Medicare Coverage for Jardiance: A Look at Benefits
Taking a Deep Dive into Medicare and Jardiance: Costs, Coverage, and Savings
Jardiance, a popular medication for managing type 2 diabetes and heart failure, is typically covered by both Medicare Part D prescription drug plans and Medicare Advantage (Part C) plans with drug coverage, but this depends on the specific plan in question.
Jardiance Cost Breakdown with Medicare
- Annual Deductible (2025): Up to $590 (must be met before coverage begins)[1][2].
- Monthly Premiums (Part D): Varies by plan and insurer, but the average Part D premium in 2025 is projected at approximately $46.50 per month[2].
- Coinsurance/Copayment: Varies by plan and formulary tier. The cost for Jardiance may be significantly higher if it is placed on a non-preferred brand tier[1][4].
- Out-of-pocket (OOP) Pharmacy Cost (retail price): Around $600 for a 30-day supply (before insurance)[1].
- Annual OOP Cap: Starting in 2025, annual OOP costs for all Part D drugs are capped at $2,000[1][2].
Medicare Advantage (Part C) Plans
- Coverage: If the Medicare Advantage plan includes Part D, Jardiance is likely covered (verify each plan’s formulary)[1].
- Copays and Deductibles: Similar to standalone Part D plans, but premiums, copays, and deductibles can vary significantly by plan and insurer[1].
- Formulary Tier Placement: Tier placement affects copay amounts, with specialty or non-preferred tiers usually resulting in higher costs[4][5].
Reducing Your Costs: Financial Assistance Options
Medicaid:
If you are eligible for both Medicare and Medicaid (“dual eligible”), Medicaid can help cover most or all Medicare Part D cost-sharing, including deductibles, copays, and coinsurance[1][4].
Extra Help (Low-Income Subsidy):
- Eligibility: For individuals with limited income and resources.- Impact: Significantly reduces or eliminates Part D premiums, deductibles, copays, and coinsurance. May cap copays at a few dollars per prescription[1][4].- Limits: Extra Help does not apply to non-Part D drugs or drugs not covered by your plan[4].
State Pharmaceutical Assistance Programs (SPAPs):
- Role: State-run programs designed to help eligible residents with Medicare Part D costs.- Impact: Varies by state, but can further reduce deductibles, premiums, and copays, or provide additional financial support beyond Extra Help and Medicaid[1].
Cost & Assistance Impact Summary Table
| Plan Type | Deductible (2025) | OOP Cap (2025) | Typical Jardiance Copay | Medicaid Impact | Extra Help Impact | SPAP Impact ||-------------------|-------------------|----------------|-------------------------|---------------------|---------------------|---------------------|| Part D | Up to $590 | $2,000 | Varies (formulary tier) | Reduces/eliminates | Reduces/eliminates | Varies by state || Part C (with D) | Up to $590 | $2,000 | Varies (formulary tier) | Reduces/eliminates | Reduces/eliminates | Varies by state |
In a Nutshell
- Jardiance is generally covered by Medicare Part D and Medicare Advantage plans, but out-of-pocket costs depend on the plan, formulary tier, and whether deductibles are met[1][4].
- Financial assistance programs like Medicaid, Extra Help, and SPAPs can significantly lower or even eliminate these costs for eligible beneficiaries[1][4].
- Always check your plan’s formulary to confirm Jardiance’s tier placement and any prior authorization requirements[4].
- Enrollees in Medicare Part D prescription drug plans can expect an annual deductible of up to $590 before coverage begins in 2025, but the average monthly premium is projected to be approximately $46.50.
- The cost for Jardiance in these plans may be significantly higher if it is placed on a non-preferred brand tier, which can lead to higher coinsurance or copay amounts.
- Medicare Advantage (Part C) plans that include Part D coverage are likely to cover Jardiance, but deductibles, copays, and premiums can vary significantly by plan and insurer.
- Financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can help eligible beneficiaries significantly lower or even eliminate out-of-pocket costs for Jardiance.
- In science-backed health-and-wellness focus, a combination of proper diet, exercise, and medications like Jardiance can effectively manage type 2 diabetes and heart failure, with the added benefit of potential cost savings through Medicare and financial assistance programs.
