Does Medicare Provide Coverage to Eliquis?

Does Medicare Provide Coverage to Eliquis?

Eliquis is another name for apixaban, a medication tablet used to prevent stroke and blood clots in people suffering from irregular heart called atrial fibrillation (AFib). Eliquis may also be prescribed by a doctor following some types of surgery, such as knee or hip replacement. Eliquis is usually covered by Medicare Advantage Part C or Medicare Part D prescription medication coverage programs. Let’s read on to learn more about Medicare coverage for Eliquis.

Cost of Eliquis with Medicare

Eliquis is an expensive drug and costs $499 for a 30-day supply. The cost of Eliquis with Medicare can vary depending on several factors, including the specific Medicare Part D plan you have, the pharmacy you use, your dosage, and which phase of your Part D coverage you are in (e.g., deductible phase, initial coverage phase, coverage gap, or catastrophic coverage phase).

The Original Medicare and Eliquis

When it comes to Original Medicare (Medicare Part A and Medicare Part B), it’s crucial to understand how this program interacts with the coverage of prescription medications like Eliquis:

  • Original Medicare (Part A and Part B): Original Medicare provides coverage for hospital (Part A) and medical (Part B) services but does not include prescription drug coverage for most medications you take at home.
  • Medicare Part D: To get prescription drug coverage under Medicare, you must enroll in a standalone Medicare Part D prescription drug plan. These plans are offered by private insurance companies approved by Medicare and are designed to help cover the cost of prescription drugs, including medications like Eliquis.

Here’s how Eliquis is typically covered with Original Medicare:

  • You receive a prescription from your healthcare provider for Eliquis.
  • To obtain coverage for Eliquis, you need to enroll in a Medicare Part D prescription drug plan separately from your Original Medicare coverage.
  • The specific cost of Eliquis with Medicare Part D will depend on the Part D plan you choose, your pharmacy, your dosage, and the phase of your coverage.

Medicare Advantage and Eliquis

Medicare Advantage (Part C) programs are available from private insurance firms. The legislation mandates that they provide the same coverage as original Medicare and prescription medication coverage. If you have a Medicare Advantage, you must utilize in-network providers and pay the plan premium, which varies based on the provider, the plan, and the cost of the medicine.

AFib Treatment and Medicare

Medicare can pay for extra atrial fibrillation (AFib) treatments in addition to prescription medications like Eliquis, which are covered by Medicare Part D and Medicare Advantage plans. If you are admitted to the hospital with AFib, Medicare Part A may cover in-patient and skilled nursing facility treatment. In general, Medicare Part B covers AFib-related out-patient treatment, such as

  • Doctor’s appointments
  • EKG (electrocardiogram) diagnostics tests.
  • Screenings and other preventive measures

Eliquis and Medicare Part D

Medicare Part D is a prescription drug coverage program offered by the U.S. government to eligible individuals enrolled in Medicare. If you have a prescription for Eliquis and are enrolled in Medicare, you may be able to get coverage for this medication through Medicare Part D.

Make Informed Choices with Medicare Advisors

If you want to learn more about several Medicare plans, consult with the professionals at Medicare Advisors. Our experts will guide you to get the right Medicare plan for your needs. Contact us for more information.