Does Wellcare Cover Eliquis?
The verdict
Covered on most plans
Yes — Wellcare (Centene) covers Eliquis on its 2026 Medicare Part D plans (Value Script and Classic PDPs) and Medicaid managed-care plans. As a Part D plan sponsor, Wellcare is legally required to carry Eliquis at the IRA negotiated Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026. Prior authorization is essentially not required on Wellcare Part D. The key cost levers are Wellcare's 5–6 tier structure, a $615 annual deductible, and the $2,100 out-of-pocket cap.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Wellcare using your member ID.
Key facts
Eliquis is covered on 99.7% of Medicare Part D plans nationally; Wellcare Part D plans require PA on only 0.2% of Medicare plans (MMIT, Sept 11, 2025).
MMIT via GoodRx (as of Sept 11, 2025)
The 2026 IRA Maximum Fair Price for Eliquis is $231 per 30-day supply — a 56% reduction from the prior list price of approximately $521; all Wellcare Part D plans must apply this price.
CMS Medicare Drug Price Negotiation Program, 2026 MFP
The 2026 Medicare Part D annual out-of-pocket cap is $2,100; once reached on a Wellcare Part D plan, Eliquis and all covered drugs cost $0 for the rest of the benefit year.
CMS Final CY 2026 Part D Redesign Program Instructions
Medicare vs. commercial coverage
Whether Wellcare 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 Wellcare's 2026 Medicare Part D plans — including Value Script and Classic PDPs — typically as a Tier 3 preferred brand. Prior authorization and step therapy are essentially nil on Wellcare Part D: 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 a Part D plan sponsor, Wellcare must apply the IRA negotiated Maximum Fair Price of $231 per 30-day supply, effective January 1, 2026 (down from approximately $521, a 56% reduction). The Wellcare-specific cost architecture is: a $615 annual deductible (the maximum allowed under the 2026 CMS Part D redesign), then tier-3 cost-share in the initial coverage phase, with a $2,100 annual out-of-pocket cap — once you hit the cap, Eliquis costs $0 for the rest of the year. Wellcare's 5–6 tier structure (Tier 1 preferred generic at $0 at preferred pharmacy; Tier 3 preferred brand; a distinct Tier 6 for select chronic-condition drugs) means you should confirm which tier Eliquis sits on your specific Wellcare plan. LIS/Extra Help enrollees pay $0–$12.65 per month. Medicare beneficiaries cannot use the BMS commercial copay card.
Commercial / Employer
Group & marketplace plans
Wellcare's commercial and ACA footprints are limited relative to its Medicare Part D and Medicaid MCO operations. Where Wellcare commercial or ACA plans are offered, Eliquis is covered for its on-label cardiovascular indications — nationally 99.6% commercial and 100% ACA coverage (MMIT, Sept 11, 2025). PA is uncommon on commercial (8.1% nationally) and rare on ACA (5%). Verify tier and cost-share on your specific plan formulary or with member services. Wellcare Managed Medicaid covers Eliquis with nominal cost-share; PA may be required in a minority of states (MMIT Medicaid 12.2% PA nationally) — check your state's Preferred Drug List. Unlike the diabetes SGLT2 drugs (e.g., Jardiance), Eliquis carries near-zero step therapy even in Medicaid, because no anticoagulant step-therapy protocol comparable to metformin-first exists for this drug class. The BMS commercial copay card (~$10 per fill) is available to commercially insured patients not on a government 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 direct-to-patient program: approximately $346 per month.
List price with no coverage — before any manufacturer savings card.
With coverage
Medicare Part D (Wellcare Value Script/Classic): $615 annual deductible first; then Tier 3 cost-share in the initial coverage phase; IRA Maximum Fair Price $231 per 30-day supply effective January 1, 2026; $2,100 annual out-of-pocket cap. LIS/Extra Help: $0–$12.65 per month. Commercial (where offered): copay card ~$10 per fill (commercially insured, non-government patients). Medicaid: nominal cost-share. All figures are estimates — verify with your specific Wellcare plan.
Typical monthly copay once prior authorization is approved.
All dollar figures are estimates. Your actual cost depends on which Wellcare plan you have, your deductible status, and whether the plan uses a fixed copay or coinsurance. The $615 deductible must be satisfied before cost-sharing kicks in on most Part D plans. Confirm your tier and cost-share on Wellcare's plan formulary or by calling member services. Medicare beneficiaries cannot use the BMS 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 the Wellcare plan formulary
Visit Wellcare.com and use the drug pricing or formulary search tool for your specific 2026 plan (Value Script, Classic PDP, or another Wellcare plan). Enter Eliquis or apixaban to see the tier, any prior authorization requirement, and estimated cost-share. Wellcare's 5–6 tier structure means the tier designation affects your per-fill cost significantly.
- 2
Call Wellcare member services
Call the number on the back of your Wellcare ID card and ask: (1) Which tier is Eliquis on my plan? (2) Have I met my $615 deductible? (3) What will my cost-share be under my plan phase? Having your drug dosage and plan ID ready will speed up the lookup.
- 3
Check for LIS/Extra Help eligibility if you have Medicare Part D
If you are a Wellcare Part D member with limited income, the Extra Help (Low Income Subsidy) program can reduce Eliquis costs to $0–$12.65 per month. Check eligibility at Medicare.gov or ask your pharmacist. Your state Medicaid office may also help you apply.
Options if Wellcare 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 covered on Wellcare Part D plans; 2026 IRA negotiated price is $197 per 30-day supply. Discuss with your prescriber whether Xarelto is appropriate for your indication and cost situation.
Warfarin (generic)
Low-cost generic anticoagulant available on Tier 1 on most Wellcare plans. 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. When available it would likely carry lower tier placement on Wellcare formularies.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes — Wellcare (Centene) covers Eliquis on its 2026 Medicare Part D plans (Value Script and Classic PDPs) and Medicaid managed-care plans, typically as a Tier 3 preferred brand. Prior authorization is not required on Wellcare Part D (MMIT: 0.2% PA nationally for Medicare). As a Part D sponsor, Wellcare must apply the 2026 IRA negotiated Maximum Fair Price of $231 per 30-day supply. Verify your specific tier and deductible status on the Wellcare formulary.
Wellcare Part D plans use a 5–6 tier structure: Tier 1 is preferred generics ($0 at preferred pharmacy), Tier 2 non-preferred generics, Tier 3 preferred brands, Tier 4 non-preferred brands, Tier 5 specialty, and on some Wellcare plans a Tier 6 for select chronic-condition drugs. Eliquis typically lands on Tier 3 (preferred brand). Your exact tier may vary by specific plan; verify on the Wellcare formulary tool or by calling member services.
No — on Wellcare Medicare Part D, prior authorization for Eliquis is essentially not required. Nationally, only 0.2% of Medicare Part D plans require PA for Eliquis and 0% require step therapy (MMIT, Sept 11, 2025). On Wellcare Managed Medicaid, PA may be required in a minority of states (about 12.2% of Medicaid plans nationally). Unlike diabetes SGLT2 drugs, there is no anticoagulant step-therapy protocol that would require trying another drug before Eliquis.
Most Wellcare 2026 Part D plans carry the maximum Part D deductible of $615. Until you satisfy this deductible, you pay the full negotiated cost at the pharmacy for non-exempt tiers. After the deductible, your Tier 3 cost-share kicks in. The IRA Maximum Fair Price of $231 for Eliquis serves as the benchmark price during the deductible phase. The $2,100 annual out-of-pocket cap then limits your total exposure for the rest of the year. Confirm your plan's specific deductible and tier-3 cost-share on the Wellcare formulary.
Yes — Wellcare Managed Medicaid covers Eliquis with nominal cost-share (typically $0–small copay depending on state). Prior authorization may be required in some states — about 12.2% of Medicaid plans nationally require PA for Eliquis (MMIT, Sept 11, 2025). There is no metformin-type step therapy for anticoagulants in Medicaid. Verify your state's Preferred Drug List and your specific Wellcare Medicaid plan's drug list.
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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 Wellcare before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.