SC Medicare Drug Spending: Apixaban
The Blood Thinner Costing South Carolina Medicare $321 Million a Year
One drug. Ranked 13th in prescriptions. But Apixaban is South Carolina's single most expensive Medicare drug by a wide margin.
$320.6M
Total SC Medicare spend on Apixaban, 2023
$854
Average cost per prescription
#13 / #1
Rank by prescriptions / rank by total cost
What is Apixaban?
Apixaban (Eliquis) is a blood thinner prescribed mainly for atrial fibrillation. AFib is one of the most common heart conditions in people over 65, and it creates blood clot risk that can lead to stroke. South Carolina has above-average rates of cardiovascular disease and stroke, particularly in the coastal and rural Lowcountry. That disease burden drives high Apixaban volume relative to the state's Medicare population size.
How does it compare to the alternative?
Warfarin, the older blood thinner, costs about $14 per prescription. Apixaban costs $854. Warfarin works but requires monthly blood tests to manage dosing safely. For patients in rural South Carolina, that monitoring burden is real. Apixaban eliminates it, which is a legitimate clinical benefit. But Apixaban remains under patent in the U.S. No generic exists.
What this means for Part D enrollees
South Carolina Medicare beneficiaries on Apixaban face tier-placement challenges just like patients in larger states. Most plans put it on Tier 3 or Tier 4. The 2025 out-of-pocket cap of $2,000 limits your annual exposure. At $854 per fill, you can reach that cap in two or three prescriptions.
SC has significant rural Medicare populations in counties like Marion, Marlboro, and Allendale where plan options during open enrollment are limited. Checking Medicare Plan Finder before each enrollment period is worth the time.
Questions to ask your doctor
Ask whether your AFib diagnosis still warrants Apixaban and whether anything about your monitoring situation has changed. For some patients, Warfarin with monitoring may still be clinically appropriate and meaningfully cheaper.
SC's 375,286 Apixaban prescriptions in 2023 cost more than Ozempic and Jardiance combined. Those two drugs totaled $323 million. Apixaban alone: $321 million.
Top 10 South Carolina Drugs by Total Medicare Part D Spending, 2023
Source: CMS Medicare Part D Prescribers by Geography and Drug, 2023. South 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.
