What Your Prescriptions Cost
How much does Xarelto cost with Medicare in 2026?
Last reviewed: · Big Sioux Benefits Data Desk
Xarelto has a Medicare-negotiated price of $197 for a 30-day supply as of January 1, 2026, down from a list price of $517, a 62% reduction (CMS, Negotiated Prices for Initial Price Applicability Year 2026). About 1.3 million Medicare beneficiaries used it in 2023, accounting for $6.3 billion in Part D gross covered drug costs.
The qualifier: Xarelto and Eliquis are both anticoagulants, both were selected for the first negotiation cycle, and they landed at similar negotiated prices, $197 and $231 respectively. That similarity matters less than people expect, because your actual cost depends on which one your plan places on a lower tier, and plans differ on that. The cost comparison is worth having with your prescriber, but it is a clinical decision first.
What a year on Xarelto looks like
| Step | Illustration under the standard 2026 benefit |
|---|---|
| Drug cost for the year at the negotiated price | About $2,364 |
| You pay during the deductible | Up to $615 |
| You pay after the deductible | 25% of the remaining cost, about $437 |
| Approximate out-of-pocket for the year | About $1,052, under the $2,100 cap |
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.
Anticoagulants are among the most commonly prescribed drugs in Medicare, and between Xarelto and Eliquis alone the program covered more than five million beneficiaries in 2023. If you are weighing the two on cost, the side-by-side is in Eliquis versus Xarelto, and the older, far cheaper alternative in this category is worth asking your prescriber about as well.
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
Is Xarelto cheaper than Eliquis under Medicare?
The negotiated prices are close: $197 for a 30-day supply of Xarelto against $231 for Eliquis. Which costs you less in practice depends on your plan's tier placement for each, which can go either way. Never switch anticoagulants on cost grounds without your prescriber, since they are not interchangeable for every patient.
Does warfarin cost less than Xarelto?
Generic warfarin is dramatically cheaper than either negotiated anticoagulant, but it requires regular blood monitoring and has significant dietary and drug interactions, which is why many prescribers moved away from it. That trade-off is a clinical conversation, not a purchasing decision.
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.