Eliquis is one of the most prescribed blood thinners on Medicare, and it’s also one of the most expensive. But several changes taking effect in 2025 and 2026 are significantly lowering what you’ll actually pay. Between the new $2,000 annual cap on Part D spending, a negotiated price dropping in 2026, and assistance programs available right now, there are concrete steps to cut your costs.
The $2,000 Annual Cap Changes Everything in 2025
Starting January 1, 2025, no Medicare Part D enrollee pays more than $2,000 out of pocket for prescription drugs in a calendar year. This is the single biggest cost reduction for Eliquis users on Medicare. Once your spending hits that threshold, you enter catastrophic coverage and pay nothing for the rest of the year.
The old coverage gap (sometimes called the “donut hole”) no longer exists. The Part D benefit now has just three phases: your annual deductible, an initial coverage phase where you pay 25% coinsurance, and catastrophic coverage where you pay zero. For a drug as expensive as Eliquis, many people will hit the $2,000 cap within the first few months of the year. After that, every refill is fully covered.
Part D plans also offer the option to spread that $2,000 across monthly payments throughout the year, so you’re not hit with large bills upfront. Ask your plan about this payment smoothing option during enrollment or at any time during the year.
A Negotiated Price Takes Effect in 2026
Eliquis was one of the first ten drugs selected for Medicare price negotiation under the Inflation Reduction Act. The negotiated maximum fair price is $231 for a 30-day supply, taking effect in 2026. That’s a substantial drop from the list price, and it will lower what both Medicare and enrollees pay.
You don’t need to do anything to benefit from this. The lower price will automatically apply to your Part D coverage starting January 2026. Combined with the $2,000 cap, this means you’ll hit that annual limit more slowly, effectively reducing your monthly costs even further.
Choose the Right Type of Plan
How your plan charges you for Eliquis matters more than most people realize. There’s a stark difference between standalone Part D plans and Medicare Advantage plans that include drug coverage.
Between 2020 and 2024, the average out-of-pocket cost for Eliquis in standalone Part D plans more than doubled, jumping from about $47 to $102 per fill. The reason: 75% of standalone plans switched to percentage-based coinsurance instead of flat copays. When you pay a percentage of an expensive drug, your costs rise as the drug’s price rises.
Medicare Advantage drug plans told a very different story over the same period. Average out-of-pocket costs barely moved, going from about $45 to $47 per fill. Only 5% of Medicare Advantage plans used coinsurance for Eliquis in 2024, with most sticking to predictable flat copays.
If you’re in a standalone Part D plan and paying coinsurance on Eliquis, switching to a Medicare Advantage plan with a flat copay could save you hundreds of dollars a year. Compare plans during open enrollment each fall using Medicare’s Plan Finder tool at medicare.gov, and pay close attention to which formulary tier each plan places Eliquis on. Lower tiers mean lower costs.
Apply for Extra Help If You Qualify
Medicare’s Extra Help program (also called the Low Income Subsidy) pays part or most of your Part D costs, including premiums, deductibles, and copays. For 2025, you may qualify if your annual income is below $23,475 as an individual or $31,725 as a couple, and your countable assets are under $18,090 individually or $36,100 for a married couple.
Assets include savings accounts, stocks, and bonds but not your home, car, or personal belongings. If you qualify, your copays for Eliquis could drop to just a few dollars per fill. You apply through the Social Security Administration, either online at ssa.gov, by phone, or at your local Social Security office.
Check State Pharmaceutical Assistance Programs
More than two dozen states run their own pharmaceutical assistance programs, often called SPAPs, that coordinate directly with Medicare Part D. These programs can help cover premiums, deductibles, or copays that Medicare doesn’t fully pay. Eligibility rules and benefits vary by state, and income limits are often more generous than the federal Extra Help program.
To find out if your state offers one, contact your State Health Insurance Assistance Program (SHIP), which provides free counseling to Medicare beneficiaries. You can find your local SHIP by calling 1-877-839-2675 or searching at shiphelp.org.
Manufacturer and Charitable Assistance
Bristol Myers Squibb, which makes Eliquis, runs a Patient Assistance Foundation that does accept Medicare patients, but with an extra requirement: you need to show that you’ve already spent at least 3% of your annual household income on out-of-pocket prescription costs in the same calendar year you’re applying. That’s on top of the foundation’s other financial eligibility criteria. If you take multiple expensive medications, you may meet that threshold relatively quickly. Applications are available at bmspaf.org.
Independent charitable foundations like the PAN Foundation also offer copay grants for specific disease categories, including conditions treated with anticoagulants. These grants cover your remaining out-of-pocket costs for medications on the fund’s formulary. The catch is that funding opens and closes unpredictably. The PAN Foundation offers a tool called FundFinder that sends you an instant notification when a relevant fund opens, so you can apply before it runs out. Check panfoundation.org to sign up and pre-screen your eligibility.
Generic Eliquis Is Still a Few Years Away
A generic version of apixaban (the active ingredient in Eliquis) would dramatically lower costs, but it isn’t commercially available yet. Key patents don’t expire until late 2026 and mid-2027, with additional FDA exclusivity periods running through October 2028. Even after patents expire, there can be delays before generics actually reach pharmacy shelves. A realistic timeline for widely available generic Eliquis is sometime in 2028 or later.
In the meantime, the strategies above are the most effective ways to lower your costs. The combination of the $2,000 annual cap already in effect and the negotiated price arriving in 2026 means the financial picture for Eliquis on Medicare is improving faster than at any point since the drug launched.