Medicare Coverage for Jardiance: A Look into Potential Benefits
Jardiance isn't just another pill for heart failure and type 2 diabetes; it's a key player in the complex world of Medicare, a drug that costs an eye-popping $7 billion from June 2022 to May 2023. So, what's the deal with this pricey med and how much will it set you back?
First off, most Medicare Part D prescription drug plans cover Jardiance, along with Medicare Advantage (Part C) plans with drug coverage, but here's the catch: whether you're a Part D or Part C enrollee, your out-of-pocket expense depends on the fine print of your plan.
The average beneficiary shelled out approximately $290 for Jardiance in 2022, but that's just an average. Your bill could be less or more.
For both Part D and Part C plans, each drug has its very own formulary, or list of covered medications. To get Jardiance coverage, you must enroll in a plan that includes it.
How much does Jardiance cost on Medicare?
Brace yourself: the out-of-pocket pharmacy cost for 30 tablets of Jardiance hovers around the ballpark of $600. But, as with everything Medicare, the actual cost you pay hinges on your insurance plan's tier for this drug, and potentially other factors.
You'll also face a monthly premium for Part C and D, with the premium varying depending on your plan. And, typically, there's a deductible you must meet before coverage kicks in. For Part D, the maximum deductible is set at $590 in 2025.
To help you navigate this tangled web, here's a glossary of handy Medicare terms:
- Out-of-pocket cost: The amount you're responsible for when Medicare doesn't cover the full expenses or offer coverage for a drug. This includes deductibles, coinsurance, copayments, and premiums.
- Premium: The money you pay each month for Medicare coverage.
- Deductible: An annual amount you must spend out-of-pocket before Medicare starts to contribute to your treatment costs.
- Coinsurance: The percentage of treatment costs you must self-fund after meeting your deductible. For Medicare Part B, this amounts to 20%.
- Copayment: A fixed dollar amount you pay for certain treatments under your insurance plan.
What tier is Jardiance with Medicare?
Every Medicare drug plan may have a different tier-placement for Jardiance, and the higher the tier, the pricier it might be after Medicare contributes its share.
To make your life easier, the Inflation Reduction Act of 2022 granted the Secretary of Health and Human Services the authority to negotiate new prices for Jardiance and nine other drugs, thus making these drugs more affordable.
Is there a cheaper substitute for Jardiance?
Unfortunately, there's no generic version of Jardiance yet available, so if you're looking for cheaper alternatives, you'll have to look elsewhere for treatments. But don't despair, financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) might offer some means to lower your expenses.
What about other diabetes or heart disease medications?
Jardiance belongs to a class of drugs known as SGLT2 inhibitors. These meds help your kidneys eliminate excess glucose from your body via urine.
Jardiance might help your heart and kidneys. Whether your plan covers Jardiance or any other heart disease drug or diabetes treatment depends on your specific plan, including:
- metformin
- nateglinide
- acarbose
- glyburide
Original Medicare's Part B might cover certain drugs, such as intravenous medications, typically ones a person cannot administer themselves.
[1] Medicare prescription drug plans and their coverage varies widely. It's crucial to research the specifics of your chosen plan before committing to enrollment.[2] Average Out-of-pocket cost for Jardiance users in 2022 may vary depending on the plan chosen and other factors.
- Jardiance is covered by most Medicare Part D prescription drug plans and Medicare Advantage (Part C) plans with drug coverage, but the out-of-pocket expense for an enrollee depends on the specifics of their plan.
- The out-of-pocket pharmacy cost for 30 tablets of Jardiance is around $600, but the actual cost an individual pays is influenced by their insurance plan's tier for this drug and potentially other factors.
- To get Jardiance coverage, one must enroll in a plan that includes it, as each drug has its own formulary, or list of covered medications, in both Part D and Part C plans.
- The Inflation Reduction Act of 2022 gave the Secretary of Health and Human Services the authority to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable.
- Unfortunately, there's no generic version of Jardiance, but financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) might help lower expenses for some enrollees.
