NC Medicare Drug Spending: Apixaban
The Blood Thinner Costing North Carolina Medicare $689 Million a Year
One drug. Ranked 12th in prescriptions. But it costs more than the next four most expensive drugs combined.
$689.3M
Total NC Medicare spend on Apixaban, 2023
$834
Average cost per prescription
#12 / #1
Rank by prescriptions / rank by total cost
What is Apixaban?
Apixaban (brand name Eliquis) is a blood thinner prescribed mainly to reduce stroke risk in people with atrial fibrillation. AFib affects roughly one in ten people by age 80, causing the heart's upper chambers to beat irregularly. Blood can pool and form clots that travel to the brain and cause a stroke. Apixaban disrupts that process.
North Carolina has one of the highest rates of AFib-related hospitalizations in the Southeast. That, combined with a large and growing Medicare population, drives significant Apixaban volume.
Why does it cost so much more than older blood thinners?
Warfarin, the original blood thinner, costs about $14 per prescription. Apixaban costs $834. Apixaban requires no regular blood monitoring, while Warfarin requires monthly INR tests to keep dosing safe. For patients in rural North Carolina, where a lab can be an hour away, that convenience is a real clinical benefit.
But Apixaban remains under patent, so no generic exists in the U.S. That keeps the price high regardless of how long it's been on the market.
What this means for your Part D plan
Most Part D plans tier Apixaban at Tier 3 or Tier 4. Starting in 2025, Medicare's $2,000 annual out-of-pocket cap limits your maximum exposure. But at $834 per prescription, you can hit that cap in just two or three fills if Apixaban is your only expensive drug.
North Carolina's rural communities often have fewer plan options during open enrollment. Using Medicare Plan Finder at medicare.gov to compare plans on your specific drugs is especially important when you're outside a major metro area.
Questions worth asking
Ask your doctor whether the original clinical reason you started Apixaban still applies. Some patients start after a procedure and stay on it longer than needed. For some, Warfarin with monitoring remains clinically appropriate and meaningfully cheaper.
NC's 826,090 Apixaban prescriptions in 2023 cost more than Ozempic, Jardiance, Trulicity, and Xarelto combined. Those four drugs totaled $1.18 billion. Apixaban alone: $689 million.
Top 10 North Carolina Drugs by Total Medicare Part D Spending, 2023
Source: CMS Medicare Part D Prescribers by Geography and Drug, 2023. North Carolina state-level data.
A note on this data: All figures come from the Centers for Medicare & Medicaid Services
(CMS) Medicare Part D Prescribers by Geography & Drug dataset, 2023. This data covers Medicare Part D
(prescription drug coverage) only and does not represent commercial insurance, Medicaid, or cash-pay prescriptions.
Suppressed values (fewer than 11 beneficiaries) are excluded from totals.
This article is for educational purposes only. Nothing here is medical advice. Talk to your doctor before
making any decisions about your medications or treatment. This content is not connected with or endorsed
by the U.S. Government or the federal Medicare program.
