Eliquis and Xarelto are the two most-prescribed newer blood thinners, and patients comparing them usually want the same thing: which one will cost me less, and how do I get it affordably? Most comparison articles answer the clinical question (dosing, bleeding, kidney function) and stop. This page focuses on the part they skip — the 2026 cost and access picture, which is where the two drugs actually diverge. SunnyPharma is an independent health education platform; we do not sell medication and do not favor one drug over the other. The clinical choice is your prescriber’s; what we can map is the money.
Eliquis and Xarelto are similarly effective and similarly priced at retail (~$500–$820/mo). The real cost difference shows up under Medicare, where the 2026 negotiated prices are Xarelto $197 and Eliquis $231. With commercial insurance, both have a $10/month copay card; the uninsured can apply to each drug’s patient assistance program. Which is cheaper for you depends on your coverage, not the drug. The clinical choice belongs to your prescriber.
- Both are direct oral anticoagulants (Factor Xa inhibitors); studies show them similarly effective for stroke prevention in AFib and clot treatment.
- Dosing differs: Eliquis twice daily; Xarelto once daily (with food at higher doses) — a convenience-vs-consistency tradeoff your prescriber weighs.
- Cost is coverage-dependent. At retail they’re nearly identical; under Medicare 2026, Xarelto ($197) is slightly lower than Eliquis ($231).
- Both have a $10 copay card (commercial insurance only) and separate patient assistance programs for the uninsured.
- Some studies suggest Eliquis has a modestly lower bleeding rate; this is a clinical factor for your prescriber, not a cost factor.
- Never switch drugs for cost alone — it’s a medical decision; ask your prescriber to weigh cost and clinical fit together.
What Eliquis and Xarelto Have in Common
Before the differences, it helps to know how similar these two are. Both Eliquis (apixaban) and Xarelto (rivaroxaban) are direct oral anticoagulants (DOACs) in the same class — Factor Xa inhibitors. Both are approved to reduce stroke risk in nonvalvular atrial fibrillation, to treat and prevent deep vein thrombosis (DVT) and pulmonary embolism (PE), and to prevent clots after hip or knee replacement. Neither requires the routine blood monitoring or dietary restrictions that older warfarin does. Studies have found them similarly effective, with some evidence Eliquis may be marginally more so for certain outcomes. For most patients, both are reasonable, effective choices — which is exactly why cost and access often become the deciding factor.
What’s Different — the Clinical Side
These differences are your prescriber’s domain. We summarize them only so the comparison is complete; this is not advice to choose one over the other.
| Factor | Eliquis (apixaban) | Xarelto (rivaroxaban) |
|---|---|---|
| Typical dosing | Twice daily | Once daily (most indications) |
| Food requirement | With or without food | With food at 15 mg and higher |
| Bleeding profile | Studies suggest modestly lower major/GI bleeding | Slightly higher in some studies |
| Kidney function | May be preferred for reduced kidney function / older adults | Dose reduced in moderate impairment |
| Convenience | More consistent blood levels | Once-daily may aid adherence |
The once-daily-vs-twice-daily tradeoff is the one patients feel most: Xarelto’s single dose can be easier to remember, while Eliquis’s twice-daily schedule keeps blood levels steadier. Neither is “better” in the abstract — it depends on you, and your prescriber decides.
The Cost Comparison That Actually Matters
Here is where most comparison pages fall short. They say “both cost about the same” and move on — which was true until 2026, but isn’t the whole story now. Your cost depends almost entirely on your coverage type, and the two drugs now diverge under Medicare.
| Your coverage | Eliquis cost | Xarelto cost |
|---|---|---|
| Medicare (2026 negotiated) | $231/mo | $197/mo |
| Commercial insurance + copay card | as low as $10/mo | as low as $10/mo |
| Uninsured, retail cash | ~$500–$820/mo | ~$500–$820/mo |
| Uninsured + discount card | ~$150–$490/mo | ~$370–$490/mo |
| Income-eligible, PAP | Free if approved | Free if approved |
The headline: under Medicare, the 2026 negotiated prices were set separately for each drug, leaving Xarelto ($197) modestly cheaper than Eliquis ($231) — both far below their old list prices of $521 and $517. With commercial insurance, the difference essentially disappears because both copay cards bring you to about $10. If you’re uninsured, the drugs are close enough that assistance eligibility, not the drug, drives your cost.
The Part D cap applies to both. In 2026, Medicare Part D caps your total out-of-pocket prescription spending at $2,100 a year. Once you hit it, you pay nothing more for covered drugs — including either of these — for the rest of the year.
Access Routes Compared
Both drugs offer the same types of help, but through different manufacturers and separate applications. You apply to each program individually.
| Help type | Eliquis (Bristol Myers Squibb) | Xarelto (manufacturer program) |
|---|---|---|
| Manufacturer copay card | $10/mo, commercial insurance only | Copay card, commercial insurance only |
| Patient assistance (free med) | BMS Patient Assistance Foundation | Manufacturer patient assistance program |
| Medicare patients | Negotiated price + Extra Help | Negotiated price + Extra Help |
| Copay card + Medicare? | Not allowed (federal law) | Not allowed (federal law) |
The most important shared rule: neither copay card can be used if you have Medicare or Medicaid — that’s federal anti-kickback law, not a manufacturer choice. Medicare patients rely on the negotiated price, the Part D cap, and Extra Help instead. For the full Eliquis-side details, see our dedicated pages below.
Eliquis cost & access in depth: Coupon & Savings Card · Patient Assistance · On Medicare
Should You Switch From One to the Other to Save Money?
If you’re on the pricier option for your coverage, switching might look like an easy saving — but it’s a medical decision, not a financial one. The two drugs differ in dosing, food requirements, and bleeding and kidney considerations, and the right one for you depends on your health profile.
Do not switch or stop a blood thinner on your own. Both carry boxed warnings that stopping abruptly raises the risk of clots and stroke. If cost is driving the thought, tell your prescriber plainly — they can decide whether the cheaper drug is also clinically right for you, or lower the cost of your current drug through a copay card or patient assistance instead. Either way, the decision goes through your prescriber, not a price chart.
Generic Timelines — Eliquis vs Xarelto
Generics will eventually lower both drugs’ costs, but the timelines differ and are reported inconsistently online, so here is the careful version.
Generic Eliquis (apixaban): FDA-approved since 2019 but blocked from US pharmacies by patent settlements until at least April 1, 2028, per Bristol Myers Squibb and federal court rulings (subject to appeals). We cover what that means for your cost in the meantime on a dedicated page.
Generic Xarelto (rivaroxaban): the situation is more complicated and reported inconsistently across sources — some indicate limited generic availability, others a much longer patent horizon, and the picture varies by dose and indication. Rather than repeat a figure that conflicts between sources, we treat it in detail on its own page.
The full generic picture, drug by drug: Generic Eliquis → · Generic Xarelto →
Frequently Asked Questions
Is Eliquis or Xarelto cheaper?
It depends on your coverage. At full retail without insurance, both cost roughly $500 to $820 per month and are very close in price. Under Medicare, the 2026 negotiated prices differ: Xarelto is $197 per month and Eliquis is $231, both down sharply from list prices above $500. With commercial insurance, both offer a manufacturer copay card that can lower out-of-pocket cost to as little as $10 a month. The cheaper option for you is determined by your insurance type, not by the drug alone.
What is the main difference between Eliquis and Xarelto?
Both are direct oral anticoagulants (Factor Xa inhibitors) used to prevent stroke in atrial fibrillation and to treat or prevent blood clots (DVT and PE). The most practical difference is dosing: Eliquis is usually taken twice daily, while Xarelto is usually taken once daily and, at higher doses, must be taken with food. Some studies suggest Eliquis has a modestly lower rate of major and gastrointestinal bleeding, but the choice between them is a clinical decision for your prescriber.
Why does Medicare charge different prices for Eliquis and Xarelto?
Under the Inflation Reduction Act, Medicare negotiated prices directly with each manufacturer for the first time, effective January 2026. The two drugs were negotiated separately, producing different results: Xarelto at $197 and Eliquis at $231 per month. These are the prices Medicare pays; your actual out-of-pocket cost depends on your Part D plan, and the 2026 Part D cap limits your total yearly drug spending to $2,100.
Can I switch from Xarelto to Eliquis to save money?
Possibly, but it is a medical decision, not just a financial one. The two drugs differ in dosing frequency, food requirements, and bleeding and kidney considerations, so a switch should only be made by your prescriber. If cost is your reason for wanting to switch, tell your prescriber directly; they can weigh whether the cheaper option is also clinically appropriate for you, or help you lower the cost of your current drug through a copay card or patient assistance instead.
Is there a generic for Eliquis or Xarelto?
Generic apixaban (generic Eliquis) is FDA-approved but blocked from US pharmacies until at least April 1, 2028 by patent settlements. The Xarelto (rivaroxaban) generic situation is more complicated and reported inconsistently across sources, so we cover it in detail on a dedicated page rather than summarize it here. Neither generic changes the assistance options available to you today.
Which is safer, Eliquis or Xarelto?
Both are well-established and effective, and both carry bleeding risk as their main safety concern. Several studies suggest Eliquis may have a modestly lower rate of major and gastrointestinal bleeding, and it may be preferred for some older adults or patients with reduced kidney function. However, safety depends on your individual health profile, and only your prescriber can determine which is safer for you. This page compares cost and access, not clinical suitability.
Do Eliquis and Xarelto have the same patient assistance options?
They have similar but separate programs run by different manufacturers. Eliquis assistance comes through Bristol Myers Squibb (the BMS copay card and the BMS Patient Assistance Foundation). Xarelto assistance comes through its manufacturer’s own copay card and patient assistance program. The eligibility rules are comparable, including the rule that copay cards cannot be used by Medicare or Medicaid patients, but you apply to each drug’s program separately.
How we reviewed this article:
Karen Cooksey researched and wrote this comparison using the 2026 Medicare Drug Price Negotiation results (CMS, via the Center for Medicare Advocacy and HHS ASPE), the Bristol Myers Squibb Eliquis savings and assistance programs, and published clinical comparisons of apixaban and rivaroxaban. Dr. Aun-Yeong Chong, a cardiologist, reviewed the clinical content — including the framing that the drug choice is a prescriber decision and the caution against stopping or switching anticoagulation for cost — for accuracy. SunnyPharma is independent, accepts no pharmaceutical funding, sells no medication, and favors neither drug; this page compares cost and access only. Figures reflect 2026 program terms and are subject to change.
Read our editorial policy →Sources & References
- Centers for Medicare & Medicaid Services. Medicare Drug Price Negotiation Program — 2026 negotiated prices (Eliquis $231, Xarelto $197). Via Center for Medicare Advocacy; 2024–2026.
- U.S. HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE). Medicare Prices Negotiated for 2026 Compared to List and U.S. Market Prices. aspe.hhs.gov; 2024.
- Centers for Medicare & Medicaid Services. 2026 Medicare Part D out-of-pocket cap ($2,100). CMS.gov.
- Bristol Myers Squibb. Eliquis savings program & Patient Assistance Foundation. eliquis.bmscustomerconnect.com; bmspaf.org.
- Published clinical comparisons of apixaban (Eliquis) and rivaroxaban (Xarelto): dosing, bleeding profile, and renal considerations (DOAC class literature).