Does Blue Cross Blue Shield cover Eliquis?

In this article:

• Does Blue Cross Blue Shield cover Eliquis?
• How much does Eliquis cost?
• How much does Eliquis cost with BCBS?
• How to check your BCBS Eliquis coverage
• What to do if insurance won’t cover Eliquis
• How to get Eliquis without insurance

In this article

• Does Blue Cross Blue Shield cover Eliquis?
• How much does Eliquis cost?
• How much does Eliquis cost with BCBS?
• How to check your BCBS Eliquis coverage
• What to do if insurance won’t cover Eliquis
• How to get Eliquis without insurance

Eliquis is a name-brand prescription medication that’s approved by the Food and Drug Administration (FDA) to prevent stroke and embolism in people with a certain type of arrhythmia (irregular heartbeat) called atrial fibrillation (AFib) and to treat and prevent blood clots. Known as a factor Xa inhibitor, Eliquis works by reducing the formation of blood clots, which can clog arteries and veins. There’s no generic version of this anticoagulant, and a 30-day supply can cost hundreds of dollars without insurance. Fortunately, many Blue Cross Blue Shield insurance plans cover Eliquis.  

Does Blue Cross Blue Shield cover Eliquis?

We checked over 20 formularies and found that Blue Cross Blue Shield (BCBS) typically covers Eliquis in its commercial, federal employee, Medicare, and Medicaid plans. 

All of the BCBS formularies we looked at cover Eliquis, although cost and coverage details may vary. Eliquis is usually labeled a Tier 2 or Tier 3 drug, and the copay and coinsurance increase for higher tiers. The specific copay amount or coinsurance percentage varies by plan. 

Eliquis usually doesn’t require prior authorization or step therapy, so you can often get the prescription without the insurance company’s formal pre-approval process and without having to try other prescription medications first. However, most formularies impose quantity limits (QL) on Eliquis, meaning Blue Cross Blue Shield will only cover a certain number of tablets every 30, 60, or 90 days. 

“In general, Eliquis is a widely prescribed anticoagulant and is often covered for common uses, such as atrial fibrillation, deep vein thrombosis, or pulmonary embolism,” says Edmond Hakimi, DO, a dual-board-certified internal medicine physician and the medical director at Wellbridge. “But coverage can vary based on state, employer, and the exact formulary your plan follows.”

How much does Eliquis cost?

Without insurance, Eliquis costs an average of $378 per 28, 5 mg tablets. This blood thinner is usually taken twice per day, so this price covers a 30-day supply. Drug prices fluctuate and vary by dosage, quantity, and pharmacy. Currently, there is no cost-saving generic version available for Eliquis. 

 

How much does Eliquis cost with Blue Cross Blue Shield?

Blue Cross Blue Shield is made up of many different plans, and prescription drug prices vary by plan, so it’s difficult to give an average cost of Eliquis with Blue Cross Blue Shield. That said, here are some sample plans that may help you get a ballpark estimate:

• Federal Employee Program (FEP) Blue Standard: Patients pay a percentage of the allowed cost, between 15 and 45%, depending on the type of pharmacy used (mail order, preferred retail pharmacy, or non-preferred retail pharmacy)
• Blue Medicare Rx Enhanced: $45 or $47 copay for a 30-day supply of a Tier 3 drug like Eliquis, depending on the pharmacy used
• Anthem Blue Cross Blue Shield Nevada Medicaid: $0 copays for covered drugs like Eliquis

How to check whether your Blue Cross Blue Shield plan covers Eliquis 

An easy way to check whether your Blue Cross Blue Shield plan covers Eliquis is to call the customer support number on the back of your insurance card. A BCBS representative can look up your plan benefits and let you know whether Eliquis is covered and how much it will cost. 

You can also look at your insurance plan documents online by logging into your BCBS account. Look for the formulary or drug list. Sometimes, health insurance companies have a formulary search bar where you can enter the name of a drug and quickly find out if it’s covered. If the list of drugs is only available as a PDF, use the Ctrl+F function to locate Eliquis in the document.

You can also ask your healthcare provider to send a prescription to your preferred pharmacy. The pharmacy staff can process the claim and tell you if your Eliquis Rx is covered, or whether it needs a prior authorization.

What to do if insurance won’t cover Eliquis 

While many BCBS plans provide coverage for Eliquis, some may not. Or, even if it is covered under your plan, the cost may still be too high. In that case, there are other options. For example, let’s say you are covered under a commercial BCBS insurance plan, such as through an employer, and Eliquis is covered, but the copay is high. The manufacturer of Eliquis, Bristol-Myers Squibb, offers a savings card for patients with commercial insurance.  You can check the manufacturer’s website for more information on eligibility and requirements. 

If your plan does not cover Eliquis at all, you can look into ways to save on Eliquis without insurance (see next section), or talk to your healthcare provider about Eliquis alternatives that may be covered under your plan. “Studies suggest that Eliquis tends to have a lower risk of significant bleeding, particularly gastrointestinal bleeding, compared to some other medications,” Dr. Hakimi says. “That is one reason doctors often prefer it. However, if cost is a significant barrier, we work with patients to find a safe and effective alternative that suits their situation.”

How to get Eliquis without insurance

You can still save on Eliquis if you are paying without insurance. One way to save money on Eliquis without insurance is by using a SingleCare card. For example, a SingleCare prescription discount card could lower the price of 60, 5 mg Eliquis tablets from about $378 to $156, depending on your choice of pharmacy. 

1. Enter your ZIP code on the SingleCare website and compare Eliquis prices by pharmacy. 
2. Click “Get Free Coupon” to generate your unique coupon card. 
3. Print it, save it to your free SingleCare account, or email or text it to yourself for easy reference. 
4. When you pick up your prescription, show the pharmacy staff the card to get a discount. 

You can use the SingleCare discount on refills, as well as the initial prescription. You can also check with your healthcare provider or pharmacist to see if they know of any local financial assistance options.