Does Medicare Cover Eliquis? 

The blood in your body is used to transport essential resources to your organs. Oxygen, nutrients and more all depend on the normal circulation of blood through your veins and arteries to keep your body functioning.

When clotting problems develop, blood can become too thick, causing clots to develop. This may raise the risk of cardiovascular events like heart attack and stroke since clots block the flow of blood. Conditions like deep-vein thrombosis (DVT), pulmonary embolism and non-valvular atrial fibrillation can also put seniors at a high risk of cardiovascular events.

How Are clotting disorders treated in seniors?

Seniors are not the only people affected by clotting disorders, but they belong to a population that is more likely to develop conditions like DVT. For many retirees, prescription medications and lifestyle changes are the recommended treatment for clotting disorders.

In concert with your doctor’s orders, getting plenty of healthy exercise each day can keep the cardiovascular system working the way it should. Medications like Eliquis may also be taken to reduce the coagulant properties of the blood. This may reduce the potential for blood clots, thereby lowering the risk of heart attack and stroke.

What is Eliquis?

Eliquis (apixaban) is an anticoagulant prescription medication that thins the blood. It works by blocking certain clotting factors, including Xa. This has the effect of causing blood to clot more slowly, so precautions need to be taken when using Eliquis. Since the medication causes the blood to clot more slowly, easy bleeding and bruising can be side effects. Despite this, many seniors and their doctors find that the benefits of Eliquis outweigh the negatives.

Does Medicare cover Eliquis?

Medicare insurance is relied on by tens of millions of American seniors and individuals with disabilities. For many, the program is a lifeline to help pay for high medical costs associated with cardiovascular health conditions. Prescriptions for Medicare recipients are granted coverage through Medicare Part D. 

Although Medicare Part D plans cover a wide range of medications, each plan may vary in costs and benefits. To know whether your Medicare Part D coverage includes Eliquis, you need to consult the formulary included with your plan.

This document lists all of the medications covered by your Part D benefits. It also lists drugs according to tier. Medications on the lower tiers are generally less expensive, while drugs on Tier III or a Specialty Tier are usually the most expensive.

Your costs for Eliquis under Medicare Part D

Some Medicare Part D prescription drug plans require a copay for certain drugs. This copay is due at the time of purchase from your local pharmacy and can vary from drug to drug. Medicare benefits under Part D do not go into effect until the plan’s deductible has been met. The deductible for prescription drug coverage varies, but no deductible can be higher than $505 in 2023.

Your premium can also vary with some Medicare recipients required to pay an additional premium on top of the plan premium. This additional premium only applies to individuals and married couples who have higher incomes. At the top, individuals who earn $403,000 or more annually and married couples earning $750,000 or more annually can expect to pay $76.40 in additional plan premium costs.

Other ways Medicare provides coverage for Eliquis

Although picking up a prescription for Eliquis at your nearest pharmacy, you may have access to a mail-order pharmacy through your plan. Medicare Advantage plans that include prescription drug coverage may cover Eliquis. You may have to visit doctors and pharmacies within the plan’s network in order to get your benefits. 

You may also be provided Eliquis during an outpatient doctor visit or an inpatient admission to a hospital or skilled nursing facility. In these cases, Medicare Parts A or B may cover the costs of medications depending on your specific circumstances.