If you’re a Medicare beneficiary prescribed Eliquis, managing the cost can be challenging. This anticoagulant medication, while crucial for preventing strokes and blood clots in people with certain conditions, can be prohibitively expensive. However, don’t lose hope: there are numerous ways to reduce the cost burden. Here are five actionable strategies to help afford Eliquis while on Medicare.
1. Understanding Your Medicare Coverage
Before diving into cost-saving measures, it’s crucial to understand how Medicare covers prescription drugs like Eliquis. Coverage typically falls under Medicare Part D or a Medicare Advantage Plan (Part C) that includes drug coverage. Both options use formularies, or lists of covered medications, to determine which drugs they pay for and their respective cost tier. Ensure Eliquis is on your plan’s formulary, and understand its tier placement, which impacts your out-of-pocket costs.
Medicare Part D includes a coverage gap, often referred to as the ‘donut hole.’ Once you and your plan spend a certain amount on covered medications, you’re in the donut hole and must pay more out-of-pocket. However, there’s a silver lining: you won’t pay more than 25% of the cost for covered brand-name drugs like Eliquis during this period, which can significantly reduce expenses.
3. Applying for Medicare Part D Extra Help
The Extra Help program is an invaluable resource for those struggling with prescription costs. It’s specifically designed to help people with limited income and resources lower or cut Part D costs. Depending on your income and resource levels, you could qualify for assistance, significantly reducing Eliquis costs.
4. Considering Manufacturer Assistance Programs
Pharmaceutical manufacturers often offer assistance programs for their medications. Bristol-Myers Squibb and Pfizer, the manufacturers of Eliquis, have a program that could help lower the cost of your prescription. These programs typically have eligibility requirements based on income, insurance status, and other factors, so make sure to investigate thoroughly.
5. Using Prescription Discount Cards and Online Platforms
Companies like GoodRx and others offer prescription discount cards and price-comparison tools. These can help you find the lowest cost for Eliquis in your area. While these aren’t insurance, they can offer significant discounts, especially for those in the donut hole or without comprehensive drug coverage.
Frequently Asked Questions About Affording Eliquis with Medicare
Q: What is the Medicare ‘Donut Hole’ and how does it affect my Eliquis costs?
The Medicare ‘Donut Hole,’ officially known as the coverage gap, is a temporary limit on what the drug plan will cover for your prescriptions. After you and your plan have spent a certain amount on covered drugs, you enter this gap and are responsible for a higher percentage of your drug costs. For Eliquis and other brand-name drugs, you’ll pay no more than 25% of the cost during this period, which can lower expenses considerably if you’ve entered the donut hole.
Q: What are the eligibility requirements for the Extra Help program?
Extra Help is a program designed to assist people with limited income and resources in covering Part D costs, including premiums, deductibles, and coinsurances. To qualify for Extra Help, your combined savings, investments, and real estate must be below a certain limit, excluding your home, vehicles, burial plot, life insurance, personal possessions, or back payments from Social Security or SSI. Income limits vary annually and depend on your living situation.
Q: How do manufacturer assistance programs work for Eliquis?
Manufacturer assistance programs, like those offered by Bristol-Myers Squibb and Pfizer, can provide financial relief to individuals struggling with the cost of their prescriptions. The specific criteria for eligibility can vary but often consider factors like income, insurance status, and overall healthcare costs. In some cases, these programs might provide medications at a reduced cost or even free for those who qualify.
Q: Can prescription discount cards be used with Medicare?
Prescription discount cards, such as those offered by GoodRx or SingleCare, can sometimes be used instead of Medicare. However, it’s important to note that these are not a form of insurance. You should compare the price with the discount card to your Medicare Part D plan’s price to see which offers the better deal for Eliquis. Always inform your pharmacist which method you want to use for each purchase, as some discount cards cannot be used in combination with Medicare.
Q: Can I appeal if Medicare doesn’t cover Eliquis?
Yes, if your Medicare Part D plan does not cover Eliquis, or if a coverage limitation is imposed, you have the right to request a coverage determination, which includes the right to appeal. The appeal process involves several steps, starting with the Redetermination by your Part D plan. If the response remains unsatisfactory, the process can proceed to Reconsideration by an Independent Review Entity, a hearing before an Administrative Law Judge, review by the Medicare Appeals Council, and finally, a judicial review in federal district court. The specifics for initiating an appeal will be detailed in your plan’s Evidence of Coverage.
Q: Can I switch to a different blood thinner to reduce costs?
If the cost of Eliquis is prohibitive, discuss with your healthcare provider the possibility of switching to a different, more affordable anticoagulant. There are several other options on the market, such as warfarin, that have been used effectively for many years and may be more cost-effective. However, each medication comes with its own benefits and risks, so it’s crucial to make this decision in close consultation with your healthcare provider.
Q: How do state pharmaceutical assistance programs affect my Eliquis costs?
State Pharmaceutical Assistance Programs (SPAPs) help citizens afford the cost of prescription drugs. Each state has different qualifications and benefits, but if you’re eligible, an SPAP could help reduce your Eliquis costs significantly. It’s important to note that if you’re enrolled in an SPAP, it might affect your eligibility for the Extra Help program.
Q: What happens if I can’t afford Eliquis during my Part D plan’s deductible period?
If you can’t afford Eliquis during your Part D plan’s deductible period, there are a few potential options. First, consider applying for Extra Help, which could lower your overall Part D costs. Second, check whether you qualify for manufacturer assistance programs or SPAPs. Lastly, using a prescription discount card may provide some financial relief.
Q: How does the tier level of Eliquis on my plan’s formulary affect the cost?
Most Part D plans categorize covered drugs into cost tiers. Lower-tier drugs are typically generic and cost less, while higher-tier drugs are usually brand-name and more expensive. Eliquis, a brand-name drug, may be placed in a higher tier, meaning you’ll pay more out-of-pocket. If cost is an issue, discuss with your doctor about possible therapeutic alternatives in lower tiers.
Q: How does ‘therapeutic substitution’ work for Eliquis?
‘Therapeutic substitution’ refers to switching to a drug that’s chemically different from the original but used for the same condition. It’s one strategy to lower drug costs, but it’s critical to do this under your doctor’s guidance, given the differences in side effects and effectiveness between drugs. For example, warfarin could be a potential therapeutic substitute for Eliquis, but the decision should be made in close consultation with your healthcare provider.
Q: Can I apply for a grant to help cover the cost of Eliquis?
Yes, some non-profit organizations offer grants to help individuals with the out-of-pocket costs of medications like Eliquis. Organizations like the Patient Advocate Foundation or the HealthWell Foundation are examples. Each organization has specific eligibility criteria, so you’ll need to research each one to find a potential match.
Q: Can I split Eliquis tablets to make my prescription last longer?
Tablet-splitting can sometimes save money with certain medications, but it’s not advisable for all. In Eliquis’ case, tablet splitting isn’t recommended due to its film-coating and the necessity for precise dosing. Always consult your doctor or pharmacist before attempting to split tablets.
Q: How does a Medicare Supplement plan (Medigap) help with Eliquis costs?
Medigap plans are designed to cover costs not covered by Original Medicare, such as deductibles and co-insurance. However, as of 2021, Medigap plans sold to new people with Medicare aren’t allowed to cover the Part D prescription deductible. If you already have a Medigap plan that includes drug coverage or you were eligible for Medicare before January 1, 2006, this could help with some of Eliquis costs, but it’s crucial to understand the specific terms of your plan.
Q: What is the role of Patient Assistance Programs (PAPs) in affording Eliquis?
Patient Assistance Programs (PAPs) are programs established by pharmaceutical companies, like Bristol-Myers Squibb and Pfizer, to offer free or low-cost drugs to individuals who are unable to afford them. Each PAP has its own qualifying criteria, often based on income, insurance status, and prescription.
Q: Is it possible to get a generic version of Eliquis to save costs?
There is no generic version of Eliquis (apixaban) available in the United States. However, the landscape of available medications changes over time as drug patents expire and new generics enter the market, so it’s always worth asking your pharmacist or healthcare provider for the most recent information.
Q: Can switching to mail-order pharmacy save on my Eliquis costs?
Some Medicare Part D plans offer a mail-order service where you can get a 90-day supply of your chronic or maintenance drugs. This service often comes at a lower cost compared to a traditional pharmacy, potentially saving you money on your Eliquis prescription. Check with your plan to see if this option is available to you.
Q: Can I use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for Eliquis?
Yes, you can use funds from a Health Savings Account (HSA) or a Flexible Spending Account (FSA) to pay for prescription medications like Eliquis. However, keep in mind that these accounts come with their own rules and requirements. For example, in order to contribute to an HSA, you must be enrolled in a High Deductible Health Plan (HDHP).
Q: What is the impact of the Inflation Rebate rule on Eliquis pricing?
Under the Inflation Rebate rule, if a manufacturer raises the price of a drug above the rate of inflation, they are required to pay a rebate to Medicare. This policy is designed to keep prescription drugs, including Eliquis, more affordable for beneficiaries. However, this doesn’t directly reduce the cost you pay at the pharmacy, but it might affect the overall cost of Medicare drug coverage.
Q: If I’m a veteran, can the VA help with Eliquis costs?
Yes, the Department of Veterans Affairs (VA) offers prescription benefits that could help with the cost of Eliquis. If you’re a veteran, it’s worth exploring this avenue. In some cases, the VA may provide more cost-effective coverage for prescription drugs than Medicare.
Q: Can I import Eliquis from another country to save on costs?
Importing prescription drugs from other countries is generally not recommended and is technically illegal in most circumstances. Although prices may be lower abroad, the U.S. Food and Drug Administration (FDA) cannot ensure the safety and efficacy of imported products. Always discuss any cost concerns with your healthcare provider to find safe and legal strategies for managing costs.