Yes, Wellcare does cover Eliquis. The blood thinner apixaban appears on the formulary for Wellcare’s Medicare Advantage plans with Part D, its standalone Medicare Prescription Drug Plans, and its Managed Medicaid HMO plans. No plan type requires prior authorization or step therapy, though Medicare plans apply a quantity limit on each fill.
Coverage Rules by Plan Type
A doctor can prescribe Eliquis under any Wellcare plan without first trying a cheaper anticoagulant and without waiting for plan approval. That holds across Medicare Advantage, standalone PDPs, and Managed Medicaid.
The one restriction on the Medicare side is a quantity limit per fill. Managed Medicaid plans impose no such limit. Wellcare’s general coverage pages do not publish the exact tablet count, so check your plan’s formulary or call Member Services at 1-888-550-5252 for the number that applies to you.
What You’ll Pay for Eliquis
Eliquis is a brand-name drug, and Wellcare’s Medicare PDPs place brand drugs on Tier 3 (Preferred Brand) or Tier 4 (Non-Preferred Drug). Both tiers charge coinsurance, a percentage of the drug’s cost, rather than a flat copay.
Under the Wellcare Value Script PDP for 2026, Tier 3 coinsurance is 25% at both preferred and standard pharmacies. Tier 4 is 40% at preferred pharmacies and 50% at standard. Under the Wellcare Classic PDP, Tier 3 is 23% and Tier 4 runs 35% at retail or 36% by mail order. If a plan places Eliquis on the Specialty Tier (Tier 5), coinsurance is 25% under both plans, and Tier 5 drugs cannot be moved to a cheaper tier through an exception.
The underlying price those percentages apply to dropped in 2026. Under the Inflation Reduction Act’s Medicare Drug Price Negotiation Program, the negotiated Maximum Fair Price for a 30-day supply of Eliquis is $231, down from a 2023 list price of $521. That is a 56% reduction, and Part D plans are required to include negotiated drugs on their formularies.
Savings at the pharmacy counter are not automatic, though. Whether your coinsurance drops depends on where your plan places Eliquis and whether you are still working through your deductible. Some beneficiaries have reported higher out-of-pocket costs despite the lower federal price.
The $2,100 Annual Out-of-Pocket Cap
The strongest cost protection for Wellcare Medicare members on Eliquis is the Part D out-of-pocket cap. In 2026, no Part D beneficiary pays more than $2,100 in total out-of-pocket prescription drug costs for the year. Once you hit that ceiling, every covered drug, Eliquis included, costs $0 for the rest of the calendar year. The old “donut hole” coverage gap is gone.
According to the manufacturer, the average Medicare patient taking Eliquis for atrial fibrillation pays about $51 per month, with half paying $30 or less. For patients prescribed it for deep vein thrombosis or pulmonary embolism, the average is around $45 per month, with half paying $15 or less. Members who qualify for Medicare’s Low-Income Subsidy (Extra Help) pay between $0 and $12.65 per month.
Spreading Costs Across the Year
Wellcare participates in the Medicare Prescription Payment Plan, a federal program that lets Part D members pay their drug costs in monthly installments instead of all at once at the pharmacy. There is no interest and no enrollment fee.
Once you enroll, you pay nothing at the counter. Wellcare bills you monthly, recalculating the amount each month by adding new drug costs to the remaining balance and dividing by the months left in the year. The program does not reduce your total cost. It just smooths it out, which matters if a January refill would otherwise hit you with several hundred dollars in coinsurance at once. Enrollment is voluntary, can start or stop at any time, and renews automatically. Sign up through Wellcare’s online portal, by calling 1-833-750-9969, or by mail.
Check Your Plan’s Tier
Wellcare offers dozens of plan variants that differ by state and cost structure, so confirm how your specific plan classifies Eliquis before you count on any particular price. Go to wellcare.com, select your state and plan type, and open the List of Drugs (Formulary) Search Tool under the Pharmacy section. Searching “Eliquis” returns the tier, available dosages, and any quantity limit. The tool also lists covered alternatives if you want to compare with other anticoagulants. Member Services at 1-888-550-5252 (TTY: 711) can walk you through your tier and estimated copay.
Requesting an Exception
If your plan places Eliquis on a higher-cost tier than you expected, or if the quantity limit does not match what your doctor prescribed, you can request a formulary or tiering exception. Your prescriber has to submit a supporting statement explaining why Eliquis is medically necessary. Requests go through phone, the CoverMyMeds electronic prior authorization portal, or Wellcare’s Drug Coverage Determination Request form.
Wellcare must respond to a standard request within 72 hours. If your prescriber certifies that waiting 72 hours could seriously harm your health, you get an expedited decision within 24 hours. An approved exception lasts through the end of the plan year, as long as you stay enrolled and the drug continues to be prescribed. A denial letter includes instructions for filing an appeal. Keep in mind that Specialty Tier placement cannot be exceptioned to a lower tier.
Manufacturer Help for Medicare Patients
Bristol-Myers Squibb and Pfizer, which make Eliquis, offer a free trial card good for one 30-day supply at no cost. Unlike the company’s copay savings card, which is restricted to commercially insured patients, the free trial card is open to government-insured patients, including Medicare members. The ELIQUIS 360 Support program at 1-855-ELIQUIS (354-7847) can point you to other savings options.
Why There Is No Generic Yet
The FDA has given tentative approval to generic apixaban from several manufacturers, but patent protections continue to block any U.S. launch. A follow-on formulation patent, upheld by the U.S. Court of Appeals for the Federal Circuit in 2021, prevents generic launches until at least April 1, 2028. Generic apixaban is already sold in Canada and the United Kingdom, but in the United States, Eliquis will remain the only option through that date. Generics typically run 80% to 85% cheaper than brand drugs, so tiering and pricing on plans like Wellcare’s would likely shift once they arrive.