Anticoagulants — often called blood thinners — are among the most widely prescribed medications in the United States, and two brand-name drugs dominate: Eliquis (apixaban) and Xarelto (rivaroxaban). They prevent dangerous blood clots, but because both are still largely brand-only, a month’s supply can list at roughly $600 or more without insurance. For many patients, the hard part is not the prescription — it is paying for it.
SunnyPharma built this guide from FDA prescribing information, the AHA/ACC/HRS atrial fibrillation guidance, Medicare’s drug-price negotiation program, and manufacturer assistance program rules. It explains what these anticoagulants do, what they treat, what they actually cost, where each one stands on generic availability, and the specific US pathways that bring many patients to little or nothing. For decisions about your own treatment — including whether to start, switch, or stop any anticoagulant — your clinician is the right source of guidance.
- Two leading DOACs: Eliquis (apixaban) and Xarelto (rivaroxaban)
- What they treat: stroke risk in atrial fibrillation, plus DVT and PE
- List price ~$600+/month, but most patients pay far less through assistance
- No coupons with Medicare: federal law bars manufacturer copay cards for government insurance
- Generic status differs: the only Xarelto generic (2.5 mg) is for a different use (CAD/PAD), not the AFib/DVT/PE doses; Eliquis generic timing is contested
- Never stop on your own: both carry boxed warnings about clot risk if discontinued early
What Eliquis and Xarelto Cost — and What Patients Actually Pay
The list price of a brand-name anticoagulant is one number; what you pay at the pharmacy is usually a very different one. The most important thing to know is that few patients who need these drugs have to pay full price — but the route to a lower price depends heavily on what kind of insurance you have, and one common assumption is simply wrong for millions of people.
The coupon trap: why “Eliquis coupon with Medicare” doesn’t work
If you have Medicare, you cannot use a manufacturer copay card or savings coupon for Eliquis or Xarelto — even though those coupons are advertised widely. This is not a plan quirk; it is federal law. The anti-kickback statute bars drug manufacturers from giving copay assistance to anyone with government insurance, including Medicare and Medicaid. Patients search for these coupons by the thousands and hit a wall nobody explains. If you are on Medicare, the copay card is not your path — the pathways below are.
Free and low-cost anticoagulant pathways
Work through these in order based on your coverage. Most patients reach a manageable or $0 cost through one of them.
- Manufacturer patient assistance (uninsured): The Bristol Myers Squibb Patient Assistance Foundation provides Eliquis at no cost to qualifying uninsured patients, and Johnson & Johnson’s program does the same for Xarelto. Both have income limits and require an application, usually with your prescriber.
- Manufacturer copay cards (commercially insured only): If you have private insurance, the Eliquis and Xarelto copay programs can cut out-of-pocket cost to as little as $0–$10 per month. These cannot be used with Medicare, Medicaid, or other government coverage.
- Medicare beneficiaries — the negotiated price: Both Eliquis ($231) and Xarelto ($197) are among the first drugs with a Medicare-negotiated price, effective January 1, 2026. That figure is what the government pays; what you pay is set by your Part D plan, but in 2026 your total Part D out-of-pocket is capped at $2,100 for the year. If your pharmacy still quotes a high price, check your plan’s formulary tier and deductible phase.
- Medicare Extra Help (Low-Income Subsidy): Helps cover Part D drug costs for people with limited income and resources.
- Generic where it applies: The only generic rivaroxaban approved so far is the 2.5 mg tablet, which is used for coronary or peripheral artery disease — not the 10, 15, or 20 mg doses used for AFib, DVT, or PE. Most anticoagulant patients therefore have no generic option yet.
Do not stop your anticoagulant because of cost. Both Eliquis and Xarelto carry an FDA boxed warning that stopping early raises the risk of clots and stroke. If you cannot afford your medication, talk to your clinician or pharmacist before skipping doses — there is almost always a pathway above that fits your situation, and a clinician can discuss lower-cost alternatives if needed.
The Two Main Anticoagulants: Eliquis and Xarelto
Eliquis and Xarelto belong to a class called direct oral anticoagulants (DOACs). They work by directly blocking factor Xa, a protein the body needs to form clots. Compared with the older drug warfarin, DOACs do not require routine blood-level (INR) monitoring, have fewer food and drug interactions, and use more predictable fixed dosing — which is why they have become the default choice for most patients who need an anticoagulant.
| Medication | Generic name | Dosing | Generic status (2026) |
|---|---|---|---|
| Eliquis | Apixaban | Twice daily | Generic approved; broad US availability contested (court date Apr 2028, some settlement supply 2025–26) |
| Xarelto | Rivaroxaban | Once daily (most doses with food) | 2.5 mg generic (CAD/PAD use only); 10/15/20 mg brand-only |
Both are factor Xa inhibitors, but they are not interchangeable dose-for-dose. Switching between anticoagulants — or to or from warfarin — is a clinical decision based on kidney function, bleeding risk, other medications, and your specific condition. Never switch or combine anticoagulants on your own.
Eliquis vs Xarelto: how the choice is made
There is no universal “better” anticoagulant. For most patients, both Eliquis and Xarelto are effective options for the same core conditions, and the choice comes down to individual factors: kidney function, bleeding risk, whether once-daily or twice-daily dosing fits your life, other medications you take, and cost under your specific insurance. Because the cost levers differ by drug (a Medicare-negotiated price for both, and limited generic availability), the cheaper option genuinely depends on your dose and coverage. Your clinician weighs these together using current cardiology guidance.
What Anticoagulants Treat
Eliquis and Xarelto are approved for the same major uses. Understanding which condition you are being treated for helps you ask the right questions about dose, duration, and cost.
- Atrial fibrillation (AFib): The most common reason these drugs are prescribed. In non-valvular AFib, the irregular heartbeat lets blood pool and clot, which can cause a stroke. Anticoagulants sharply reduce that stroke risk. This is typically lifelong therapy, which is what makes the monthly cost so important.
- Deep vein thrombosis (DVT): A clot, usually in a leg vein. Anticoagulants both treat an existing DVT and prevent new ones.
- Pulmonary embolism (PE): A clot that has traveled to the lungs — a medical emergency. After initial treatment, anticoagulants prevent recurrence.
- Clot prevention after surgery: Both drugs are used to prevent venous clots after certain procedures, such as hip or knee replacement.
Anticoagulant Safety and Side Effects
Because anticoagulants reduce the blood’s ability to clot, the central trade-off is bleeding risk. For most patients the benefit — preventing a stroke or a life-threatening clot — clearly outweighs that risk, but it is why these drugs require attention and should never be started or stopped casually.
- Most common concern: bleeding, ranging from minor bruising and nosebleeds to more serious bleeding. Report black or bloody stools, vomiting blood, severe or unusual headaches, or any bleeding that won’t stop.
- Boxed warnings: Both Eliquis and Xarelto carry FDA boxed warnings that stopping the drug early increases the risk of clots and stroke, and that spinal or epidural procedures carry a risk of serious bleeding. Tell any provider doing a procedure that you take an anticoagulant.
- Drug interactions: Some medications and supplements raise or lower anticoagulant levels. Always give your clinician and pharmacist your full medication list.
There are reversal options in an emergency. If you are in an accident or need urgent surgery, modern anticoagulants can be reversed or managed by clinicians. Carry a card or wear identification noting that you take an anticoagulant so emergency providers know.
Generic Anticoagulants: Where Things Stand in 2026
Generic availability is the single biggest factor that will lower these drugs’ cost over the next few years — but the picture is different for each drug, and a lot of confusion surrounds it.
- Xarelto (rivaroxaban): The FDA approved the first generic rivaroxaban (the 2.5 mg tablet) in March 2025 — but that dose is approved for coronary and peripheral artery disease, not for AFib, DVT, or PE. The 10, 15, and 20 mg doses used for those conditions remain brand-only, so most anticoagulant patients still have no generic option and should use the access pathways above.
- Eliquis (apixaban): The picture is contested. The FDA approved generic apixaban years ago, and a federal court set April 2028 as the earliest broad launch date — but some manufacturers reportedly reached pharmacies earlier under 2024–25 settlements, and supply has been intermittent. Whether you can find a generic apixaban depends on your pharmacy. Until broad availability settles, the Medicare-negotiated price (for Medicare patients) and manufacturer assistance (for others) are the reliable cost levers.
Generic anticoagulants cost dramatically less in countries like Canada, Mexico, and India, and you may see these prices advertised. For US patients this is educational context, not a recommended route — the domestic pathways above can usually bring your cost down without the legal, safety, and quality-assurance questions that come with importing medication.
Anticoagulant Cost & Access Guides
This hub links to in-depth guides on specific anticoagulant questions — what each drug costs, how to access assistance, and where generics stand. More guides are being added; the ones below are live now.
Frequently Asked Questions
Anticoagulants are medications that reduce the blood’s ability to clot, lowering the risk of dangerous clots. The two most prescribed direct oral anticoagulants (DOACs) are Eliquis (apixaban) and Xarelto (rivaroxaban). They are used to prevent stroke in people with non-valvular atrial fibrillation, to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), and to prevent venous blood clots after certain surgeries. They have largely replaced warfarin because they do not require routine blood-level monitoring.
Both Eliquis and Xarelto are brand-name drugs still protected by patents in the US, so there is no low-cost generic competition for most doses. List prices run roughly $600 or more per month without insurance. Most patients pay far less through insurance, manufacturer copay cards (for the commercially insured), manufacturer patient assistance programs (for the uninsured), or, for Medicare beneficiaries, the new Medicare-negotiated prices for Eliquis ($231) and Xarelto ($197) that took effect in 2026.
For Xarelto, the only generic rivaroxaban approved so far is the 2.5 mg tablet, which is for coronary or peripheral artery disease — not the 10, 15, or 20 mg doses used for AFib, DVT, and PE, which remain brand-only. For Eliquis, generic apixaban has been approved and a federal court set April 2028 as the earliest broad launch, though some settlement supply has reached pharmacies earlier and intermittently. Until generics are broadly available, most patients reduce cost through patient assistance programs, copay cards, or the Medicare-negotiated price.
No. Federal anti-kickback law prohibits using manufacturer copay coupons or savings cards if you have Medicare, Medicaid, or any other government insurance. Those coupons are only for people with commercial (private) insurance. Medicare beneficiaries instead lower costs through the Medicare-negotiated price (in effect for Eliquis in 2026), the Part D out-of-pocket cap, Medicare Extra Help (Low-Income Subsidy), or the manufacturer’s patient assistance program if they qualify.
Uninsured patients who meet income limits may qualify for free medication through the manufacturer patient assistance programs: the Bristol Myers Squibb Patient Assistance Foundation for Eliquis and Johnson & Johnson’s program for Xarelto. These programs provide the medication at no cost to eligible patients who are uninsured or underinsured and fall under their income thresholds. Commercially insured patients can use manufacturer copay cards to lower out-of-pocket costs, though these cannot be used with Medicare or Medicaid.
Both are direct oral anticoagulants that prevent clots, and both treat atrial fibrillation, DVT, and PE. The main practical differences are dosing and cost details. Eliquis (apixaban) is taken twice daily; Xarelto (rivaroxaban) is taken once daily and most doses are taken with food. Choice between them is a clinical decision based on kidney function, bleeding risk, other medications, and dosing preference. On cost, both have a Medicare-negotiated price effective 2026 ($231 Eliquis, $197 Xarelto), and generic availability is limited, so the cheaper option depends on your dose and insurance.
The most important risk with any anticoagulant is bleeding, since the medication reduces clotting. This can range from minor bruising and nosebleeds to more serious bleeding. Patients should report unusual bleeding, black or bloody stools, or severe headaches to their clinician. Both Eliquis and Xarelto carry boxed warnings that stopping the drug early raises the risk of clots and stroke, and that spinal procedures carry a bleeding risk. Never stop an anticoagulant without medical guidance.
Stopping an anticoagulant because you cannot afford it is dangerous. Both Eliquis and Xarelto carry an FDA boxed warning that stopping early increases the risk of blood clots and stroke. If cost is the barrier, talk to your clinician or pharmacist before skipping doses, and use the patient assistance, copay, or Medicare pathways first. A clinician can also discuss whether a different, lower-cost anticoagulant is appropriate, rather than going without treatment.
For most patients, direct oral anticoagulants like Eliquis and Xarelto offer practical advantages over warfarin: they do not require routine blood-level (INR) monitoring, have fewer food interactions, and have more predictable dosing. Warfarin remains the preferred option in specific situations, such as mechanical heart valves and certain kidney conditions, and it is far cheaper as a generic. The right choice is individual and made with your clinician.
How we reviewed this article:
SunnyPharma follows strict sourcing guidelines and relies on peer-reviewed studies, government agencies (FDA, CMS/Medicare, NIH), and medical associations (AHA, ACC, HRS). Dr. Chong’s review covers the clinical content; cost and program details are drawn from official Medicare and manufacturer sources. We use only credible, verifiable sources to ensure accuracy.
Read our editorial policy →Sources & References
- FDA — Eliquis (apixaban) Prescribing Information: accessdata.fda.gov
- FDA — Xarelto (rivaroxaban) Prescribing Information: accessdata.fda.gov
- 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: ahajournals.org
- Medicare — Drug Price Negotiation Program (negotiated prices effective 2026): cms.gov
- CMS — Draft CY 2026 Part D Redesign Program Instructions Fact Sheet (annual out-of-pocket threshold $2,100): cms.gov
- Medicare.gov — Costs for Medicare drug coverage (Part D) and the out-of-pocket cap: medicare.gov
- Bristol Myers Squibb Patient Assistance Foundation (Eliquis): bmspaf.org
- Johnson & Johnson Patient Assistance Foundation (Xarelto): jjpaf.org
- HHS Office of Inspector General — copay coupons and the federal anti-kickback statute: oig.hhs.gov
- NIH MedlinePlus — Apixaban: medlineplus.gov
- NIH MedlinePlus — Rivaroxaban: medlineplus.gov
- FDA Roundup, March 4, 2025 — first generic rivaroxaban (2.5 mg) approval for CAD/PAD: fda.gov
- CDC — Venous Thromboembolism (DVT/PE) information: cdc.gov
- KFF — Medicare drug price negotiation explainer: kff.org
- Medicare Rights Center — Extra Help (Low-Income Subsidy): medicareinteractive.org
- American Heart Association — Atrial Fibrillation and stroke prevention (patient education): heart.org