Drugs Q & A

Why Is Eliquis So Expensive? 5 Top Reasons

In recent years, the rising cost of prescription medications has become a pressing concern for individuals, healthcare providers, and policymakers alike. Among these medications, Eliquis, a widely prescribed anticoagulant, has garnered attention for its steep price tag. With its effectiveness in preventing strokes and reducing the risk of blood clots, Eliquis has become a crucial medication for millions of patients worldwide.

However, its affordability remains a significant challenge for many. So, why exactly is Eliquis so expensive?

What is Eliquis?

Eliquis, generically known as apixaban, is classified as a direct oral anticoagulant (DOAC). It works by inhibiting specific clotting factors within the blood, which effectively prevents the formation of blood clots. This unique pharmacological characteristic renders Eliquis highly effective in mitigating the risk of stroke among patients afflicted with atrial fibrillation—an irregular heart rhythm that predisposes individuals to clot formation. Additionally, Eliquis is instrumental in the prevention and treatment of blood clots in patients undergoing hip or knee replacement surgery.

As a direct oral anticoagulant, Eliquis offers several advantages over traditional anticoagulant therapies, such as warfarin. Unlike warfarin, which necessitates regular monitoring and dose adjustments, Eliquis exhibits predictable pharmacokinetics and does not require routine blood monitoring. This convenience factor enhances patient compliance and reduces the burden associated with managing anticoagulant therapy.

Moreover, Eliquis boasts a favorable safety profile, with reduced risks of major bleeding compared to warfarin. This attribute is particularly advantageous for elderly patients and those with comorbidities who are at increased risk of bleeding complications. Additionally, Eliquis demonstrates a lower propensity for drug interactions compared to older anticoagulants, minimizing the likelihood of adverse reactions when used concomitantly with other medications.

The efficacy and safety profile of Eliquis has been validated through extensive clinical trials, including the landmark ARISTOTLE study, which demonstrated its superiority over warfarin in preventing stroke and systemic embolism, with significantly lower rates of major bleeding. These compelling clinical data have solidified Eliquis’s position as a first-line therapy for stroke prevention in patients with atrial fibrillation and as a preferred option for thromboprophylaxis in orthopedic surgery.

Furthermore, Eliquis offers the convenience of once-daily dosing, simplifying medication regimens and enhancing patient adherence—an essential factor in achieving optimal therapeutic outcomes. Its rapid onset of action and relatively short half-life allow for prompt anticoagulation effects and quick recovery following discontinuation, facilitating perioperative management in surgical patients. However, due its price tag, buying Eliquis remains a significant challenge for many.

How much does Eliquis cost?

The cost of Eliquis oral tablet 5 mg typically ranges between $635 to $779.34 for a supply of 60 tablets, varying based on the pharmacy you visit. Despite its efficacy and widespread use, the high cost of Eliquis can pose a financial burden for patients, particularly those without adequate insurance coverage or financial assistance. As a result, affordability remains a significant concern, prompting calls for pricing reforms and greater transparency in the pharmaceutical industry.

Reasons Why Eliquis is so Expensive

Research and Development Costs

One of the primary factors contributing to the high cost of Eliquis is the extensive research and development (R&D) process undertaken by its manufacturer, Bristol Myers Squibb and Pfizer. Developing a new medication involves substantial investments in scientific research, clinical trials, and regulatory approvals, which can span over a decade and cost billions of dollars. Additionally, the costs associated with failed drug candidates during the development phase further inflate the expenses borne by successful drugs like Eliquis.

Patent Protection and Market Exclusivity

Upon successfully developing a new medication, pharmaceutical companies are granted patent protection, which allows them to exclusively market and sell the drug for a certain period, typically 20 years from the date of filing. This exclusivity ensures that the company can recoup its R&D investments and generate profits before generic versions enter the market. For Eliquis, the patent protection granted to Bristol Myers Squibb and Pfizer has enabled them to maintain a monopoly on the drug, thus keeping prices high.

Marketing and Distribution Costs

In addition to R&D expenses, pharmaceutical companies allocate significant resources to marketing and distributing their products. This includes advertising campaigns, sales representatives, and distribution networks aimed at promoting the medication to healthcare providers and patients. While these efforts are essential for raising awareness and driving sales, they also contribute to the overall cost of the drug, which is ultimately passed on to consumers and healthcare systems.

Regulatory Hurdles and Compliance

Another aspect influencing the cost of Eliquis is the stringent regulatory requirements imposed by health authorities such as the Food and Drug Administration (FDA) in the United States and the European Medicines Agency (EMA) in Europe. Pharmaceutical companies must adhere to strict guidelines throughout the drug development process, from preclinical studies to post-market surveillance, to ensure safety, efficacy, and quality. Complying with these regulations adds to the expenses associated with bringing a drug to market and maintaining its approval status.

Healthcare System Dynamics

Beyond the pharmaceutical industry’s practices, broader healthcare system dynamics also play a role in the pricing of medications like Eliquis. In the United States, where the pharmaceutical market operates under a predominantly private insurance system, drug prices are subject to negotiation between manufacturers, insurers, pharmacy benefit managers (PBMs), and other stakeholders. The lack of price regulation or negotiation mechanisms often leads to higher drug prices compared to other countries with more centralized healthcare systems.

Any Hope for Patients?

Despite its high cost, manufacturers of Eliquis and other expensive medications often offer patient assistance programs to help alleviate the financial burden for eligible individuals. These programs may provide financial assistance, Eliquis coupons co-pay support, or access to free medication for patients who meet certain criteria, such as income level or insurance status. While these initiatives can make Eliquis more affordable for some patients, they do not address the underlying issues contributing to its high cost.

In addition, the introduction of generic alternatives can exert downward pressure on drug prices by increasing competition in the market. However, for complex medications like Eliquis, developing generic equivalents involves overcoming regulatory hurdles and patent challenges, which can delay market entry. As a result, branded drugs like Eliquis may maintain their high prices until generic competition becomes available.


The high cost of Eliquis reflects a combination of factors, including extensive R&D expenses, patent protection, marketing and distribution costs, regulatory compliance, and healthcare system dynamics. While this poses challenges for patients and healthcare systems, it also underscores the complexities of drug development and pricing in the pharmaceutical industry. Addressing the affordability of medications like Eliquis requires a multifaceted approach involving collaboration among stakeholders, policy reforms, and innovation in drug development and pricing models. Ultimately, ensuring access to essential medications at reasonable prices is essential for promoting public health and well-being.


Joan David-Leonhard

Joan David Leonhard is a recent Pharm.D graduate with a strong passion for the pharmaceutical industry and a particular interest in pharmaceutical media and communication. Her brief internship experience includes roles in pharmacy where she built strong patient-pharmacist relationships and a pharmaceutical media internship where she actively contributed to drug information articles, blog posts, social media engagement, and various media projects.
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