Does Medicare Cover Apixaban? Which Part Pays and What the Tier Means

Yes. Medicare covers apixaban, and the part that pays is Part D, the drug benefit. Apixaban is sold under the brand name Eliquis. It comes as tablets that you take by mouth at home. Drugs you take at home sit in Part D, so your drug plan is where coverage lives.

Apixaban is a blood thinner. It is used to lower the risk of stroke for some people with a heart rhythm problem called atrial fibrillation. It is also used to treat blood clots in the veins and to help keep those clots from coming back. This guide covers the payment side only: which part pays, where the drug sits on plan drug lists, and what that spot means for your cost. It does not give dosing advice, and it does not say if this drug is right for any one person. Those calls belong to you and your doctor. You can see the full data for this drug on our apixaban page.

Which part pays

Medicare splits drug coverage by where and how a drug is given.

The full list of covered drugs lives on our medications hub.

• Part D: pays for apixaban you take at home. This is the normal path for this drug.
• Part A: covers drugs given during a covered hospital or skilled stay, as part of that stay. If you take apixaban in a hospital, it is inside the payment for that stay.
• Part B: pays for some drugs a clinician gives in an office or clinic. Apixaban has no such form in the CMS Part B spending file, so Part B is not a path for this drug.
• Medicare Advantage: most plans with drug coverage use the same drug list and tier system as other Part D plans. The plan's own list decides your cost.
• Medigap: Medicare Supplement plans sold today do not include drug coverage. Drug coverage comes from Part D or from a Medicare Advantage plan with drug coverage.

What a tier is

Each Part D plan keeps a drug list, called a formulary. The plan sorts the drugs on its list into tiers, which are cost levels. Low tiers cost less. High tiers cost more.

The tier is the honest cost signal for a drug. CMS does not publish a copay for apixaban, because each plan sets its own price for its tier. Two plans can place the same drug on the same tier and charge sums that are not the same.

• Tier 1 is most often for low-cost generic drugs, with the lowest copays.
• Tier 2 is most often for preferred brand drugs or higher-cost generics. Many plans set a flat copay for this tier.
• Tier 3 and above cost more, and some plans charge a share of the drug's price, called coinsurance, on these tiers.
• A specialty tier holds very high-cost drugs, and it almost always uses coinsurance.

Where apixaban sits

The data here comes from the CMS monthly Part D formulary file for plan year 2027, checked on 2026-10-30. The file covers 5,495 Part D plans.

So the usual case is Tier 3. That spot tends to cost more than Tier 1 or Tier 2. If your plan is one of the few Tier 1 or Tier 2 plans, your cost should be lower. Check your own plan's list before the year starts, and again if the plan sends a change notice.

One more figure needs care. CMS dashboard data put average spending per beneficiary for Eliquis at $4,695 in 2024. That is a program average across Part D. It is not a copay, and it is not what any one person pays at the pharmacy. Plans, the program, and patients each pay a part of drug costs, and those shares are not the same as the average.

• All 5,495 plans list apixaban. The listing share is 100%.
• The most common tier is Tier 3. Of the listing plans, 5,057 place it on Tier 3, which is 92.03%.
• The rest spread out: 125 plans place it on Tier 1, and 313 plans place it on Tier 2.
• The file lists two forms: a 2.5 MG oral tablet and a 5 MG oral tablet, both sold as Eliquis.

What you may pay across the year

Your cost for apixaban is not just the tier copay. Part D has stages, and the sums below come from the Verified Figures Ledger.

Coverage and costs change. Drug lists (formularies), tiers, and copays can change during the year and differ by plan. Always check with your insurance company or plan directly to confirm what is covered and what you will pay.

• Deductible: the standard Part D deductible is capped at $615 for 2026. Your plan can set a lower one, and some plans waive it for low tiers. For 2027, the cap rises to $700. That 2027 figure takes effect on 2027-01-01.
• Coverage stage: after the deductible, you pay your tier copay or coinsurance, and the plan pays the rest, until your total out-of-pocket cost for covered drugs hits the cap.
• Cap: for 2026, once your out-of-pocket cost for covered drugs reaches $2,100, you pay $0 for covered drugs for the rest of the year. For 2027, the cap is $2,400. That 2027 figure also takes effect on 2027-01-01.
• Extra Help: if you qualify for Extra Help with drug costs, you pay no more than $5.10 for a generic drug and no more than $12.65 for other drugs in 2026. Apixaban is sold as the brand drug Eliquis, so the cap for other drugs is the one that fits it. Our guide to checking Medicare Savings Programs and Extra Help shows how to check if you qualify.

Sample situation

James takes apixaban and wants to know what it will cost next year. Each fall, he reads the letter his drug plan sends about the new year. This year, the letter said apixaban would stay on Tier 3 in his plan. James did not stop with the letter. He called the plan and asked if the deductible would apply to his Tier 3 drugs, and what he would pay each time he filled the drug.

The plan told him the deductible cap for 2026 is $615, and that what he pays for covered drugs counts toward the $2,100 out-of-pocket cap for 2026. Once he hits that cap, he pays $0 for covered drugs for the rest of the year. The plan also told him the caps change next year. For 2027, the deductible cap is $700 and the out-of-pocket cap is $2,400.

James wrote those sums down. One short call told him how the year could play out, so the first fill in January would not be a shock.

How to check your own plan

• Find your plan's drug list online or in the plan's mailed book, and look up apixaban or Eliquis by name and strength.
• Note the tier, and then find what your plan charges for that tier in its summary of benefits.
• Ask if the deductible applies to that tier in your plan.
• Ask the pharmacy what the drug costs with your plan before you fill it. Small sums add up over a year.
• If the cost is hard to pay, ask the plan and your doctor's office about help programs, and check if you qualify for Extra Help.

Sources

• https://careandlivingguide.com/medications/apixaban
• https://www.medicare.gov/health-drug-plans/part-d/basics/costs
• https://www.medicare.gov/basics/costs/help/drug-costs