TRICARE Eliquis Coverage & 2026 Copay Guide

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## Quick answer TRICARE covers Eliquis (apixaban) as a **brand-name formulary drug**, typically requiring a higher copay than generics. To get coverage, your doctor must prescribe it for an FDA-approved use, and you generally save the most money by using the TRICARE Pharmacy Home Delivery service or a military pharmacy.

## In detail Eliquis is a blood thinner (anticoagulant) used to prevent blood clots and reduce the risk of stroke. Under the TRICARE pharmacy benefit managed by Express Scripts, Eliquis is currently classified as a **Tier 2 (Brand-Name) formulary drug**.

### Coverage Requirements While Eliquis is on the TRICARE formulary, coverage is subject to specific clinical criteria: * **Medical Necessity:** In some cases, TRICARE may require you to try a generic alternative (like warfarin) first, unless your doctor submits a medical necessity form explaining why Eliquis is required. * **Prior Authorization:** Some specific uses may require prior authorization from Express Scripts to ensure the prescription meets FDA guidelines or Defense Health Agency (DHA) standards.

### 2026 Pharmacy Costs Costs for Eliquis depend on your beneficiary status (Group A or B) and where you fill the prescription. *Note: Active Duty Service Members (ADSMs) always pay $0 for covered prescriptions.*

### Regional Management While Express Scripts handles the pharmacy benefit Tiering, your regional contractor manages the clinical referrals that may lead to an Eliquis prescription: * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance * **Overseas:** International SOS

## Who this applies to * **Active Duty Service Members:** Fully covered with $0 copay, usually filled at Military Treatment Facilities (MTFs). * **Retirees and their Families:** Subject to standard Tier 2 brand-name copays. * **TRICARE For Life (TFL) Beneficiaries:** TRICARE acts as the primary payer for prescriptions; Eliquis is covered under the standard pharmacy benefit even though Medicare Part D is not required. * **TRICARE Reserve Select (TRS) / Retired Reserve (TRR):** Members pay the same retail and mail-order pharmacy rates as Group B retirees.

Common scenarios

**1. The Cost-Conscious Retiree** John is a retired Navy commander living in Florida (East Region). He takes Eliquis daily for atrial fibrillation. By switching from his local CVS to **TRICARE Pharmacy Home Delivery**, he reduces his cost from $43 every month to **$38 every three months**, saving over $360 a year in 2026 rates.

**2. The Active Duty Spouse** Sarah is married to an active duty soldier in California (West Region). She is prescribed Eliquis following hip surgery to prevent DVT. She fills her initial 30-day supply at a **network retail pharmacy** near the base and pays the **$43 brand-name copay** because she opted for the convenience of a local pharmacy over the base MTF.

**3. Filling Overseas** A retiree living in Germany (Overseas Region) must pay up-front for Eliquis at a local pharmacy. They then submit a claim to **International SOS** for reimbursement. They are reimbursed the cost of the drug minus the applicable brand-name copay.

## Related terms * **Formulary:** The list of brand-name and generic drugs covered by TRICARE. * **Tier 2 Brand-Name:** A category for drugs that have no generic equivalent but are not "Non-Formulary." * **Express Scripts:** The private contractor that manages TRICARE’s pharmacy network and home delivery. * **Prior Authorization:** A requirement for your doctor to get "pre-approval" before TRICARE will cover the medication. * **Anticoagulant:** A class of medication, popularly called "blood thinners," used to prevent or treat blood clots.

## Sources * TRICARE Formulary Search Tool: [https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/](https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/) * TRICARE Pharmacy Costs: [https://www.tricare.mil/Costs/PharmacyCosts](https://www.tricare.mil/Costs/PharmacyCosts) * Defense Health Agency (DHA) Pharmacy Operations: [https://health.mil/](https://health.mil/)