Key Takeaways

• PSHB and Medicare integration changed prescription coverage in 2026—know your plan’s formulary for Eliquis costs.
• Review plan documents and use annual enrollment to optimize your prescription coverage and out-of-pocket costs.

Facing big changes in federal health benefits can feel daunting, especially as prescription needs grow in retirement. Understanding what the FEHB to PSHB transition means for your Medicare drug coverage—especially if you take Eliquis—will help you plan smart and avoid costly surprises in 2026.

What Is Medicare PSHB Integration?

Background of PSHB transition

The Postal Service Health Benefits (PSHB) program became the new standard for eligible Postal Service retirees on January 1, 2025. The change was mandated by federal law to create a separate health benefits program specifically for USPS employees and retirees, moving them out of the Federal Employees Health Benefits (FEHB) program.

PSHB is designed to work alongside Medicare, especially for participants who are 65 or older and eligible for Medicare Part A and Part B. This integration is meant to streamline benefits and ensure consistent coverage for retirees shifting from FEHB to PSHB. It also aims to reduce confusion about which plan pays for what, including prescription drug expenses.

Key dates and milestones

• January 1, 2025: PSHB program officially launched; all eligible postal retirees and family members began coverage under PSHB if enrolled.
• 2025-2026: First full cycle of annual enrollment under the new PSHB structure.
• Ongoing: Medicare-eligible retirees must maintain both Medicare Part A and Part B to maximize their PSHB options, as many PSHB plans coordinate directly with Medicare.

How Does Medicare Cover Eliquis?

Medicare prescription drug basics

Medicare covers prescription drugs through Medicare Part D plans and some Medicare Advantage plans. If you take Eliquis—commonly prescribed for atrial fibrillation (AFib) or to reduce blood clot risk—coverage typically comes from a Medicare Part D prescription drug plan. Medicare does not cover prescription drugs under Part A (hospital) or Part B (medical) except in limited, specific circumstances.

Each Medicare drug plan has its own formulary, or list of covered drugs, and tiers that determine your share of the cost. Eliquis is often listed as a brand-name drug, which may place it in a higher cost tier.

Covered conditions and eligibility

Eliquis is covered for conditions like nonvalvular atrial fibrillation, deep vein thrombosis (DVT), and pulmonary embolism, assuming it is medically necessary and prescribed by your doctor. Eligibility depends on your Medicare Part D plan’s coverage rules, any required prior authorization, and step therapy or quantity limits. If you are covered through PSHB and have Medicare, your PSHB prescription coverage will work with Medicare to help pay for Eliquis if it is part of your plan’s approved list.

Will PSHB Affect Eliquis Costs?

Understanding PSHB formularies

Each PSHB plan’s formulary guides which medications are covered and at what cost. When FEHB transitioned to PSHB in 2025, some formularies updated their lists. Eliquis coverage and out-of-pocket costs may now differ from what you experienced under your former FEHB plan.

Formularies can change annually, so it’s wise to review the upcoming year’s plan documents to see if Eliquis is still listed and whether it remains in the same pricing tier. Some plans may use different preferred alternatives, prior authorization requirements, or step therapy protocols.

Potential out-of-pocket changes

The PSHB transition may affect your Eliquis costs if your new PSHB plan places Eliquis in a higher or lower cost-sharing tier or changes the co-payment requirements. Also, if your specific plan offers secondary coverage after Medicare pays, you could see differences in how much you owe at the pharmacy. Always check for updated cost-sharing, deductible, or copayment information each enrollment period, as your expenses may change from year to year.

Which Retirees Qualify for Eliquis Coverage?

Eligibility criteria explained

Retirees who qualify for Medicare and are enrolled in both Part A and Part B are typically eligible for a PSHB plan that coordinates benefits with Medicare. To have Eliquis covered, you must enroll in a Medicare Part D drug plan or select a PSHB plan that offers its own prescription coverage integrated with Medicare.

Eligibility for Eliquis coverage within PSHB depends on:

• Your enrollment in Medicare Part A and B
• Your PSHB or drug plan’s formulary including Eliquis
• Any clinical restrictions or prior authorization steps required by the plan

Enrolling in Medicare and PSHB

To ensure no gap in prescription drug coverage, enroll in Medicare as soon as you’re eligible—usually at age 65—or when you retire, if later. During your first PSHB open enrollment, select a plan that works with your Medicare coverage and includes your medications. If you miss the initial enrollment window or want to switch, use the annual PSHB open season.

What Should Retirees Check with Their Plan?

Plan documents to review

Before the start of each calendar year, review the following documents:

• Plan brochures and summary of benefits
• Formulary or drug list for your PSHB plan
• Evidence of Coverage (EOC)
• Any notices about changes to prescription drug coverage

These documents spell out which prescriptions are covered, under what circumstances, and your likely share of the cost.

Questions to ask your benefits office

Be proactive and contact your HR or benefits office if you’re unsure about coverage details. Consider asking:

• Is Eliquis included in my new PSHB plan’s formulary?
• What will my co-pay or coinsurance be for Eliquis in 2026?
• Is prior authorization required for Eliquis?
• How will Medicare and PSHB coordinate for my prescriptions?

Best Practices for Managing Costs in 2026

Cost comparison tools

Many PSHB plans and Medicare drug plans offer online cost comparison tools. Use these to estimate your out-of-pocket costs for Eliquis and any other medications. Compare plans side by side to see which option aligns with your prescription needs and budget.

Annual enrollment period strategies

Take advantage of the annual PSHB and Medicare open enrollment periods. Review your coverage every year to confirm that Eliquis is included and affordable. If necessary, switch to a plan that better suits your current health and drug needs. Keep an eye out for any plan updates or changes that affect formulary status or costs.

What If You Change Prescriptions?

Switching medications under PSHB

If your doctor recommends a new medication or you need to change from Eliquis to another drug, check both your PSHB plan and Medicare Part D plan for coverage details. Formularies differ, and alternate drugs may be in a different pricing tier.

Coordination with Medicare Part D

Your PSHB plan may serve as secondary coverage to Medicare Part D, covering some out-of-pocket costs after Medicare pays its share. Always update your plan with new prescriptions and consult your pharmacy or plan provider for guidance. Track any changes in covered drugs, and adjust your plan during open enrollment if needed.