Potential 2025 Year End Eliquis Savings

I wanted to purchase my last batch of Eliquis pills at the end of 2025 so that I could delay paying the large drug deductible in 2026.

So, I purchased my last 90 pills of Eliquis today and was surprised to see they were free, $ 0.00. If you are on Eliquis you might want to check your insurance to see if you can do the same, only 2 days remaining in 2025. See my attached receipt.

Sweet! I think you hit the $2K out-of-pocket maximum for drugs that was implemented during the Biden years.

I was thinking the same thing. So, just now I checked my insurance prescription claims online and this is what I see:

Claims overview from Past 18 months: Total claims: 7, Total cost: $8080.64, Your total costs: $716.00

And then for my "purchase" today: Service date: 12/29/2025, Total cost: $1559.50, Your cost: $0.00

Was there some recent law passed that gave expensive drugs like Eliquis a lower threshold for when we stop paying? Not sure why insurance is showing me claims from the last 18 months.

Hmm... now I don't know why you got it fully paid.

Medicare only looks at the calendar year. So likely what happened is that your last Eliquis claim pushed you over the $2000 callendar year limit and therefore no cost to you. Keep in mind that to get to $2,000, it's not just what you pay (co-pay), but the drugs total cost.

Jim

Quote
mjamesone
Keep in mind that to get to $2,000, it's not just what you pay (co-pay), but the drugs total cost.

Not sure this is correct.

"Medicare drug coverage stages
Generally, Medicare drug plans and Medicare Advantage Plans with drug coverage have 3 stages:

Deductible stage: If your Medicare plan has a deductible, you pay all out-of-pocket costs until you reach the full deductible. No Medicare drug plan may have a deductible more than $590 in 2025 ($615 in 2026). Some Medicare drug plans don’t have a deductible.
Initial coverage stage: After you reach your full deductible (if your plan has a deductible), you’ll pay 25% of the cost as coinsurance for your generic and brand-name drugs until your out-of-pocket spending on covered Part D drugs reaches $2,000 in 2025 ($2,100 in 2026) (including certain payments made on your behalf, like through the Extra Help program). Then, you’ll automatically get “catastrophic coverage.”
Catastrophic coverage stage: You won’t have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year."

Source

Not sure this is correct.

This might help here: [www.cms.gov]

The confusion is True Out-of-Pocket is (TrOOP) is what is used for the calculation and TrOOP can be more than what you actually pay.

Jim



Edited 2 time(s). Last edit at 01/03/2026 12:06AM by mjamesone.