How Blood Thinners Like Eliquis and Xarelto Are Covered on Medicare

Anticoagulants, the drugs commonly called blood thinners, are some of the most prescribed medications among Medicare beneficiaries. Eliquis and Xarelto in particular are used by millions of people to prevent strokes and dangerous blood clots. They are also expensive, which makes how Medicare covers them a real financial question. The good news is that the coverage rules are straightforward once you understand which part of Medicare pays, and recent changes have made these drugs far less punishing on the wallet than they used to be.

Bryce's Take

Eliquis and Xarelto come up constantly, because so many of my clients are on one of them for atrial fibrillation or clot prevention. The two things I always make sure people understand: these are Part D drugs, so you need drug coverage in place, and thanks to the $2,000 cap that started in 2025, your worst-case yearly exposure is far lower than it used to be. If your blood thinner is eating into your budget, let us compare plans on your exact drug list and see if there is a better fit.

Blood thinners fall under Part D, not Part B

Eliquis and Xarelto are oral prescription drugs you fill at a pharmacy, so they are covered under Medicare Part D, your prescription drug coverage, whether you get that through a standalone Part D plan or bundled into a Medicare Advantage plan. This matters because people sometimes assume an important heart or stroke medication would be covered under Part B, the medical side. It is not. If you have Original Medicare with a Medigap plan but no Part D plan, these drugs would not be covered at all, which is one more reason to have drug coverage in place.

Both are on the first negotiated drug list

Eliquis and Xarelto are both among the first 10 drugs Medicare negotiated under the Inflation Reduction Act, with the new lower prices taking effect January 1, 2026. That is significant because these are exactly the kind of long-standing, heavily used drugs the negotiation program was designed to address. As with all the negotiated drugs, the lower price helps, but your actual out-of-pocket still depends on your plan's formulary and tier placement.

What you pay depends on your plan

How much you pay for Eliquis or Xarelto varies from plan to plan. These are usually brand-name drugs placed on a mid or higher formulary tier, and the copay or coinsurance attached to that tier differs between plans. This is why the same drug can cost noticeably more on one plan than another. Comparing plans on your specific medication, rather than on premium alone, is the only reliable way to know what you will actually pay for the year.

Warfarin: the older, cheaper alternative

Before the newer anticoagulants existed, warfarin was the standard blood thinner, and it is still widely used. Warfarin is available as a low-cost generic, so it is dramatically cheaper than Eliquis or Xarelto on most plans. The tradeoff is that warfarin requires regular blood monitoring to keep your dose in a safe range, along with attention to diet and drug interactions. The newer agents do not require that routine monitoring, which is a big part of why doctors often prefer them. Whether warfarin is appropriate for you is entirely a medical decision for your physician, not a coverage decision, but it is worth knowing the option exists if cost is a concern.

The $2,000 cap changes the math

The most important recent change for anyone on an expensive blood thinner is the $2,000 annual out-of-pocket cap on Part D covered drugs, which began in 2025. Once your covered drug cost-sharing reaches $2,000 in a plan year, you pay nothing more for the rest of the year. For someone taking Eliquis or Xarelto plus other medications, this cap limits total exposure in a way that simply did not exist a few years ago. It does not lower what the drug costs overall, but it puts a firm ceiling on your share.

Getting the best coverage for your blood thinner

The move each year is the same: during the Annual Enrollment Period, compare Part D plans based on your exact medications and doses. Check where each plan places Eliquis or Xarelto on its formulary and what the cost-sharing is at that tier. Factor in the $2,000 cap and, if your income is limited, check whether you qualify for Extra Help. A little comparison work here often uncovers meaningful savings, and it is exactly what I do with clients.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.