Eliquis (apixaban) is covered by most Medicare prescription drug coverage plans.
Eliquis is an anticoagulant used to lower the chance of stroke in people with atrial fibrillation, a common type of irregular heartbeat (arrhythmia). It’s also used to prevent or treat blood clots in the legs, also known as deep vein thrombosis, and blood clots in your lungs, or pulmonary embolisms.
Keep reading to learn more about Medicare coverage for Eliquis and other atrial fibrillation (AFib) treatment.
For Medicare to cover your Eliquis prescription, you must have either Medicare Part D or a Medicare Advantage plan (sometimes called Medicare Part C). Both options are sold by private insurance companies approved by Medicare.
Medicare Advantage plans (Part C) provide your Part A and Part B coverage. Many Part C plans also offer Part D plus coverage for extra benefits not covered by Medicare, such as dental, vision, and hearing.
Most Part D and Part C plans come with:
- a premium (what you pay for your coverage)
- a yearly deductible (what you pay for the drugs/healthcare before your plan starts paying a share)
- copayments/coinsurance (after your deductible is met, your plan pays a share of the cost and you pay a share of the cost)
Before committing to a Part D or Part C plan, review the availability. Plans vary in cost and drug availability. Plans will have their own formulary, or list of covered prescription drugs and vaccines.
Eliquis is an expensive drug. How much you pay for it depends on the plan you’ve selected. Your deductible and copay will be the primary determining factors in your cost.
Beyond prescription drugs like Eliquis covered by Medicare Part D and Medicare Advantage plans, Medicare may cover other atrial fibrillation (AFib) treatment.
If you’re hospitalized as a result of your AFib, Medicare Part A may cover inpatient hospital and skilled nursing facility care.
Medicare Part B generally covers AFib related outpatient care, such as
- doctor visits
- diagnostic tests, such as EKG (electrocardiogram)
- certain preventative benefits, such as screenings
For eligible beneficiaries with certain heart conditions, Medicare often covers cardiac rehabilitation programs, such as:
- exercise therapy
Medicare will cover Eliquis if you have Medicare prescription drug coverage. You can get Medicare prescription drug coverage from Medicare-approved private insurance companies. The two programs are:
- Medicare Part D. This is an add-on coverage to Medicare parts A and B.
- Medicare Advantage Plan (Part C). This policy provides your Part A and Part B coverage plus your Part D coverage.
Eliquis is used to treat atrial fibrillation. Medicare may cover other care and treatments for people with AFib.