The newer blood thinners that most people take today, like Eliquis and Xarelto, cost roughly $520 a month at list price. That’s more than $6,000 a year for a single medication, and for many patients, it’s one they’ll take for the rest of their lives. The high price comes down to a combination of patent protection, a pricing system that rewards higher list prices, and the sheer number of people who need these drugs.
What These Drugs Actually Cost
The two most commonly prescribed blood thinners in the U.S. are Eliquis (apixaban) and Xarelto (rivaroxaban). In 2023, the list price for a 30-day supply of Eliquis was $521, and Xarelto was $517. By 2024, Eliquis had climbed to about $550 a month. Generic warfarin, the older blood thinner these drugs replaced, costs as little as $4 to $15 a month at most pharmacies.
That price gap is enormous, and it explains why so many people searching for answers feel stuck. Nearly 4 million Medicare beneficiaries alone take Eliquis. In 2021, Medicare spent $8.9 billion on Eliquis, making it the single most expensive drug in the entire Medicare Part D program. Across all 10 of the costliest Medicare drugs, Eliquis accounted for nearly a third of total spending.
Patent Protection Blocks Generic Competition
The biggest reason newer blood thinners stay expensive is simple: no generic versions are available yet. Brand-name drugs are protected by patents that give the manufacturer exclusive rights to sell them, and drug companies typically file multiple patents to extend that protection as long as possible.
Eliquis is covered by several patents. One expired in 2019, but another doesn’t expire until November 2026, and a third runs until 2031. The FDA has already given tentative approval to generic versions of Eliquis, meaning they’ve passed quality and safety reviews, but manufacturers can’t actually sell them until the key patent expires. Generic Eliquis could reach pharmacies in late 2026 at the earliest, which would likely drive the price down dramatically, the same way generic warfarin became one of the cheapest prescriptions available.
Until that happens, Bristol Myers Squibb and Pfizer (the companies behind Eliquis) face no price competition from equivalent products. That’s the fundamental dynamic keeping prices high.
The Rebate System That Inflates List Prices
The sticker price of a blood thinner isn’t what every player in the system actually pays. Pharmacy benefit managers, the middlemen who negotiate drug prices on behalf of insurance companies, extract significant rebates from manufacturers. For Eliquis, those rebates recently averaged about 45% of the list price. In theory, that should lower costs. In practice, it often doesn’t help the person picking up the prescription.
Here’s why: rebate savings typically flow to the insurance plan or the PBM, not to individual patients. And when your insurance uses coinsurance (where you pay a percentage of a drug’s cost rather than a flat copay), your share is calculated on the full price before rebates. So you might owe 25% of $550, not 25% of the post-rebate price. The manufacturer collects a lower net price after paying rebates, but the patient’s bill reflects the higher number.
This creates a perverse incentive. PBMs demand steeper rebates, so manufacturers raise list prices to compensate, and patients with coinsurance end up paying more. The pharmacy cost of Eliquis grew 22% between 2020 and 2024, even as rebates also increased. Both numbers went up together, and patients absorbed the difference.
Why Cheaper Warfarin Isn’t Always the Answer
If generic warfarin costs a fraction of the price, why doesn’t everyone just take that instead? Because warfarin comes with significant hidden costs and burdens that newer blood thinners don’t.
Warfarin requires regular blood tests, typically every few weeks, to make sure the dose is keeping your blood in the right range. Too little and it doesn’t prevent clots; too much and you risk dangerous bleeding. These lab visits add up in both time and money. Warfarin also interacts with dozens of foods (especially leafy greens) and other medications, making it harder to manage.
A study of veterans enrolled in both VA and Medicare found that patients on warfarin had roughly $8,563 more in total annual medical costs compared to patients on newer blood thinners, even after accounting for the higher prescription price. That gap came from more hospitalizations, more complications, and more medical visits. Warfarin patients also had higher medical costs in years when they survived the full year ($10,588 more) and in years of death ($9,461 more). So while the pill itself is cheap, the total cost of warfarin therapy to the healthcare system is often higher.
This doesn’t help if you’re the one staring at a $550 pharmacy bill, of course. The savings from fewer complications benefit the insurance system broadly, not your wallet specifically.
Medicare Negotiation Will Lower Prices in 2026
Both Eliquis and Xarelto were among the first 10 drugs selected for price negotiation under the Inflation Reduction Act. Starting January 1, 2026, Medicare will pay negotiated “maximum fair prices” for these drugs. The negotiated price for a 30-day supply of Xarelto drops to $197, down from a $517 list price. Eliquis drops to $231, down from $521.
These negotiated prices represent reductions of roughly 55 to 62 percent. For Medicare beneficiaries specifically, this is a significant shift. Between the negotiated prices taking effect and generic Eliquis potentially entering the market around the same time, 2026 could be the year blood thinner costs finally come down meaningfully.
The Inflation Reduction Act also caps total out-of-pocket drug spending for Medicare Part D enrollees at $2,000 per year starting in 2025, which provides a ceiling for patients taking multiple expensive medications.
Options for Reducing Your Cost Now
If you’re paying high prices for blood thinners before these changes take effect, a few options exist. The Bristol Myers Squibb Patient Assistance Foundation provides Eliquis free of charge to eligible patients. Medicare patients need to show they’ve spent at least 3% of their annual household income on out-of-pocket prescription costs in the same calendar year, along with meeting other financial eligibility criteria.
Manufacturer copay cards can reduce costs for people with commercial insurance, though these typically aren’t available to Medicare or Medicaid enrollees. Asking your pharmacist to run your prescription through a discount program like GoodRx or Cost Plus Drugs can sometimes beat your insurance price, particularly if you have a high-deductible plan. Some patients also find lower prices through mail-order pharmacies or by comparing costs across different retail pharmacies, where prices for the same drug can vary by hundreds of dollars in the same city.