
By proactively managing your Medicare plan and exploring all assistance options, you can ensure that this critical medication remains accessible and affordable year-round.
Frequently Asked Questions About Eliquis and Medicare Costs
- Can I use an Eliquis manufacturer coupon if I have Medicare?
- No. Federal regulations generally prohibit Medicare beneficiaries (including those on Part D) from using manufacturer coupons or copay cards to reduce out-of-pocket costs, as this interferes with the structure of the federal program. However, you can apply for their full, income-based Patient Assistance Program (PAP).
- What is the 'Donut Hole' for Eliquis now?
- The term "Donut Hole" (Coverage Gap) still exists, but the cost burden is significantly lower than in the past. While in the Donut Hole, you currently pay no more than 25% of the cost for brand-name drugs like Eliquis.
- If I switch Part D plans, will my doctor need to approve Eliquis again?
- Typically, no. If Eliquis is on the new plan's formulary, you should be able to continue filling it. However, if the plan imposes prior authorization requirements, your doctor might need to submit a form stating the necessity of the drug. Always confirm the new plan's specific rules before switching.
- How often should I review my Part D plan to save money on Eliquis?
- You should review your plan every single year during the Annual Enrollment Period (October 15 – December 7). Formularies and costs change annually, and a different plan may save you thousands of dollars next year.
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