Provider Briefing: Apixaban Supply in 2026

Apixaban (Eliquis) remains one of the most prescribed anticoagulants in the United States, with over 30 million prescriptions dispensed annually. The entry of multiple generic manufacturers into the market in late 2024 and early 2025 was expected to improve both access and affordability. While this is broadly happening, the transition has introduced supply inconsistencies that are directly affecting patient adherence and clinical outcomes.

This briefing summarizes the current supply landscape, prescribing implications, and practical resources for providers managing patients on Apixaban.

Timeline: How We Got Here

Brand-name Eliquis, manufactured by the Bristol-Myers Squibb/Pfizer alliance, was one of the highest-revenue drugs globally, exceeding $10 billion in annual U.S. sales at its peak. Patent litigation settlements in the early 2020s paved the way for generic entry:

• Late 2024: First generic Apixaban products received FDA approval and entered the market
• Early 2025: Multiple additional generic manufacturers launched, increasing competition
• Mid-2025 through 2026: Generic market share has grown steadily, but supply chain stabilization remains ongoing

The transition from a single-source brand product to a multi-manufacturer generic landscape is inherently disruptive. Wholesaler contracts are being renegotiated, pharmacy buying groups are shifting preferred products, and some manufacturers have experienced production ramp-up delays.

Prescribing Implications

The supply inconsistencies create several clinical concerns that providers should be aware of:

Adherence Gaps

Patients unable to fill their Apixaban prescription on time may experience unintended gaps in anticoagulation. For patients with atrial fibrillation, even a few days without anticoagulation significantly elevates stroke risk. The boxed warning on Apixaban specifically addresses the danger of premature discontinuation.

Patient Confusion About Generics

Patients switching from brand Eliquis to generic Apixaban — or between different generic manufacturers — often express concern about differences in pill appearance, color, or markings. Providers and clinical staff should proactively counsel patients that all FDA-approved generic versions are bioequivalent and therapeutically interchangeable.

Formulary and Prior Authorization Variability

Insurance formularies are in flux as plans negotiate generic pricing and manufacturer preferences. Some plans have moved generic Apixaban to Tier 1 or Tier 2, while others still require brand Eliquis with manufacturer coupons. Prior authorization requirements have generally decreased but persist in some Medicaid and Medicare Advantage plans.

Current Availability Picture

As of early 2026, the Apixaban supply situation can be characterized as follows:

• Brand Eliquis: Generally available through standard distribution channels, though at significantly higher cost ($500–$600/month cash price)
• Generic Apixaban: Available from multiple manufacturers (including Aurobindo, Micro Labs, Apotex, and others), but specific manufacturer availability varies by region and pharmacy. Cash prices range from $30–$80/month.
• FDA Shortage Status: Apixaban is not currently listed on the FDA drug shortage database. However, localized supply gaps persist, particularly for specific NDCs.

Providers should be aware that a patient reporting difficulty finding Apixaban may be experiencing a manufacturer-specific or pharmacy-specific issue rather than a true market-wide shortage.

Cost and Access Considerations

The economic landscape for Apixaban has improved significantly with generic entry:

• Commercial insurance: Generic Apixaban copays typically range from $10–$50/month. Brand Eliquis with the manufacturer savings card can be as low as $10/month for eligible patients.
• Medicare Part D: Patients in the coverage gap may still face significant out-of-pocket costs, though generic pricing has reduced this burden. The Inflation Reduction Act's $2,000 out-of-pocket cap (effective 2025) provides additional protection.
• Uninsured patients: Generic Apixaban at $30–$80/month represents a dramatic improvement from the $500+/month brand price. Patient assistance programs from Bristol-Myers Squibb and Pfizer remain available for those who qualify.

For detailed patient-facing savings information, providers can direct patients to our guide on saving money on Apixaban.

Tools and Resources for Providers

Several tools can help you and your clinical staff support patients experiencing supply difficulties:

Medfinder for Providers

Medfinder offers real-time pharmacy availability data that your staff can use to help patients locate Apixaban in stock. Rather than telling patients to "call around," you can direct them to a specific pharmacy that has their medication available right now.

Alternative Prescribing

When supply gaps are expected to be prolonged, consider whether a therapeutic alternative is appropriate for your patient. The major DOAC alternatives include:

• Rivaroxaban (Xarelto): Factor Xa inhibitor; once-daily dosing with food; generic available
• Dabigatran (Pradaxa): Direct thrombin inhibitor; twice-daily; specific reversal agent (Idarucizumab) available; generic available
• Edoxaban (Savaysa): Factor Xa inhibitor; once-daily; requires initial parenteral anticoagulation for VTE treatment
• Warfarin (Coumadin): Vitamin K antagonist; requires INR monitoring; widely available and very inexpensive ($4–$10/month)

See our clinical overview of alternatives to Apixaban for additional details.

Bridge Therapy Considerations

For patients who will experience a gap in oral anticoagulation, bridge therapy with low-molecular-weight heparin (LMWH) such as Enoxaparin may be appropriate depending on the patient's thromboembolic risk profile. Consult current ACC/AHA guidelines for bridging recommendations specific to your patient's indication.

Looking Ahead

The Apixaban generic market is expected to continue maturing through 2026 and into 2027. Key trends to watch:

• Price compression: As more manufacturers enter and compete, generic prices should continue to decline
• Supply stabilization: Manufacturing capacity is catching up with demand, and wholesale distribution patterns are normalizing
• Formulary optimization: Insurance plans will increasingly prefer generic Apixaban, simplifying prescribing and reducing prior authorization burden

In the interim, proactive communication with patients about potential supply challenges — and having a documented plan for therapeutic substitution — will minimize adherence gaps and associated thromboembolic risk.

Final Thoughts

The transition to generic Apixaban is ultimately a positive development for patients and the healthcare system. Lower prices and multiple manufacturers mean better long-term access and affordability. But the short-term disruptions are real and require provider awareness and action.

Encourage your patients to use Medfinder to track down their medication. Counsel them on the bioequivalence of generic products. Have a documented alternative plan in each patient's chart. And most importantly, reinforce the critical message: never stop anticoagulation therapy without medical guidance.

For a provider-specific guide on helping patients find their medication, see our article on how to help your patients find Apixaban in stock.