Did you know that millions of Americans rely on Eliquis to prevent strokes and treat blood clots? But with the high cost of prescription drugs, many people wonder how to get Eliquis cheaper on Medicare. If you’re one of them, you’re in the right place!
In this article, we’ll dive into the different ways you can save money on Eliquis through Medicare. We’ll cover everything from Medicare Part D plans to Extra Help programs and other tips to lower your prescription costs. By the end of this article, you’ll have a clear understanding of how to access this life-saving medication without breaking the bank.
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Understanding Medicare Coverage for Eliquis
The Role of Medicare Part D in Eliquis Coverage
Medicare Part D is a prescription drug plan that helps cover the cost of medications like Eliquis. Part D plans are offered by private insurance companies and vary widely in terms of coverage, premiums, and out-of-pocket costs. When you enroll in a Medicare Part D plan, you pay a monthly premium and, in most cases, a deductible before your coverage kicks in. After meeting the deductible, you will pay a copay or coinsurance for your prescriptions, including Eliquis. The cost of Eliquis with Part D coverage can vary, but the average monthly copay is around $44, with some paying as little as $30.
One important aspect of Medicare Part D is the formulary, which is the list of drugs covered by the plan. Eliquis is typically placed in a higher tier, meaning it has a higher copay compared to lower-tier generic drugs. Additionally, certain restrictions like prior authorization or step therapy may apply. Prior authorization requires your doctor to justify the medical necessity of Eliquis before the plan approves coverage. Step therapy might require you to try a less expensive medication first before approving Eliquis.
Navigating Through Medicare Advantage for Eliquis
When it comes to getting Eliquis through Medicare Advantage plans, it’s important to know that these plans, also known as Medicare Part C, combine the benefits of Original Medicare (Part A and Part B) with additional services, which often include prescription drug coverage. However, not all Medicare Advantage plans cover every medication, so you’ll need to check if Eliquis is on your plan’s formulary, which is the list of covered drugs. Plans have different tiers for medications, and Eliquis is typically placed in a higher tier due to its cost, which means higher copayments or coinsurance. Additionally, some plans might require prior authorization, which means your doctor needs to confirm that Eliquis is medically necessary before the plan will cover it.
Another factor to consider is that Medicare Advantage plans can include restrictions like step therapy. Step therapy requires you to try less expensive medications before “stepping up” to Eliquis. This process helps ensure that Eliquis is only used when absolutely necessary and other cheaper alternatives have been tried and found ineffective. It’s crucial to work with your healthcare provider to navigate these requirements and ensure that all necessary paperwork is submitted to your plan. This way, you can avoid delays in getting your medication.
Strategies to Lower Your Eliquis Costs with Medicare
Prior Authorization and Step Therapy
When you’re trying to get Eliquis covered by Medicare, you might come across terms like “prior authorization” and “step therapy.” These are ways that Medicare ensures you’re getting the most cost-effective treatment before moving on to more expensive options.
Prior authorization means that your doctor needs to get approval from your Medicare plan before your prescription for Eliquis is covered. This process helps make sure that the medication is necessary and appropriate for your condition, potentially saving you from unexpected costs.
Step therapy requires you to try less expensive medications before “stepping up” to Eliquis. For instance, your plan might want you to start with a generic drug or a different brand-name drug that treats the same condition. If those don’t work, you can then move on to Eliquis. This process helps control costs and ensures that you’re not paying more than you need to for effective treatment.
Medicare Extra Help Program
The Medicare Extra Help program, also known as the Low-Income Subsidy (LIS), is designed to assist individuals with limited income and resources in covering the costs associated with Medicare Part D prescription drug plans. This includes premiums, deductibles, and co-payments.
In 2024, to qualify for Extra Help, an individual must have an annual income of less than $22,590, and for married couples, the limit is $30,660. Additionally, the resource limits are $17,220 for individuals and $34,360 for married couples, excluding items like your primary home and vehicle. If you qualify, you could pay as little as $4.50 for generic drugs and $11.20 for brand-name drugs, significantly reducing the cost of Eliquis.
The program also eliminates the late enrollment penalty for those who delayed signing up for Medicare Part D. To apply for Extra Help, you can visit the Social Security Administration’s website or contact your local State Health Insurance Assistance Program (SHIP) for assistance.
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Manufacturer Coupons and Assistance Programs
One of the most effective ways to lower the cost of Eliquis with Medicare is by taking advantage of manufacturer coupons and assistance programs. The manufacturer, Bristol-Myers Squibb, offers several options to help reduce the out-of-pocket costs for Eliquis. Eligible patients can use a co-pay card to pay as little as $10 per 30-day supply for up to 24 months.
Additionally, there is a free 30-day trial offer available for new patients, allowing them to receive up to 74 tablets at no cost. For those who need further assistance, the Bristol-Myers Squibb Patient Assistance Foundation provides support to eligible individuals, helping cover the costs of Eliquis for those who qualify based on income and other criteria. These programs are designed to make it easier for patients to afford their medication and continue their treatment without financial strain, but it is important to carefully review the eligibility requirements and terms of use before applying.
Prescription Savings Cards
Prescription savings cards are a valuable tool for reducing the cost of Eliquis, especially if you’re on Medicare. These cards work like a coupon, providing significant discounts at participating pharmacies. For example, programs like SingleCare, GoodRx, and Optum Perks offer discounts up to 80% off the retail price of medications, including Eliquis.
You don’t need to sign up for a membership or pay any fees to use these cards. Simply present the card or coupon at the pharmacy to receive the discount. Many major pharmacies, including CVS, Walgreens, and Walmart, accept these cards, making it convenient to find a participating location near you. Additionally, Eliquis offers a co-pay card that can reduce the cost to as little as $10 per month for eligible patients.
Pharmacy Price Comparison
When it comes to purchasing Eliquis, the cost can vary significantly depending on where you buy it. Conducting a pharmacy price comparison is a practical strategy to ensure you’re getting the best possible deal. Start by checking prices at different local pharmacies, including big chains like CVS, Walgreens, and Walmart, as well as smaller independent pharmacies.
You can also use online tools like GoodRx or SingleCare to compare prices and find available discounts or coupons. These tools can often help you save a substantial amount, sometimes reducing the cost to as low as $565 at certain pharmacies compared to over $700 at others. Additionally, consider using mail-order services, which may offer lower prices for a 90-day supply. By investing a little time in comparing prices and exploring these options, you can significantly cut down on your medication expenses.
Long-Term Savings Strategies
90-Day Supply
One effective way to save money on Eliquis and other prescription medications under Medicare is by opting for a 90-day supply instead of a 30-day supply. Many Medicare Part D and Medicare Advantage plans offer this option through mail-order pharmacies.
By choosing a 90-day supply, you can reduce your trips to the pharmacy and often benefit from lower copayments compared to filling a 30-day prescription each month. This approach not only adds convenience but can also lead to significant savings over time. Additionally, some plans provide discounts or lower prices for medications when ordered in bulk, making it a smart strategy for those who need long-term medication.
Mail-Order Pharmacies
One effective long-term strategy to save on Eliquis is to use mail-order pharmacies. These services can often offer lower prices for medications compared to local pharmacies. By getting a 90-day supply instead of a 30-day one, you can reduce the total cost significantly. Mail-order pharmacies, like Express Scripts, allow you to have your medication delivered directly to your home, which can save you multiple trips to the pharmacy.
Additionally, mail-order services often have lower copays, especially when they are part of your Medicare plan’s preferred network. Using these services not only provides convenience but also ensures that you maintain a consistent supply of your medication without gaps in treatment, which is crucial for managing conditions like atrial fibrillation or blood clots.
Keep Costs Down with The Medicare Family
Managing the cost of Eliquis through Medicare can be challenging, but there are many strategies available to help you save money. From utilizing Medicare Part D and Medicare Advantage plans to exploring manufacturer coupons, assistance programs, and mail-order pharmacies, you can find ways to make your medication more affordable. Remember, understanding these options and how they work together can significantly reduce your out-of-pocket expenses.
For personalized support in navigating your Medicare options and finding the best coverage for your needs, schedule a FREE call with The Medicare Family. Our experts are here to help you understand Medicare in simple terms and find the right plan for your situation. With over 40 years of experience and a commitment to providing lifetime support, we are dedicated to making Medicare easy to understand and stress-free. Contact us today to get started on your path to better coverage and savings.
Frequently Asked Questions
How to save money on prescriptions on Medicare?
To save money on prescriptions with Medicare, consider using Medicare Part D plans, applying for Extra Help if you have limited income, and exploring state pharmaceutical assistance programs. Additionally, using mail-order pharmacies and switching to generic drugs can significantly reduce costs.
Can Medicare negotiate drug prices?
Yes, Medicare can now negotiate drug prices thanks to the Inflation Reduction Act of 2022. This new authority allows Medicare to negotiate prices for certain high-cost drugs, with the first negotiated prices becoming effective in 2026. The program will expand annually to include more drugs.
