Does Aetna Cover Eliquis?
The verdict
Covered on most plans
Yes — Aetna covers Eliquis for AFib and VTE across commercial, ACA, Medicare, and Medicaid, managed through its CVS Caremark PBM. Nationally, 99.6% of commercial plans, 100% of ACA plans, and 99.7% of Medicare Part D plans cover Eliquis (MMIT, as of Sept 11, 2025). The Aetna-specific caution: CVS Caremark excluded Eliquis from its commercial preferred formulary in 2022, then restored it mid-year after patient advocacy pressure. For 2026, Caremark states 99% of members are unaffected by formulary removals. The honest advice for Aetna commercial patients is to confirm your tier on your specific Caremark plan formulary. On Aetna Medicare plans, coverage is steady with near-zero prior authorization.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Aetna using your member ID.
Key facts
Eliquis is covered on 99.6% of commercial, 100% of ACA, and 99.7% of Medicare Part D plans nationally (MMIT, as of Sept 11, 2025); CVS Caremark briefly excluded it from commercial preferred formulary in 2022 before restoring it.
MMIT via GoodRx (as of Sept 11, 2025)
The 2026 IRA negotiated Maximum Fair Price for Eliquis is $231 per 30-day supply — a 56% cut from the prior list price of approximately $521.
CMS Medicare Drug Price Negotiation Program, 2026 MFP
Average Eliquis out-of-pocket in stand-alone Medicare Part D more than doubled — from $46.76 to $102.32 — between 2020 and 2024 as coinsurance adoption rose from 10.7% to 75%.
USC Schaeffer Center / JAMA Health Forum (Feb. 14, 2025)
Medicare vs. commercial coverage
Whether Aetna covers Eliquis depends heavily on which kind of plan you hold. They follow completely different rules — here's each one, side by side.
Medicare
Part D & Advantage plans
Eliquis is covered on Aetna/CVS Medicare Part D plans as a Tier 3 preferred brand. Prior authorization and step therapy are essentially nil for Eliquis on Medicare — nationally only 0.2% of Part D plans require PA and 0% require step therapy (MMIT, as of Sept 11, 2025). As a Part D sponsor, Aetna is required to carry Eliquis at the IRA negotiated Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 (a 56% reduction from the prior list price of approximately $521). The MFP is a payer-side ceiling, not an automatic fixed copay: per a USC Schaeffer Center/JAMA analysis (Feb. 14, 2025), average Eliquis out-of-pocket in stand-alone Part D more than doubled — from $46.76 to $102.32 — between 2020 and 2024 as the share of plans using coinsurance rose from 10.7% to 75%. The $2,100 annual out-of-pocket cap (CMS 2026 Part D redesign) limits worst-case exposure; once you reach it, Eliquis costs $0 for the rest of the year. LIS/Extra Help enrollees pay $0–$12.65 per month. Medicare beneficiaries cannot use the BMS commercial copay card.
Commercial / Employer
Group & marketplace plans
Eliquis is covered on Aetna commercial and ACA plans via CVS Caremark, with 99.6% commercial and 100% ACA coverage nationally (MMIT, Sept 11, 2025). PA is required in approximately 8.1% of commercial plans. The Aetna/Caremark-specific caveat: CVS Caremark excluded Eliquis from its commercial preferred formulary in 2022 before restoring it mid-year after patient and advocacy pushback. For 2026, Caremark states 99% of members are unaffected by formulary removals. Because this history is attributable to a single PBM (Caremark), Aetna commercial patients should verify Eliquis tier on their specific Caremark plan formulary at caremark.com before filling. The BMS commercial copay assistance card (~$10 per fill) is available to commercially insured patients not enrolled in a government health program. Aetna Better Health Medicaid covers Eliquis with nominal cost-share; PA possible in some states (MMIT Medicaid 12.2% PA). Confirm your state's Preferred Drug List.
Your cost, three ways
What Eliquis actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
Approximately $550–$800 per 30-day supply at retail pharmacy (pharmacy-variable estimate). BMS offers a direct-to-patient program at approximately $346 per month.
List price with no coverage — before any manufacturer savings card.
With coverage
Medicare Part D: cost-share depends on your Aetna plan's tier and benefit phase; $2,100 annual out-of-pocket cap in 2026; IRA Maximum Fair Price $231 per 30-day supply effective January 1, 2026. LIS/Extra Help enrollees: $0–$12.65 per month. Commercial/ACA: BMS copay card ~$10 per fill for commercially insured patients not enrolled in a government program. All figures are estimates — confirm on your Aetna/Caremark plan formulary.
Typical monthly copay once prior authorization is approved.
All dollar figures are estimates and vary by plan tier, pharmacy, and benefit phase. The IRA Maximum Fair Price of $231 is a ceiling on what your Part D plan pays — your out-of-pocket share depends on copay vs. coinsurance structure. Verify your tier on the Aetna member portal or at caremark.com for commercial plans. Medicare beneficiaries cannot use the BMS commercial copay card.
Check YOUR exact coverage in 3 steps
General answers only get you so far. Here's how to confirm your own plan's decision in a few minutes.
- 1
Look up Eliquis on your Aetna plan formulary or caremark.com
Log in to aetna.com or caremark.com, navigate to the drug formulary tool, and search for Eliquis (or apixaban). Select your specific 2026 plan to see the tier, any prior-authorization requirement, and estimated cost-share. Given the 2022 Caremark exclusion history, verify the current formulary listing even if you have taken Eliquis on your plan before.
- 2
Call Aetna member services for your exact 2026 cost-share
Call the member services number on the back of your Aetna ID card and ask: (1) What tier is Eliquis on my 2026 plan? (2) Is prior authorization or a step required? (3) Does my plan use a fixed copay or coinsurance for Eliquis? For Medicare plans: am I in a coinsurance plan for Tier 3 drugs, and what is the $2,100 cap impact?
- 3
Ask your pharmacist to run a real-time benefits check
Your pharmacist can run an Aetna/Caremark real-time eligibility check that shows your exact cost at that pharmacy before you fill. If your pharmacist's system shows a different tier than expected, call Aetna member services to clarify. For Medicare LIS/Extra Help, bring your Extra Help confirmation to confirm the reduced cost-share.
Options if Aetna won't cover Eliquis
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Xarelto (rivaroxaban)
Another oral DOAC anticoagulant covered on Aetna/Caremark formularies. The 2026 IRA negotiated price for Xarelto is $197 per 30-day supply. Discuss with your prescriber whether Xarelto is clinically appropriate.
Warfarin (generic)
A lower-cost generic anticoagulant (Tier 1–2). Requires regular INR monitoring. Discuss with your prescriber.
Apixaban generic (~2028)
No FDA-approved generic apixaban is expected until approximately 2028. Once available, it would likely carry significantly lower cost-share on Aetna/Caremark formularies.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes — Aetna covers Eliquis for AFib and VTE across commercial, ACA, Medicare Part D, and Medicaid via CVS Caremark. Nationally, 99.6% of commercial plans and 99.7% of Medicare plans cover Eliquis (MMIT, Sept 11, 2025). Given CVS Caremark's 2022 commercial exclusion/restoration history, verify your tier on your specific Aetna plan formulary at aetna.com or caremark.com. On Aetna Medicare plans, PA is essentially not required (0.2% nationally).
CVS Caremark excluded Eliquis from its commercial preferred formulary in 2022 but restored it mid-year after patient and provider advocacy. For 2026, Caremark states 99% of members are unaffected by formulary exclusions. Because Aetna's commercial plans run on Caremark, the honest advice is to verify that Eliquis remains on your specific 2026 plan formulary at caremark.com before filling. On Aetna Medicare plans, this exclusion history does not apply — Medicare-covered drugs are governed by different formulary rules.
CMS negotiated an Eliquis Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 — a 56% cut from the prior list price of approximately $521. Aetna's Medicare Part D plans must apply this price as a ceiling. However, the MFP is not an automatic fixed copay: a USC Schaeffer Center/JAMA analysis found average Eliquis Part D out-of-pocket more than doubled between 2020 and 2024 as plans shifted to coinsurance. Your actual cost depends on Aetna's specific plan design and benefit phase.
PA is not typically required for Eliquis on Aetna Medicare Part D — nationally only 0.2% of Medicare plans require it (MMIT, Sept 11, 2025). On Aetna commercial plans, PA is required in approximately 8.1% of plans nationally. Given Caremark's 2022 commercial formulary history, verify your specific plan formulary before assuming no PA is needed. Aetna Better Health Medicaid plans may require PA in some states (12.2% nationally).
Starting in 2026, Medicare Part D has a $2,100 annual out-of-pocket cap (CMS Final CY 2026 Part D Redesign). Once you reach this cap on an Aetna Medicare plan, all covered Part D drugs including Eliquis cost $0 for the rest of the year. This cap is especially valuable for patients taking Eliquis year-round for AFib — prior years had no annual ceiling, leaving some patients with uncapped catastrophic-phase costs.
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Read moreThis content is for informational purposes only and does not constitute medical, financial, or insurance advice. Coverage rules, prior-authorization criteria, and copay amounts change frequently and vary by plan, formulary tier, and effective date — always verify current benefits directly with Aetna before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.