Eliquis Is Now a Negotiated Medicare Drug at $231/Month: Which Part D Plan Costs You Less in 2026?
Eliquis Is Now a Negotiated Medicare Drug at $231/Month: Which Part D Plan Costs You Less in 2026?
You take Eliquis 5mg twice a day for atrial fibrillation, Jardiance 10mg for Type 2 diabetes, and Lantus insulin. Before 2026, that combination could cost you anywhere from $1,800 to over $5,000 out of pocket annually, depending entirely on which Part D plan you chose. Now — with the Inflation Reduction Act's first negotiated drug prices in effect and the $2,000 out-of-pocket cap from last year — the landscape has genuinely shifted.
But here's what has not changed: the plan you're currently enrolled in still determines whether you pay $2,000 or $2,328 for that exact same drug list this year. And for people with lighter drug loads, the gap is even wider.
Let me show you the math.
What the IRA Actually Changed for 2026 (No Jargon)
The Inflation Reduction Act, signed in 2022, rolled out Medicare drug reforms in stages. The Medicare Rights Center recently marked sixteen years of the Affordable Care Act — noting that each major reform since 2010 has layered new protections onto Medicare's drug benefit. The IRA is the most consequential layer yet. Here's what's fully in effect as of 2026:
1. The $35/month insulin cap. In effect since 2023. If you use insulin covered by Medicare Part D, your cost is capped at $35 per month per insulin product — regardless of your plan's normal copay or tier placement.
2. The $2,000 out-of-pocket cap. In effect since 2025. Once your True Out-of-Pocket costs — called TrOOP, which is the amount you actually pay at the pharmacy counter — reach $2,000, you pay nothing for covered drugs for the rest of the calendar year. The old "donut hole" coverage gap is gone. For a deeper look at how TrOOP accumulates month by month, see Medicare's $2,000 Drug Cap Explained: What Eliquis Users Actually Pay Before and After Hitting It in 2026.
3. Negotiated drug prices. Effective January 1, 2026. CMS negotiated Maximum Fair Prices (MFPs) for the first ten high-spending Medicare drugs. These are not voluntary rebates — they are legally binding prices that every Part D plan must apply when you fill those prescriptions. Eliquis and Jardiance are both on the list.
What the Negotiated Prices Actually Are in 2026
Before negotiation, Eliquis (apixaban 5mg, 60 tablets) carried a Part D price of roughly $550/month. Jardiance (empagliflozin 10mg, 30 tablets) ran about $570/month.
Under CMS's published Maximum Fair Prices effective January 2026:
- Eliquis (apixaban 5mg, 60 tablets): ~$231/month
- Jardiance (empagliflozin 10mg, 30 tablets): ~$197/month
These are not the prices you see at the pharmacy — they are the plan's drug cost, which then determines your copay based on which formulary tier your plan places those drugs on. A plan can still put a negotiated drug on Tier 4 (specialty) and charge you 40% coinsurance. The MFP sets the price floor; your plan's tier placement sets what percentage of that price you pay.
And that distinction — which tier, which plan — is where the real annual cost difference lives.
Three Plans, One Drug List, Very Different Annual Totals
The drug list: Eliquis 5mg twice daily, Jardiance 10mg once daily, Lantus insulin glargine
2026 Part D parameters used: $590 standard deductible, 25% initial coverage coinsurance, $2,000 TrOOP cap. Copay figures modeled from CMS formulary design guidelines.
| Plan A | Plan B | Plan C | |
|---|---|---|---|
| Monthly premium | $52 | $0 | $18 |
| Annual premium | $624 | $0 | $216 |
| Deductible | $0 | $590 | $590 |
| Eliquis tier | Tier 3 (25%) | Tier 3 (25%) | Tier 4 (40%) |
| Jardiance tier | Tier 3 (25%) | Tier 3 (25%) | Tier 3 (25%) |
| Insulin | $35 cap | $35 cap | $35 cap |
Plan A — $52/month premium, no deductible
From January 1, your monthly cost at the pharmacy:
- Eliquis: 25% × $231 = $57.75
- Jardiance: 25% × $197 = $49.25
- Lantus: $35.00 (capped)
- Monthly patient cost: ~$142
TrOOP accumulates at $142/month. At that rate, you reach the $2,000 cap in approximately 14 months — which means you don't hit it within 2026 on this drug list. You pay the full 12 months of copays.
Annual drug out-of-pocket: $142 × 12 = $1,704 Annual premiums: $624 Plan A total annual cost: $2,328
Plan B — $0 premium, $590 deductible
Month 1: you pay 100% of drug costs until the $590 deductible is met. After that: same 25% coinsurance as Plan A — $107/month for Eliquis + Jardiance, plus $35 insulin = $142/month
TrOOP after month 1: $590 Remaining TrOOP to reach $2,000 cap: $1,410 ÷ $142 ≈ 10 more months
That puts you at the cap in November. December costs you nothing.
Annual drug OOP: $590 + ($142 × 10) + $0 = ~$2,000 Annual premiums: $0 Plan B total annual cost: ~$2,000
Plan C — $18/month premium, $590 deductible, Eliquis on Tier 4
Same structure as Plan B, but Eliquis is placed on Tier 4 — meaning 40% coinsurance instead of 25% after the deductible.
Monthly costs after deductible:
- Eliquis: 40% × $231 = $92.40
- Jardiance: 25% × $197 = $49.25
- Lantus: $35.00
- Monthly: ~$177
TrOOP after month 1: $590 Remaining to cap: $1,410 ÷ $177 ≈ 8 months → hits $2,000 in September
October, November, December: $0
Annual drug OOP: $590 + ($177 × 8) = ~$2,000 Annual premiums: $18 × 12 = $216 Plan C total annual cost: ~$2,212
The Side-by-Side
| Plan A | Plan B | Plan C | |
|---|---|---|---|
| Annual drug OOP | $1,704 | ~$2,000 | ~$2,000 |
| Annual premiums | $624 | $0 | $216 |
| Total annual cost | $2,328 | ~$2,000 | ~$2,212 |
| Months until OOP cap | Never in 2026 | November | September |
Plan B saves $328 over Plan C and $328 over Plan A. Same drugs, same ZIP code, same negotiated Eliquis price — the difference is entirely in premium structure and one tier placement.
This is exactly the kind of drug-by-drug, plan-by-plan calculation that Pelandri runs for you — so you don't have to build the spreadsheet yourself.
Why Negotiated Prices Make Plan Selection More Complex, Not Less
You might assume that lower drug prices reduce the stakes of plan comparison. The opposite is often true.
Here's why: lower negotiated prices slow your path to the $2,000 TrOOP cap.
Before 2026, Eliquis at $550/month with 25% coinsurance meant you were paying $137.50/month just for that one drug. Add Jardiance, add insulin — and many beneficiaries hit the $2,000 cap by March or April. Once you hit the cap, the plan's copay structure was irrelevant. You paid $0 regardless.
Now, at $231/month for Eliquis (25% = $57.75), you accumulate TrOOP more slowly. As shown above, someone on this three-drug combo with Plan A doesn't hit the cap at all in 2026 — which means every dollar in plan premium is real money lost, and every tier-placement difference compounds across all 12 months.
For beneficiaries on one or two moderate-cost drugs, the $2,000 cap may never trigger at all. For them, choosing a high-premium plan with slightly lower copays can easily cost $400–700 more per year than a low-premium plan with the same drugs on the same tier. You can model your exact break-even at Pelandri.
If Your Income Qualifies You for Extra Help, The Math Shifts Again
If your income is at or below 150% of the federal poverty level — roughly $22,590 for a single person in 2026 — you may qualify for the Part D Low Income Subsidy, known as Extra Help. Under Extra Help:
- Your deductible is eliminated
- Copays are capped at roughly $4.90 for generics and $12.15 for brand-name drugs
- Premiums are partially or fully subsidized
The IRA improved Extra Help eligibility starting in 2024, bringing more lower-income beneficiaries into the program. If you qualify, your plan's tier placement matters far less — but your pharmacy choice matters significantly. Extra Help beneficiaries who use a plan's designated preferred pharmacy pay lower copays than those using a standard network pharmacy. On a brand-name drug, that difference can be $30–50 per fill. We walk through how the preferred pharmacy network interacts with Extra Help in the worked example at Eliquis + Lisinopril + Atorvastatin: Why Your Part D Plan Choice Means the Difference Between $242 and $2,000 Per Year.
The Variable That Overrides Everything: Your ZIP Code
Part D plans are regional. There are typically 20–35 plans available in any given ZIP code, and the same plan name can carry different formulary placements, different deductibles, and different preferred pharmacy networks depending on whether you're in Los Angeles, rural Tennessee, or suburban Ohio.
CMS's Medicare Plan Finder at medicare.gov/plan-compare is the official comparison tool — you enter your medications, doses, and preferred pharmacy, and it estimates annual costs across all available plans. The limitation: it estimates based on plan-reported data, and doesn't always reflect how your specific TrOOP path plays out month by month when your drugs are on different tiers with different coinsurance rates.
The $328 gap in the scenario above wasn't visible from the premium alone. Plan B looked identical to Plan C on monthly premium comparisons. The difference only emerged when you modeled the full year.
Before Open Enrollment Closes, Run Your Own Numbers
The IRA's negotiated prices are a genuine win for beneficiaries taking Eliquis, Jardiance, Xarelto, Januvia, and the other first-wave drugs. The $2,000 cap is real. The $35 insulin limit is real. These are the most significant structural changes to Medicare Part D since the program launched in 2006, building on the donut hole closure that began with the ACA in 2010.
And still: in the scenario above, three plans offering access to the same negotiated Eliquis price produced annual costs ranging from $2,000 to $2,328 — a gap driven by premium structure and one tier difference. Before accounting for pharmacy network variation, which can add another $200–400 per year on brand-name drugs.
For beneficiaries on more complex drug lists — mixing negotiated and non-negotiated drugs, brand and generic, across multiple conditions — the spread between the cheapest and most expensive plan in the same ZIP code regularly exceeds $1,000 per year.
Open Enrollment runs October 15 through December 7 each year. Most beneficiaries stay in last year's plan by default. For some, that's fine. For many — especially those whose drug list changed, whose plan changed its formulary, or who haven't run the numbers since the IRA's reforms took effect — it's a costly mistake.
Run your specific drug list, pharmacy preference, and income level through Pelandri and see what your actual annual cost looks like across every plan available in your ZIP code.
Sources
- Listen to the Latest ‘KFF Health News Minute’ — KFF Medicare
- Sixteen Years of the Affordable Care Act — Medicare Rights Center
- “Me engañaron”: agentes encadenan a un padre que había ido al ICE a reunirse con sus hijos — KFF Medicare
- ‘They Tricked Me’: A Father Was Chained After He Went to ICE To Reunite With His Kids — KFF Medicare
- Aunque tengas seguro dental, la factura puede ser muy alta — KFF Medicare