Does Humana Cover Eliquis?
The verdict
Covered on most plans
Yes — Humana covers Eliquis for atrial fibrillation and VTE across Medicare Part D and its other lines of business, typically as a Tier 3 preferred brand with little to no prior authorization. As one of the largest Part D sponsors, Humana is legally required to carry Eliquis at the 2026 IRA negotiated Maximum Fair Price of $231 per 30-day supply. Your actual cost turns on whether your specific plan uses a fixed copay or coinsurance — and once you hit the $2,100 annual out-of-pocket cap, Eliquis costs $0 for the rest of the year.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Humana using your member ID.
Key facts
Eliquis is covered on essentially all Part D plans: 99.7% Medicare coverage nationally (MMIT, Sept 11, 2025), with prior authorization required on only 0.2% of plans.
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% reduction 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; once reached, all covered Part D drugs including Eliquis cost $0 for the rest of the benefit year.
CMS Final CY 2026 Part D Redesign Program Instructions
Medicare vs. commercial coverage
Whether Humana 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 Humana's 2026 Medicare Part D plans (Basic Rx, Value Rx, Group, CarePlus in FL) as a Tier 3 preferred brand. Prior authorization and step therapy are essentially nil on Medicare — nationally 0.2% PA and 0% step (MMIT, Sept 11, 2025). As a Part D sponsor Humana is legally required to cover Eliquis at the IRA negotiated Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 (down from ~$521, a 56% reduction). However, the MFP is a payer-side ceiling, not an automatic fixed copay: per a USC Schaeffer Center/JAMA analysis (Feb. 14, 2025), the average Eliquis out-of-pocket cost 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 for it rose from 10.7% to 75%. The $2,100 annual out-of-pocket cap (CMS 2026 Part D redesign) limits your worst-case exposure; once you reach it, Eliquis is $0 for the remainder of the benefit year. Medicare LIS/Extra Help enrollees pay $0–$12.65 per month. CenterWell (Humana's preferred mail-order pharmacy) typically carries the lowest cost-sharing tier — filling via CenterWell may reduce your per-fill cost. Medicare beneficiaries cannot use the BMS commercial copay card.
Commercial / Employer
Group & marketplace plans
Humana's commercial book is small relative to its Medicare footprint, but where commercial and ACA plans are offered, Eliquis is covered for its on-label cardiovascular indications. Nationally, MMIT data (Sept 11, 2025) shows 99.6% commercial coverage and 100% ACA coverage for Eliquis, with prior authorization required in approximately 8.1% of commercial plans and 5% of ACA plans — lower than many other branded drugs. Tier placement on Humana commercial and ACA plans is not publicly confirmed at the drug level; verify on your specific plan's formulary or with member services. The BMS direct-to-patient program offers Eliquis at approximately $346 per month without insurance; a commercial copay assistance card (~$10 per fill) is available for commercially insured patients who are not enrolled in a government health program (Medicare, Medicaid, or CHIP). Medicaid plans managed by Humana Managed Care cover Eliquis with nominal cost-share; PA is possible in some states (MMIT Medicaid 12.2% PA nationally). 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; 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 plan's tier structure and benefit phase; $2,100 annual out-of-pocket cap applies 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: copay card available (~$10 per fill for commercially insured, non-government patients). All figures are estimates — confirm with your plan.
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 plan pays the pharmacy — your out-of-pocket share depends on whether your plan uses a fixed copay or coinsurance percentage. Verify your specific cost-share on Humana's plan formulary or by calling member services. 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 Humana's online formulary tool
Go to Humana.com, sign in to MyHumana, and use the drug pricing tool to search for Eliquis (or apixaban). Select your specific 2026 plan to see the exact tier, cost-share, and whether PA is required. Humana's tool also shows CenterWell mail-order pricing.
- 2
Call Humana member services or your pharmacist
Call the member services number on the back of your Humana ID card. Ask specifically: (1) What tier is Eliquis on my plan? (2) Do I need prior authorization? (3) What will my copay or coinsurance be after my deductible? Your pharmacist can also run a real-time eligibility check.
- 3
Ask your prescriber about the LIS/Extra Help program if you are on Medicare
If you are enrolled in Medicare and have limited income, the Extra Help (Low Income Subsidy) program can reduce your Eliquis cost to $0–$12.65 per month. Your prescriber or a Social Security office can help you apply. You can also check eligibility at Medicare.gov.
Options if Humana 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 by Humana Part D as a Tier 3 preferred brand with a 2026 IRA negotiated price of $197 per 30-day supply. Discuss with your cardiologist whether Xarelto is appropriate for your indication.
Warfarin (generic)
An older vitamin K antagonist anticoagulant; available as a low-cost generic (Tier 1–2). Requires regular INR monitoring. Not appropriate for all patients — discuss with your prescriber.
Apixaban generic (~2028)
No FDA-approved generic apixaban is expected until approximately 2028. Once available, a generic would likely carry significantly lower cost-share on Humana formularies.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes — Eliquis is covered on Humana Medicare Part D plans as a Tier 3 preferred brand in 2026. Prior authorization is essentially not required on Medicare (0.2% PA nationally per MMIT). As a Part D sponsor, Humana must apply the IRA negotiated Maximum Fair Price of $231 per 30-day supply. Your actual out-of-pocket cost depends on your plan's copay or coinsurance structure and which benefit phase you are in; the $2,100 annual cap limits your worst-case exposure.
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. This MFP is a ceiling on what Part D plans pay the pharmacy. However, the USC Schaeffer Center/JAMA (Feb. 14, 2025) found that average Eliquis out-of-pocket costs in stand-alone Part D plans more than doubled from 2020 to 2024 as plans shifted from fixed copays to coinsurance. Whether you personally pay less depends on your specific Humana plan's cost-sharing structure.
Starting in 2026, the Medicare Part D out-of-pocket maximum is $2,100 per year (CMS Final CY 2026 Part D Redesign). Once you reach this cap on a Humana Part D plan, you pay $0 for all covered Part D drugs — including Eliquis — for the rest of the benefit year. This is particularly important for anticoagulant patients who take Eliquis year-round. In prior years, there was no annual cap, leaving some patients with uncapped costs.
No — the Bristol-Myers Squibb copay assistance card for Eliquis is not available to patients enrolled in government health programs including Medicare, Medicaid, or CHIP. It is valid only for commercially insured patients. If you have Humana Medicare Part D or a Medicare Advantage plan, you cannot use the BMS copay card. LIS/Extra Help enrollees may qualify for reduced cost-share of $0–$12.65 per month through the federal subsidy program.
Prior authorization is not typically required for Eliquis on Humana Medicare Part D. Nationally, only 0.2% of Medicare Part D plans require PA for Eliquis and 0% require step therapy (MMIT, Sept 11, 2025). On Humana commercial and Medicaid plans, PA is required in a minority of cases — approximately 8.1% of commercial and 12.2% of Medicaid plans nationally. Check your specific plan's formulary or call Humana member services to confirm.
CenterWell is Humana's preferred mail-order pharmacy and typically carries the lowest cost-sharing tier for Tier 3 drugs on Humana Part D plans. Filling a 90-day supply via CenterWell may reduce your per-fill cost compared to a retail pharmacy. Log in to MyHumana or call member services to compare CenterWell mail-order pricing with your retail pharmacy for your specific plan.
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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 Humana before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.