Does Oscar Health Cover Eliquis?
The verdict
Covered on most plans
Yes — Oscar Health covers Eliquis for AFib and VTE on its commercial and ACA plans. Oscar is a digital-first, ACA and small-group focused insurer, so coverage follows the broadly-covered commercial pattern: MMIT data (as of Sept 11, 2025) shows 99.6% commercial and 100% ACA coverage for Eliquis nationally. Oscar does not publish per-drug tier placements at the same level of detail as large national plans, so the coverage answer is yes — but use Oscar's in-app drug lookup for your exact tier and copay.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Oscar Health using your member ID.
Key facts
Eliquis is covered on 99.6% of commercial and 100% of ACA plans nationally (MMIT, as of Sept 11, 2025) — Oscar's core market. Plan-specific tier and copay must be verified via Oscar's app drug lookup.
MMIT via GoodRx (as of Sept 11, 2025)
The 2026 IRA negotiated Maximum Fair Price for Eliquis is $231 per 30-day supply, effective January 1, 2026 — applicable to Oscar Medicare Part D enrollees.
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 rest of the benefit year.
CMS Final CY 2026 Part D Redesign Program Instructions
Medicare vs. commercial coverage
Whether Oscar Health 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
Oscar Health's Medicare presence is limited compared to its core commercial and ACA business. Where Oscar Medicare plans are offered, Eliquis is covered under Part D with the 2026 IRA negotiated Maximum Fair Price of $231 per 30-day supply (effective January 1, 2026, a 56% reduction from approximately $521). The $2,100 annual out-of-pocket cap (CMS 2026 Part D redesign) also applies to any Oscar Medicare members. Prior authorization for Eliquis on Medicare is near-nil nationally (0.2% PA, 0% step therapy per MMIT, Sept 11, 2025). Verify whether Oscar offers Medicare plans in your state — coverage availability is state-specific. Medicare beneficiaries cannot use the BMS commercial copay card.
Commercial / Employer
Group & marketplace plans
Eliquis is covered on Oscar Health's commercial and ACA plans for its approved indications (AFib, DVT, PE). Oscar is primarily an ACA and small-group insurer with membership concentrated in individual and employer markets. Nationally, 99.6% of commercial and 100% of ACA plans cover Eliquis (MMIT, Sept 11, 2025), with PA required in approximately 8.1% of commercial and 5% of ACA plans. Oscar does not publish plan-level drug tier placements at the same granularity as large national carriers — tier and copay vary by Oscar's state-specific plan design and are not confirmed at the drug level in a primary public source. Use Oscar's in-app drug lookup or contact member services for your exact cost-share. Medicaid plans operated by Oscar are limited; where available, Eliquis is covered with nominal cost-share. The BMS commercial copay card (~$10 per fill) is available for commercially insured patients not enrolled in a government health program.
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
Oscar commercial/ACA: plan-specific cost-share not publicly published at the drug level — verify on Oscar's drug lookup tool or member services. BMS copay card ~$10 per fill for commercially insured patients not enrolled in a government program. Any Oscar Medicare: IRA Maximum Fair Price $231 per 30-day supply effective January 1, 2026; $2,100 annual out-of-pocket cap applies. All figures are estimates — confirm with Oscar.
Typical monthly copay once prior authorization is approved.
Oscar does not publish plan-level copay amounts for individual drugs publicly. All cost-share data must be confirmed through Oscar's app drug lookup or by calling member services at the number on your Oscar ID card. The IRA Maximum Fair Price of $231 per 30-day supply is a Medicare-specific ceiling — it does not directly set your commercial out-of-pocket. 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
Use Oscar's app or website drug lookup for your exact tier and copay
Log in to the Oscar app or oscarhealth.com and use the drug search tool. Search for Eliquis or apixaban and select your specific plan to see your tier and estimated cost-share. Oscar's app is designed to surface this information clearly — it is the most reliable source for Oscar plan-specific cost data, which is not uniformly published in public formulary documents.
- 2
Call Oscar member services if the app does not show your specific plan detail
Call the member services number on the back of your Oscar ID card and ask: (1) Is Eliquis covered on my plan? (2) What tier is it on? (3) Is prior authorization required, and if so, what are the criteria? (4) What will my copay or coinsurance be per fill? Oscar's support team can confirm coverage and walk you through any PA process.
- 3
Ask your prescriber to check your benefits and submit a PA if needed
If PA is required, your prescribing physician will need to submit documentation of your diagnosis (AFib, DVT, or PE) and clinical indication through Oscar's prior-authorization process. For Medicare enrollees, check whether Oscar offers plans in your area and confirm your Medicare benefit applies the $2,100 annual cap. Oscar members on low income may qualify for Medicare Extra Help — verify at Medicare.gov.
Options if Oscar Health 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 broadly covered on commercial and ACA plans. Discuss with your prescriber whether Xarelto is appropriate for your indication; confirm tier on the Oscar drug lookup.
Warfarin (generic)
A lower-cost generic anticoagulant (Tier 1–2 on most formularies). Requires regular INR monitoring. Discuss with your prescriber.
Apixaban generic (~2028)
No FDA-approved generic apixaban is expected until approximately 2028. Once available, a generic would likely carry lower cost-share on Oscar formularies.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes — Oscar Health covers Eliquis for AFib, DVT, and PE on its commercial and ACA plans. Nationally, 99.6% of commercial and 100% of ACA plans cover Eliquis (MMIT, Sept 11, 2025). Because Oscar does not publish per-drug tier placements publicly, use Oscar's in-app drug lookup or call member services to confirm your specific tier and copay before filling.
Oscar is a digital-first insurer that designs its member experience around app-based tools rather than downloadable formulary PDFs. Tier and copay details are accessible in Oscar's app and member portal but are not always posted in a public drug list at the individual drug level. This differs from large national carriers like Humana or Aetna, which post searchable formularies with specific tier assignments. Use Oscar's app drug lookup for the most accurate cost-share information for your specific plan.
PA is nationally uncommon for Eliquis — approximately 8.1% of commercial plans and 5% of ACA plans require it (MMIT, Sept 11, 2025). Oscar's specific PA criteria for Eliquis are not confirmed in a primary public document. Use Oscar's drug lookup tool or call member services to determine whether your specific plan requires PA. If PA is needed, your prescriber will document the clinical indication (AFib, DVT, or PE) in the request.
The 2026 IRA negotiated Maximum Fair Price of $231 per 30-day supply applies to Medicare Part D plans. If you are an Oscar Medicare enrollee, this price applies to your plan as a payer-side ceiling. Oscar's core membership is commercial and ACA, where the IRA price does not directly govern commercial cost-share. For commercial and ACA plans, your out-of-pocket is set by Oscar's plan design — verify via the Oscar drug lookup or member services.
The Bristol-Myers Squibb commercial copay assistance card (~$10 per fill) is available to commercially insured patients not enrolled in Medicare, Medicaid, or CHIP. If you have an Oscar commercial or ACA plan, the BMS copay card may apply — verify eligibility at the BMS website or with your pharmacist. Oscar Medicare enrollees cannot use the commercial copay card. Oscar's app can show whether any manufacturer or pharmacy savings programs are available for your specific plan.
Related Articles
Does Oscar Health Cover Phentermine (Adipex-P)? 2026 | Curex
Oscar Health marketplace plans frequently exclude phentermine as an AOM. But the generic is just $10–$40 cash — coverage rarely matters here.
Read moreDoes Oscar Health Cover Propecia? Hair Loss 2026 | Curex
Oscar Health does not cover Propecia for hair loss — cosmetic exclusion applies. Finasteride 5 mg (Proscar) IS covered as a Tier 1 generic for BPH.
Read moreDoes Oscar Health Cover Farxiga? Coverage & Cost 2026
Yes — Oscar covers Farxiga on commercial and ACA plans; metformin-first step likely. Tier not public — use Oscar app. Generic dapagliflozin now available.
Read moreDoes Oscar Health Cover Ozempic? 2026 Coverage Guide | Curex
Oscar covers Ozempic for T2D with prior auth — never for weight loss. ACA plan formulary, PA steps, NovoCare card, and 2026 cost facts explained.
Read moreDoes Oscar Health Cover Contrave? 2026 ACA Guide | Curex
Oscar marketplace plans frequently exclude Contrave. Where covered, BMI prior auth applies. CurAccess ~$99/mo beats the retail price for most members.
Read moreDoes Oscar Health Cover Adderall? 2026 Coverage Guide | Curex
Oscar Health covers Adderall via its PBM — generic preferred low-tier, brand non-preferred. Tier not published; use Oscar drug lookup to confirm.
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 Oscar Health before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.