Apixaban, marketed as Eliquis, is a widely prescribed anticoagulant medication used to prevent dangerous blood clots. It is a direct-acting Factor Xa inhibitor that blocks a specific protein in the blood clotting cascade, reducing the risk of stroke and systemic embolism in patients with conditions like atrial fibrillation. Since blood thinners require long-term treatment, the high cost of the brand-name product leads many patients to seek the more affordable generic version. Understanding the true cost of apixaban requires navigating its current complex market status.
Status of Generic Apixaban Availability
Although the U.S. Food and Drug Administration (FDA) approved the first two generic applications for apixaban in late 2019, the drug is not yet available in U.S. pharmacies. This delay results from ongoing patent litigation and subsequent extensions granted to the brand-name manufacturer. These legal protections have effectively blocked generic manufacturers from bringing lower-cost versions to the market.
The FDA confirmed that generic apixaban is chemically equivalent to the brand name, meeting necessary standards for effectiveness and safety. However, the approved generic products remain locked out of the commercial market until the patent exclusivity period expires. Current estimations suggest the earliest a widely available generic version will appear on U.S. pharmacy shelves is November 2026, with some projections extending that date to April 2028.
This delay forces patients to rely on brand-name Eliquis or seek alternative, non-U.S. sources, which carries regulatory uncertainties. When the generic finally enters the market, the initial price may still be relatively high until competition increases. Prices typically drop substantially once three or more manufacturers are producing and selling the generic drug.
Baseline Cash Price and Influencing Factors
Since generic apixaban is not commercially available in the U.S., the baseline cash price is tied to the brand-name drug, Eliquis. Without insurance, discounts, or patient assistance, the retail price for a 30-day supply (typically 60 tablets of the 5mg dose) generally ranges from $606 to over $800. While the specific dosage impacts the total cost, the 2.5mg and 5mg tablets are often priced similarly per pill.
Several variables influence a patient’s out-of-pocket cash cost within this broad price range. Pharmacy choice is a factor, as large national chains often have different wholesale purchasing costs and markups compared to smaller, independent pharmacies. Geographic location also plays a role, since the cost of living and regional competition affect the final retail price.
The quantity dispensed also affects the baseline cost; a 90-day supply, while costing more overall, may offer a lower cost-per-pill compared to a 30-day prescription. This high baseline price applies to the drug purchased domestically. In contrast, generic apixaban purchased from credentialed international pharmacies can cost significantly less, sometimes ranging from $75 to $195 for a 30-day supply. This international price previews the substantial savings patients can expect once the generic is available domestically and competition drives down the cost.
Strategies for Reducing Out-of-Pocket Expenses
Since the generic is not yet available, most cost reduction strategies focus on lowering the out-of-pocket expense for brand-name Eliquis. For patients with private commercial insurance, the manufacturer offers a Co-pay Card program. This program allows eligible patients to pay as little as $10 for a 30-day supply or for their first 90-day supply.
For individuals enrolled in Medicare, costs are managed through Medicare Part D prescription drug plans. The average monthly cost for Eliquis patients with Medicare is around $54, though this varies widely depending on the specific coverage tier and whether the annual deductible has been met. Future federal legislation is expected to negotiate a maximum fair price for Eliquis for Medicare beneficiaries, projected to be $231 for a 30-day supply starting in 2026.
Patients who are uninsured or underinsured may qualify for a manufacturer patient assistance program, which provides the medication at no cost if specific income and eligibility requirements are met. Pharmacy discount cards, such as those offered by third-party services, can reduce the retail cost substantially, bringing the price down to around $488 to $600 for a 30-day supply. Comparison shopping remains an effective strategy, as calling different pharmacies can often reveal hundreds of dollars in price differences for the same prescription.