Does SelectHealth Cover Eliquis? A Woman's Complete Guide to Coverage, Costs, and What to Ask Your Doctor

Does SelectHealth Actually Cover Eliquis?

SelectHealth, the health plan affiliated with Intermountain Health and serving members primarily in Utah, Idaho, Nevada, and surrounding states, does list Eliquis on its formulary in most plan types. The short answer is yes, coverage exists, but the details depend on which SelectHealth product you have, what your prescriber lists as the diagnosis, and whether prior authorization is required.

Eliquis contains apixaban, a direct oral anticoagulant (DOAC) that the FDA has approved for five specific indications: reducing stroke risk in nonvalvular atrial fibrillation, treating deep vein thrombosis (DVT) and pulmonary embolism (PE), reducing recurrent DVT and PE after initial treatment, and prophylaxis following hip or knee replacement surgery. SelectHealth, like most commercial insurers, cross-references your diagnosis code against the approved indication before covering the drug.

What Tier Is Eliquis On SelectHealth Plans?

On most SelectHealth commercial plans, Eliquis sits at Tier 3 (preferred brand) rather than generic Tier 1 or Tier 2. A Tier 3 placement typically means a higher copay, often $50 to $100 for a 30-day supply after your deductible is met, compared with $10 to $20 for a generic.

Apixaban does not yet have an FDA-approved generic in the United States as of early 2025. Patent litigation has kept generic versions off the market, which is the main reason your plan cannot simply substitute a cheaper equivalent.

SelectHealth Medicare Advantage and Part D

If you are enrolled in a SelectHealth Medicare Advantage or standalone Part D plan, the formulary and cost-sharing structure differ from commercial coverage. Most Medicare Part D plans place Eliquis in a higher tier, and the Medicare coverage gap (the "donut hole") has been eliminated as of 2024 under the Inflation Reduction Act, which caps out-of-pocket Part D drug costs at $2,000 annually. For postmenopausal women managing atrial fibrillation, this cap change is clinically significant because Eliquis is often a long-term medication.

How to Find Out Your Exact Eliquis Benefit

Coverage details change every plan year, and SelectHealth publishes updated formularies each January. Here is a practical checklist for getting the real number before you fill your prescription.

Step 1: Look Up Your Plan's Formulary Online

Go to the SelectHealth member portal at selecthealth.org, log in, and search "apixaban" or "Eliquis" in the drug cost estimator. The tool shows your tier, your estimated copay based on your current deductible status, and whether prior authorization applies to your plan.

Step 2: Call the Pharmacy Benefits Number on Your Card

The member services number routes you to general coverage questions. The pharmacy benefits number on the back of your card connects you directly to the pharmacy benefit manager (PBM), which holds the specific tier and step-therapy rules for your formulary.

Step 3: Ask About Step Therapy

Some SelectHealth plans require step therapy, meaning your prescriber must document that you tried and failed (or have a contraindication to) warfarin before Eliquis is approved. If you are newly diagnosed with DVT after a long-haul flight or a postpartum complication, your prescriber can often bypass this requirement with a medical necessity letter stating that a DOAC is the standard of care for your situation.

Step 4: Request Prior Authorization If Needed

Prior authorization (PA) for Eliquis most commonly applies to the atrial fibrillation indication. Your prescriber's office submits the PA form. If it is denied, you have the right to an internal appeal, followed by an external independent review. Do not accept the first denial without appealing, since denial reversal rates for specialty drugs run roughly 40 to 60% on first appeal at major commercial insurers.

Eliquis and Women's Health: Why This Drug Is Not Just a "Heart Drug"

Most coverage articles treat Eliquis as a gender-neutral cardiac medication. That framing misses how often women encounter clotting disorders tied directly to female physiology. Below is a life-stage map of how blood clot risk and Eliquis use intersect with your hormonal status.

Reproductive Years and Hormonal Contraception

Combined estrogen-progestin contraceptives, including the pill, patch, and vaginal ring, increase VTE risk by a factor of three to four compared with non-users, according to data from the Danish cohort study published in the New England Journal of Medicine. Women who develop a DVT or PE while on hormonal contraception are typically advised to stop estrogen-containing methods and transition to a progestin-only or non-hormonal option.

If your prescriber starts you on Eliquis after a clot linked to the pill, you will need a new contraception strategy immediately. Progestin-only pills, the hormonal IUD, the copper IUD, and barrier methods are all compatible with Eliquis from a clot-risk standpoint.

PCOS and Clot Risk

Women with polycystic ovary syndrome (PCOS) carry a modestly elevated baseline VTE risk, partly due to insulin resistance, chronic low-grade inflammation, and, in some cases, higher estrogen exposure during stimulated cycles. A meta-analysis in Human Reproduction found that PCOS was associated with a 70 to 80% higher odds of VTE compared with controls. If you have PCOS and develop a clot, your prescriber may also screen for inherited thrombophilias such as Factor V Leiden or prothrombin gene mutation before deciding on long-term anticoagulation.

Trying to Conceive and the Fertility Window

If you are on Eliquis and want to become pregnant, you need a preconception plan. Apixaban crosses the placenta and carries significant fetal bleeding risk. The standard transition is from a DOAC to low-molecular-weight heparin (LMWH, typically enoxaparin), which does not cross the placenta and has decades of safety data in pregnancy. This transition should happen before conception, not after a positive test. Discuss timing with your hematologist and OB-GYN at least two to three months before you begin trying.

Perimenopause and Atrial Fibrillation

Atrial fibrillation (AFib) incidence rises significantly after age 50, and the menopausal transition itself appears to contribute independently of age. A study in JAMA Cardiology found that women who experienced early menopause (before age 45) had a significantly higher lifetime AFib risk. If you are in perimenopause and have palpitations, a formal heart rhythm evaluation is warranted before attributing symptoms to hormonal fluctuation alone.

For perimenopausal women with AFib and a CHA2DS2-VASc score of 2 or higher, current ACC/AHA guidelines recommend oral anticoagulation, and DOACs are preferred over warfarin for most patients without mechanical valves or severe mitral stenosis.

Menopause Hormone Therapy and Clot Risk

Oral menopausal hormone therapy (MHT/HRT) containing conjugated equine estrogen or oral estradiol increases VTE risk, with the Women's Health Initiative trial reporting a roughly doubling of DVT and PE risk in users of combined estrogen-progestin therapy. Transdermal estradiol carries a substantially lower thrombotic risk and is often preferred for women with prior VTE or elevated cardiovascular risk.

If you are postmenopausal, have had a previous clot, and need symptom relief, discuss transdermal MHT with your menopause specialist. Being on Eliquis does not automatically mean you cannot use hormone therapy, but the decision requires an individualized risk-benefit conversation.

Pregnancy and Lactation: The Most Important Section

Eliquis is contraindicated in pregnancy. This is not a soft caution. Apixaban crosses the placenta and is an anticoagulant with no established safe dose for the fetus. Animal reproductive studies showed fetal harm at clinically relevant doses, and there are insufficient human data to establish safety in any trimester, per the FDA prescribing information.

What to Use Instead During Pregnancy

The standard anticoagulant for pregnant women who require treatment or prophylaxis is LMWH, most commonly enoxaparin (Lovenox). Unfractionated heparin is an alternative in some scenarios. Neither crosses the placenta in clinically significant amounts. Warfarin is used in very limited pregnancy scenarios (mechanical heart valves in the second trimester) but carries fetal warfarin syndrome risk in the first trimester.

If you are diagnosed with DVT or PE during pregnancy, your obstetric and hematology teams will coordinate LMWH dosing using anti-Xa levels, dosed by weight and adjusted as pregnancy progresses.

Postpartum and the Clot-Danger Window

The postpartum period, particularly the first six weeks after delivery, carries the highest VTE risk of a woman's entire reproductive life. Risk is elevated three to five times above baseline during this window, according to a systematic review in the BMJ. Women who had a cesarean delivery, prolonged bed rest, preeclampsia, or BMI above 30 face the highest risk.

After delivery, anticoagulation decisions depend on whether you are breastfeeding. Limited data from small pharmacokinetic studies suggest that apixaban is detectable in breast milk, but the relative infant dose is low. The American College of Obstetricians and Gynecologists (ACOG) notes that data are insufficient to classify DOACs as safe during breastfeeding, and LMWH or warfarin remain the preferred options while nursing.

Contraception Requirement While on Eliquis

If you are of reproductive age and taking Eliquis, you need effective contraception. The drug's teratogenic risk makes an unplanned pregnancy a medical emergency requiring immediate specialist consultation. Given that combined hormonal methods increase clot risk, your options include:

• Progestin-only pill (no estrogen, minimal added thrombotic risk)
• Levonorgestrel or etonogestrel IUD
• Copper IUD
• Condoms or other barrier methods

Discuss your contraception choice with your prescriber at the same visit where Eliquis is initiated.

Who This Is Right For and Who Should Look at Alternatives

Women Who Are Good Candidates for Eliquis

Eliquis tends to be the right fit if you are in any of these situations:

• Postmenopausal woman with nonvalvular atrial fibrillation and a CHA2DS2-VASc score of 2 or higher
• Woman of any age with a newly diagnosed provoked or unprovoked DVT or PE who is not pregnant or breastfeeding
• Woman with a history of recurrent VTE on long-term anticoagulation who has tried warfarin and found the INR monitoring burdensome
• Woman undergoing hip or knee replacement who needs short-course thromboprophylaxis

Eliquis showed a 31% relative risk reduction in stroke compared with warfarin in the ARISTOTLE trial, with significantly less major bleeding. The ARISTOTLE trial enrolled both men and women, though women represented only about 35% of the cohort, a limitation worth naming.

Women Who Need a Different Approach

Eliquis is not appropriate if you are:

• Pregnant (use LMWH)
• Breastfeeding (use LMWH or warfarin per specialist guidance)
• Actively trying to conceive (transition to LMWH before conception)
• Diagnosed with antiphospholipid syndrome (APS), particularly triple-positive APS: the TRAPS trial in the New England Journal of Medicine showed that rivaroxaban (a similar DOAC) was inferior to warfarin in APS, and the same concern applies to apixaban
• Carrying a mechanical heart valve (DOACs are contraindicated; warfarin is required)

Managing Eliquis Costs at SelectHealth

The Bristol-Myers Squibb Copay Card

For commercially insured patients (not Medicare, not Medicaid), Bristol-Myers Squibb and Pfizer offer the Eliquis 360 Support copay card, which can reduce your out-of-pocket cost to as low as $10 per 30-day supply. This card applies to SelectHealth commercial plans. It does not work if your primary insurance is Medicare Part D or a federal health program.

Patient Assistance Programs

If you are uninsured or underinsured and do not qualify for the copay card, Bristol-Myers Squibb's patient assistance program (PAP) may provide Eliquis at no cost. Income thresholds apply, and the application is submitted through your prescriber's office.

90-Day Mail-Order Supplies

Most SelectHealth pharmacy plans charge a lower copay for 90-day supplies through their mail-order pharmacy partner. After your first fill at a retail pharmacy, ask your prescriber to send a 90-day supply prescription to SelectHealth's mail-order option. For a maintenance medication like Eliquis that you will likely take for months to years, this can save $50 to $150 per quarter.

Formulary Exception Requests

If SelectHealth places Eliquis on a non-preferred tier for your specific plan, your prescriber can request a formulary exception, citing clinical documentation that Eliquis is medically necessary for you specifically. The CMS formulary exception process is codified for Medicare plans, and commercial plans have analogous internal processes.

What to Say to Your Prescriber Before Your Next Refill

These are the specific questions that tend to reveal coverage and cost solutions:

1. "Can you confirm the diagnosis code on my prescription matches an FDA-approved Eliquis indication?"
2. "Does my SelectHealth plan require step therapy through warfarin first, and if so, can you document my clinical reason to skip that step?"
3. "Can you write me a 90-day supply so I can use mail-order pricing?"
4. "Is there documentation you can submit for prior authorization if SelectHealth requires it?"
5. "Given my [contraception/fertility/menopause] status, is Eliquis still the right anticoagulant for me right now?"

The fifth question is the one most women do not think to ask. Your hormonal status genuinely changes whether a DOAC, LMWH, or even warfarin is the best fit for your stage of life.

The Evidence Gap: What We Do Not Know About Eliquis in Women

Women have been under-represented in major anticoagulation trials. In ARISTOTLE, women were only 35% of participants. In AMPLIFY, the VTE treatment trial that compared apixaban with enoxaparin-warfarin, sex-disaggregated subgroup data showed similar efficacy in women and men, but the trial was not powered to detect female-specific differences in bleeding outcomes at different body weights or hormonal exposures.

Specifically, we do not have high-quality prospective data on:

• Optimal apixaban dosing in women with very low body weight (under 50 kg), who may have higher drug exposure
• Eliquis pharmacokinetics across the menstrual cycle, where estrogen and progesterone fluctuations theoretically could alter drug metabolism
• Long-term outcomes in women with PCOS-related VTE managed on apixaban

Where we lack direct evidence, clinicians extrapolate from the general DOAC pharmacology data and from smaller observational studies. This article follows that same honest framing: the sex-specific sections above reflect current clinical reasoning, not randomized controlled trial data in all cases.