Medicaid programs in every state have received one million free prescriptions of the blood thinner Eliquis since a drugmaker’s pricing deal with Washington took effect, the White House said this week. The prescriptions cost the programs nothing to fill because Bristol Myers Squibb agreed months ago to hand the pills to state Medicaid programs at no charge rather than bill for them like any other prescription drug. It is one thread of a wider push to bring so-called most-favored-nation prices into Medicaid, and it raises a narrower, more useful question for a Medicaid household managing a blood thinner: what actually changed, and does it reach the pharmacy counter.
How Bristol Myers Squibb’s Deal Turned Into a Million Free Refills
Eliquis (apixaban) is the nation’s most-prescribed oral blood thinner, taken daily by people with atrial fibrillation to lower their risk of stroke and by patients recovering from blood clots in the legs or lungs. Bristol Myers Squibb announced an agreement with the federal government in December 2025 to supply Eliquis to the Medicaid program for free starting January 1, 2026, paired with a separate pledge to donate more than seven tons of the drug’s raw ingredient to a national supply reserve and three years of tariff relief for the company in return.
That agreement sits inside a larger federal structure. The Centers for Medicare & Medicaid Services opened its GENEROUS Medicaid drug payment model in November 2025, built to funnel most-favored-nation-style manufacturer rebates and free supply into state Medicaid budgets rather than leave each state to negotiate alone. By September 18, 2026, the White House said the arrangements had delivered one million free Eliquis prescriptions to Medicaid, brought 26 manufacturers on board covering about 89 percent of the branded drug market, and were projected to save Medicaid $64.3 billion over the next decade.
Free download: What to ask the plan, the prescriber and the pharmacy, when to request an exception, and which records to keep. Download the free prescription coverage checklist.
What “Free” Actually Means at the Medicaid Pharmacy Counter
“Free” in this deal describes what happens between the drug company and the state, not a new discount card handed to a patient. Under the ordinary Medicaid Drug Rebate Program, a state pays a pharmacy for a filled prescription and later collects a rebate from the manufacturer. Under this arrangement, Bristol Myers Squibb removes its own price from that transaction for Eliquis, so the state’s Medicaid program carries no cost for the medicine itself. The pharmacy still processes the claim the way it always has, through the enrollee’s existing Medicaid pharmacy benefit, with no separate application, no new drug card and no waiting period tied to the manufacturer’s agreement.
For most Medicaid enrollees, out-of-pocket costs at the counter were already small before this deal — states set their own modest copay rules for prescription drugs, and several waive them entirely for certain drug classes or populations. What the arrangement changes is who absorbs the cost of the medicine: instead of the state Medicaid program, and ultimately state and federal taxpayers, paying for each Eliquis fill, the manufacturer now supplies the drug without charge. That is the mechanism behind the million-prescription figure — it counts fills the program did not have to pay for, not a rebate mailed to a household.
Who Qualifies — and Why Nobody Has to Apply for It
Qualifying for the free supply does not require a separate application, income test or enrollment step beyond what already applies: a person needs to be covered by their state’s Medicaid program and hold a prescription for Eliquis written for one of its approved uses. That covers adults with nonvalvular atrial fibrillation taking the drug to lower stroke risk, patients being treated for a blood clot in the leg or lung, people working to prevent a clot from recurring after an earlier one, and patients recovering from hip or knee replacement surgery. Anyone already filling an Eliquis prescription through Medicaid should already be receiving the benefit automatically, because the change happens on the manufacturer’s and the state’s side of the transaction rather than on any form the patient submits.
The deal does not extend to people covered by Medicare, an employer plan or private insurance, who pay for Eliquis under separate pricing rules outside this Medicaid-specific arrangement. It also does not cover every drug Medicaid pays for. The free-supply terms apply to Eliquis specifically, under Bristol Myers Squibb’s own agreement, while the other manufacturers participating in the broader Medicaid pricing push have negotiated their own separate rebate or discount terms for their own products. The Council of Economic Advisers’ $64.3 billion savings estimate reflects that whole basket of deals across all 50 state Medicaid programs, not the Eliquis agreement alone.
What a Manufacturer’s Deal Leaves to the Patient
A rebate or free-supply agreement changes what a state Medicaid program pays a drug company. It does nothing for the separate moment when a pharmacy claim gets flagged, a plan swaps a covered brand for a different tier, or a prior authorization lapses right before a refill is due. Those are the gaps that leave a household scrambling for the right form days before a bottle runs empty, and Medicare enrollees face their own version of that same scramble as coverage rules shift year to year.
The Medicare Cost & Coverage Protection Kit runs through the prior-authorization appeal steps alongside a medication and cost tracker, so a denied claim or a shifted drug tier has a documented next move instead of a missed dose.
Open the medication and cost tracker in The Medicare Cost & Coverage Protection Kit.
AI-assisted research and drafting; reviewed by an editor.
