Does Blue Cross Blue Shield Cover Eliquis?
The verdict
Covered on most plans
Yes — Blue Cross Blue Shield plans cover Eliquis for AFib and VTE across commercial, ACA, Medicare, and Medicaid. Coverage is near-universal: MMIT data (as of Sept 11, 2025) shows 99.6% commercial, 100% ACA, and 99.7% Medicare coverage nationally. However, BCBS is a federation of more than 30 independent regional affiliates — Anthem/Elevance, HCSC, Florida Blue, Highmark, CareFirst, and others — each with its own formulary and PBM. Your tier, cost-share, and any PA rule depend on your specific Blue plan; check your member ID card to identify your affiliate.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Blue Cross Blue Shield using your member ID.
Key facts
Eliquis is covered on essentially all BCBS plans: 99.6% of commercial, 100% of ACA, and 99.7% of Medicare Part D plans nationally (MMIT, as of Sept 11, 2025).
MMIT via GoodRx (as of Sept 11, 2025)
The IRA negotiated Maximum Fair Price for Eliquis is $231 per 30-day supply, effective January 1, 2026 — a 56% cut from the prior list price of approximately $521.
CMS Medicare Drug Price Negotiation Program, 2026 MFP
The 2026 Medicare Part D annual out-of-pocket cap is $2,100; after reaching it, all covered Part D drugs including Eliquis cost $0 for the remainder of the benefit year.
CMS Final CY 2026 Part D Redesign Program Instructions
Medicare vs. commercial coverage
Whether Blue Cross Blue Shield 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 Blue Cross Blue Shield Medicare Part D plans as a Tier 3 preferred brand. Prior authorization and step therapy are essentially nil for Medicare — nationally only 0.2% of Medicare Part D plans require PA for Eliquis and 0% require step therapy (MMIT, as of Sept 11, 2025). As Part D sponsors, Blue Medicare plans are legally 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 plans 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 across Blue Cross Blue Shield commercial and ACA plans, with 99.6% commercial and 100% ACA coverage nationally (MMIT, Sept 11, 2025). Prior authorization is required in approximately 8.1% of commercial plans and 5% of ACA plans. Because BCBS is a federation, PBM arrangements vary by affiliate — some Blue plans use CVS Caremark, others use Express Scripts/Evernorth or in-house formularies. CVS Caremark briefly excluded Eliquis from its commercial preferred formulary in 2022 before restoring it mid-year after patient advocacy pushback; for 2026, Caremark states 99% of members are unaffected by formulary removals. If your Blue commercial plan uses CVS Caremark, verify Eliquis is on your specific plan formulary. Tier placement is not uniformly published across affiliates — verify on your plan's drug list. Medicaid plans managed by Blue affiliates cover Eliquis with nominal cost-share; PA varies by state (MMIT Medicaid 12.2% PA nationally). The BMS copay assistance card (~$10 per fill) is available to commercially insured patients not enrolled in a government health program. Confirm your state Preferred Drug List for Medicaid.
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; verify with your pharmacy). 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 specific Blue 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 with your specific Blue plan.
Typical monthly copay once prior authorization is approved.
All dollar figures are estimates and vary by Blue affiliate, PBM, plan tier, and benefit phase. Identify your specific BCBS affiliate from your member ID card, then look up Eliquis on that plan's drug list. The IRA Maximum Fair Price of $231 is a ceiling on what your Part D plan pays the pharmacy — your out-of-pocket share depends on whether your plan uses a fixed copay or coinsurance. 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
Identify your specific Blue plan using your member ID card
Blue Cross Blue Shield is a federation of more than 30 independent regional affiliates. Your member ID card names your specific Blue plan (e.g., Anthem, Florida Blue, HCSC, Highmark, CareFirst). Use that plan's website to look up Eliquis on the drug formulary or pricing tool — national BCBS data does not apply uniformly across affiliates.
- 2
Search the drug formulary on your affiliate's website
Log in to your Blue plan's member portal and run a drug search for Eliquis (or apixaban). The tool shows tier placement, any prior-authorization requirement, and estimated cost-share for your specific plan and pharmacy. If your plan uses CVS Caremark, you can also search on caremark.com.
- 3
Call member services or your pharmacist to confirm 2026 cost-share
Call the member services number on the back of your Blue ID card and ask: (1) What tier is Eliquis on my 2026 plan? (2) Is prior authorization required? (3) What will I owe per fill after my deductible, and does my plan use a copay or coinsurance for Eliquis? Your pharmacist can also run a real-time benefits check.
Options if Blue Cross Blue Shield 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 most BCBS formularies. The 2026 IRA negotiated price for Xarelto is $197 per 30-day supply. Discuss with your prescriber whether Xarelto is clinically appropriate for your indication.
Warfarin (generic)
A lower-cost generic anticoagulant (Tier 1–2 on most formularies). Requires regular INR monitoring and dietary care. Not appropriate for all patients — discuss with your prescriber.
Apixaban generic (~2028)
No FDA-approved generic apixaban is expected until approximately 2028. Once available, generic apixaban would likely carry lower cost-share on BCBS formularies.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Eliquis is covered on essentially all Blue Cross Blue Shield plans: MMIT data (as of Sept 11, 2025) shows 99.6% commercial, 100% ACA, and 99.7% Medicare Part D coverage nationally. Because BCBS is a federation of independent regional affiliates, the tier, prior-authorization rule, and copay differ by your specific Blue plan. Identify your affiliate from your member ID card and verify on that plan's formulary.
CMS negotiated an Eliquis Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 — a 56% reduction from the prior list price of approximately $521. All BCBS 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 out-of-pocket in stand-alone Part D more than doubled between 2020 and 2024 as plans shifted to coinsurance. Your actual cost depends on your specific plan's structure.
CVS Caremark excluded Eliquis from its commercial preferred formulary in 2022 but restored it mid-year following patient and advocacy pushback. For 2026, Caremark states 99% of members are unaffected by formulary removals. Not all BCBS affiliates use CVS Caremark; some use Express Scripts or other PBMs. If your Blue commercial plan is Caremark-administered, verify Eliquis is on your current plan formulary before filling.
Prior authorization is essentially not required for Eliquis on Medicare Part D. Nationally, only 0.2% of Medicare plans require PA for Eliquis and 0% require step therapy (MMIT, Sept 11, 2025). On BCBS commercial plans, PA is required in approximately 8.1% of plans nationally. Medicaid plans affiliated with BCBS may require PA in some states (12.2% nationally). Verify on your specific Blue plan.
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 a BCBS Medicare plan, all covered Part D drugs — including Eliquis — cost $0 for the rest of the year. This cap is especially important for patients taking Eliquis year-round for AFib or VTE prevention. In prior years there was no annual cap, leaving some patients with uncapped costs in the catastrophic phase.
Related Articles
Does BCBS Michigan Cover Contrave? 2026 MI Guide | Curex
BCBS Michigan upheld weight-loss exclusions (DIFS 2025). Contrave is plan-dependent. MI Medicaid favors weight-loss GLP-1s; Contrave varies by PDL.
Read moreDoes BCBS of Illinois Cover Jardiance? 2026
BCBS of Illinois (HCSC) covers Jardiance across commercial, ACA, Medicare, and Medicaid. Metformin-first step is common. 2026 MFP $197 for Medicare.
Read moreDoes BCBS Alabama Cover Wegovy? 2026 Guide | Curex
BCBS Alabama Wegovy coverage is employer-dependent and unpublished. Alabama Medicaid excludes obesity GLP-1s. How to verify your specific plan.
Read moreDoes Blue Cross Blue Shield of Minnesota Cover Mounjaro? 2026 | Curex
BCBS of Minnesota covers Mounjaro for type 2 diabetes with PA — not weight loss. MN Medicaid covers weight-loss GLP-1s for Zepbound, not Mounjaro.
Read moreDoes Blue Cross Blue Shield Cover Ambien? 2026 | Curex
Blue Cross Blue Shield covers generic zolpidem (Tier 1–2); brand Ambien is non-preferred. Quantity limits apply. Verify your specific BCBS plan for 2026.
Read moreDoes BCBS of Texas Cover Ozempic? 2026 Guide | Curex
BCBS Texas (HCSC) covers Ozempic for T2D with PA — not weight loss. HCSC shares PA with BCBS IL. TX Medicaid uses separate Star MCOs. Verify on BCBS TX.
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 Blue Cross Blue Shield before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.