Drug CostMay 19, 2026·7 min read·By Jacob Posner, Founder & Editor
How Much Does Eliquis Cost Under Medicare in 2026?
Starting January 1, 2026, the IRA Maximum Fair Price for Eliquis is $231 for a 30-day supply, down from a list price of $521. Medicare Part D enrollees benefit from both the negotiated rate and the $2,100 annual out-of-pocket cap. Generic apixaban is also available at $30 to $80 per month at retail pharmacies.
Quick Answer: In 2026, Eliquis (apixaban) carries an IRA Maximum Fair Price of $231 per 30-day supply for Medicare Part D patients, a 56% reduction from the prior list price of $521. What you actually pay depends on your Part D plan's tier and cost-sharing, but all Medicare Part D enrollees are protected by the $2,100 annual out-of-pocket cap. Generic apixaban launched in late 2024 and retails at $30 to $80 per month without insurance. Brand-name Eliquis retails at $500 to $600 per month without any assistance.
Eliquis (apixaban) is a direct oral anticoagulant (DOAC) that prevents blood clots in people with atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism (PE). It is one of the most prescribed drugs in the United States, and for years it was one of the most expensive outpatient medications for Medicare patients. The Inflation Reduction Act of 2022 changed that. Starting January 1, 2026, Eliquis became the first wave of drugs subject to the IRA's Medicare drug price negotiation, with a Maximum Fair Price of $231 for a 30-day supply.
Eliquis is an oral tablet, which means it is billed under Medicare Part D (the outpatient prescription drug benefit) and not Part B. There is no HCPCS J-code for oral tablets. Your cost-sharing depends on your specific Part D plan's formulary tier and deductible, but you are protected by the $2,100 annual out-of-pocket cap that took effect in 2026 for all Part D enrollees. For patients without any insurance, generic apixaban became available in late 2024 and typically costs $30 to $80 per month at major retail pharmacies.
Patients who cannot afford Eliquis even with Part D coverage should know that Bristol Myers Squibb runs the BMS Patient Assistance Foundation (BMSPAF), which provides free Eliquis to eligible uninsured and underinsured patients with incomes up to approximately 300% of the Federal Poverty Level. The program ships directly to the patient's home. For a broader look at what you qualify for based on income, the Medicaid income limits guide covers eligibility by state.
What Eliquis Medicare 2026 Costs by Point of Pay (2026)
The price you pay depends almost entirely on WHERE you pay. The same eliquis medicare 2026 can cost many times more at a hospital than at your local pharmacy:
2026 Eliquis Medicare 2026 Price by Point of Pay
Where you pay
Typical cost
Notes
Retail pharmacy, brand (cash, no insurance)
$500 - $600/month
Brand Eliquis list price, no assistance
Retail pharmacy, generic apixaban (cash)
$30 - $80/month
Generic available since late 2024; multiple manufacturers
Medicare Part D (2026 IRA Maximum Fair Price)
$231/month (MFP base)
Effective Jan 1, 2026; actual patient cost depends on plan tier and deductible, capped at $2,100/year OOP
Inpatient hospital stay
Included in DRG bundle
Medicare covers oral drugs during inpatient stays under Part A; patient faces the $1,736 Part A deductible per benefit period
Medicaid
$1 - $4/prescription
Covered in most state formularies; preferred anticoagulant in many states
2026 IRA Maximum Fair Price sourced from CMS fact sheet. Retail ranges from GoodRx and PharmacyChecker. Brand retail represents list price without assistance.
Source: CMS IRA Negotiated Drug Prices 2026, GoodRx, PharmacyChecker
Why Hospitals Charge So Much
When you are admitted to a hospital, oral drugs like Eliquis are typically bundled into the Diagnosis Related Group (DRG) payment the hospital receives from Medicare under Part A. This means you generally will not see Eliquis as a separate line item on an inpatient hospital bill. Instead, your main cost exposure is the Part A inpatient deductible of $1,736 per benefit period in 2026. That said, hospital chargemasters sometimes show Eliquis at $500 to $1,200 or more for a course of treatment during admission, reflecting the full facility markup.
If you are in an outpatient observation status (not formally admitted), the hospital may bill Eliquis under Part B or ask you to use your own Part D coverage. This distinction matters: observation status means Part A does not apply, and you could be asked to pay a retail or Part D cost-sharing amount for each dose. Always ask the hospital whether you are admitted or under observation status, as this directly affects your Eliquis cost during the stay.
The IRA's Maximum Fair Price does not cap what Medicare patients pay at the pharmacy counter directly; it caps what Medicare Part D plans pay the manufacturer. Your actual Part D cost-sharing still depends on your plan's formulary placement. However, because the MFP of $231 is lower than most plans' prior negotiated rates, many Part D plans moved Eliquis to a preferred tier for 2026, reducing member cost-sharing significantly. Compare your plan's Eliquis tier during open enrollment each fall using the Medicare Plan Finder at medicare.gov.
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Eliquis is co-marketed by Bristol Myers Squibb and Pfizer. Both companies maintain assistance programs for uninsured and underinsured patients. The BMS Patient Assistance Foundation (BMSPAF) is the primary free-drug program. Commercial patients can access the Eliquis copay card for up to $10 per month.
Patient assistance programs for Eliquis Medicare 2026
Manufacturer program
Cost / Benefit
How to apply
BMS Patient Assistance Foundation (BMSPAF)
Free Eliquis for eligible uninsured or underinsured patients (income up to ~300% FPL)
bmspaf.org
Eliquis Copay Card (commercial insurance)
$10/month for up to 24 months (not valid for Medicare/Medicaid patients)
eliquis.bmscustomerconnect.com/savings
BMSPAF requires proof of income and insurance status. Medicare and Medicaid patients are not eligible for the commercial copay card but may qualify for BMSPAF if they are not enrolled in Part D. Eligibility is verified annually.
Eliquis is covered under Medicare Part D as an outpatient oral prescription drug. Starting January 1, 2026, the IRA Maximum Fair Price of $231 per 30-day supply applies as the ceiling for what Part D plans pay the manufacturer. Your actual cost at the pharmacy depends on your specific plan's tier placement and deductible. Many Part D plans placed Eliquis on a preferred tier for 2026 in response to the lower MFP, which reduces member cost-sharing compared to prior years.
All Medicare Part D enrollees are protected by the $2,100 annual out-of-pocket cap in 2026. Once your total Part D out-of-pocket spending (copays, coinsurance, and deductibles for all covered drugs) reaches $2,100, your plan pays 100% for the rest of the year. Patients who take Eliquis as a long-term medication and have high drug costs in other areas may hit this cap partway through the year. The Part D Extra Help (Low Income Subsidy) program can further reduce costs to $0 to $11 per month for qualifying low-income Medicare enrollees.
Common Eliquis Medicare 2026 Billing Errors
Eliquis billing errors are most common in transitions between inpatient and outpatient settings, and in cases where the IRA price reduction has not been correctly applied. Check for these errors if you receive an unexpected bill:
Billed at the pre-IRA list price ($521) instead of the 2026 Maximum Fair Price ($231) for Medicare Part D claims
Eliquis charged as a separate line item during an inpatient (Part A) stay when it should be bundled in the DRG payment
Outpatient observation status drug charges billed at inpatient rates, inflating the cost
Brand Eliquis billed when generic apixaban was dispensed (or vice versa), creating a tier mismatch
Failure to apply the Part D $2,100 annual OOP cap once the threshold has been met
Commercial copay card applied to a Medicare claim (not permitted under federal law)
Frequently Asked Questions
What is the 2026 Medicare price for Eliquis?
The 2026 IRA Maximum Fair Price for Eliquis (apixaban) is $231 for a 30-day supply. This is the ceiling price that Medicare Part D plans pay the manufacturer under the Inflation Reduction Act drug negotiation program, effective January 1, 2026. It represents a 56% reduction from the prior list price of $521 per 30-day supply. What you actually pay at the pharmacy depends on your Part D plan's tier and cost-sharing rules.
Does the $231 IRA price mean I pay $231 per month for Eliquis on Medicare?
Not necessarily. The $231 Maximum Fair Price is what Medicare pays the manufacturer, not the patient cost-sharing amount. Your out-of-pocket cost at the pharmacy depends on your Part D plan's formulary tier, deductible, and coinsurance. Many plans have placed Eliquis on a preferred or mid-tier for 2026, with typical member copays ranging from $47 to $100 per month before the deductible is met. All costs count toward the $2,100 annual OOP cap.
What is the 2026 Part D out-of-pocket cap and how does it affect Eliquis costs?
In 2026, the Medicare Part D annual out-of-pocket cap is $2,100. Once you have paid $2,100 in total covered drug costs across all your Part D drugs for the year, your plan covers 100% of remaining costs. For Eliquis patients who may also take other costly medications, this cap provides meaningful protection. It is a permanent change under the Inflation Reduction Act of 2022.
Is generic apixaban the same as Eliquis?
Yes. Generic apixaban contains the same active ingredient as Eliquis and is FDA-approved as therapeutically equivalent. Generic versions became available in late 2024 following patent settlements. At retail (without insurance), generic apixaban costs approximately $30 to $80 per month compared to $500 to $600 for brand Eliquis. Medicare Part D plans generally cover both, and some plans may require use of the generic first (step therapy). Check your plan's formulary before assuming your plan covers the brand.
How do I get free Eliquis through the BMS patient assistance program?
The Bristol Myers Squibb Patient Assistance Foundation (BMSPAF) provides free Eliquis to uninsured or underinsured patients with incomes up to approximately 300% of the Federal Poverty Level. Apply at bmspaf.org or by calling 1-800-736-0003. You will need to provide proof of income, insurance status, and a valid prescription. The program ships directly to your home, and enrollment must be renewed annually.
Does Eliquis have a HCPCS J-code for hospital billing?
No. Eliquis is an oral tablet, and HCPCS J-codes are reserved for injectable and infused drugs administered in clinical settings. Oral drugs do not carry J-codes. In an inpatient hospital stay, Eliquis is typically bundled into the facility's DRG payment and should not appear as a separate billable line item. If you see Eliquis listed with a J-code on your hospital bill, that is a billing error worth disputing.
What happens to my Eliquis cost if I am hospitalized?
If you are formally admitted (inpatient), oral drugs like Eliquis are covered by Medicare Part A within the DRG bundle. You are not separately billed for Eliquis. Your main cost is the $1,736 Part A deductible per benefit period in 2026. If you are in observation status (technically outpatient), the hospital may bill Eliquis under Part B or direct you to use your Part D plan. Always confirm your admission status, as observation patients face different cost exposure than formally admitted patients.
Can I use an Eliquis copay card on Medicare?
No. The Eliquis commercial copay card (offering $10 per month) cannot be used by Medicare or Medicaid patients under federal anti-kickback rules. If you are on Medicare, the copay card is not permitted. The appropriate savings options for Medicare patients are the Part D $2,100 annual OOP cap, the Part D Extra Help program (for low-income enrollees), and the BMSPAF free-drug program for those who are uninsured or not enrolled in Part D.
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