What Your Prescriptions Cost
Which costs less with Medicare, Eliquis or Xarelto?
Last reviewed: · Big Sioux Benefits Data Desk
By negotiated price, Xarelto is slightly cheaper: $197 for a 30-day supply against Eliquis at $231, both effective January 1, 2026 (CMS, Negotiated Prices for Initial Price Applicability Year 2026). Across a year that gap is about $408 in drug cost, which translates to roughly $100 in your own cost sharing under the standard benefit, before your plan's tier placement is taken into account.
The qualifier, and it should come before any cost comparison: these are not interchangeable drugs. They have different dosing schedules, different interaction profiles, and different evidence for particular conditions. Anticoagulants are also drugs where switching carries real clinical risk. The cost information here is worth bringing to your prescriber; it is not a basis for changing medications on your own.
Side by side, 2026
| Eliquis | Xarelto | |
|---|---|---|
| Negotiated price, 30-day supply | $231.00 | $197.00 |
| 2023 list price, 30-day supply | $521.00 | $517.00 |
| Discount from list | 56% | 62% |
| Medicare users, 2023 | 3,928,000 | 1,324,000 |
| Part D gross covered costs, 2023 | $18.3 billion | $6.3 billion |
| Illustrative annual out-of-pocket | About $1,154 | About $1,052 |
How this illustration is built: the 2026 standard Part D benefit, meaning a full $615 deductible, then 25% coinsurance, then $0 once your out-of-pocket total reaches $2,100. Your plan may use copays instead of coinsurance, may charge a smaller deductible or none, and may place the drug on a different tier, so treat this as the shape of the year rather than a quote. We are not showing plan-specific copays because we will not publish a number we cannot source.
The practical point: a roughly $100 annual difference is small enough that a single tier placement decision by your plan can reverse it. If your plan puts Eliquis on a preferred brand tier and Xarelto on a non-preferred tier, Eliquis is cheaper for you despite the higher negotiated price. Check your own plan's formulary for both before drawing any conclusion, and take that information to the person who prescribes it.
Sources
- CMS — Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 — prices effective January 1, 2026; accessed 2026-08-21
- CMS — Medicare Part D Spending by Drug — CY2025 full year and CY2026 Q1 files; accessed 2026-08-21
- CMS — Announcement of Calendar Year 2026 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (Part D benefit parameters) — CY2026 parameters; accessed 2026-08-21
Related questions
Can I ask my doctor to switch me to the cheaper one?
You can and should raise cost with your prescriber, because they often do not know what a given drug costs you. What you should not do is switch or stop an anticoagulant on your own. The clinical differences between these drugs are real, and the risk of getting anticoagulation wrong is serious.
Why does Eliquis cost more if both were negotiated?
CMS negotiated each drug separately against statutory factors including therapeutic alternatives and manufacturer-submitted cost data, so the resulting prices differ. Eliquis also started from a slightly higher list price and received a smaller percentage discount, 56% against Xarelto's 62%.
Drug costs turn on your specific prescriptions, so the arithmetic is worth doing once, properly: book a free, no-pressure conversation, see your county's South Dakota plan lineup, or browse all answers. SHIINE, the state's free counseling program, is at 1-800-536-8197 and sells nothing.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or SHIINE (South Dakota's SHIP) for all of your options.