Medicare Coverage for Jardiance: A Question Answered
Medicare's go-to med for heart failure and type 2 diabetes is Jardiance. Most Part D plans include coverage for this little wonder. But, like any Medicare plans, it's all about the plan you've got. Part C plans with drug coverage should also cover it, but it's all in the fine print.
From the June of 2022 to May of 2023, Medicare splashed out a cool $7 billion on Jardiance. For the enrollees, that meant an average out-of-pocket cost of around $290 in 2022.
Every drug doled out by Medicare has a formulary, a list of covered meds. To get coverage, you need to enroll in a prescription drug plan that lists Jardiance in its formulary.
What's the final bill for Jardiance on Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is roughly $600, dependent on the pharmacy in question. The actual amount you'll pay depends on your insurance plan's tier for this drug and the usual coinsurance, premiums, and deductibles. Oh, by the way, Part C and D isn't free, you've gotta pay for that monthly premium too.
Generally, you'll have a deductible to meet before coverage kicks in, but don't freak out—the max for Part D in 2025 is $590. And, don't worry, there's a cap on what you'll pay out of pocket for all drugs with Part D: $2,000 annually.
Terms to Know
- Out-of-pocket cost: Money paid when Medicare doesn't cover it all. Costs include deductibles, coinsurance, copayments, and premiums.
- Premium: Monthly fee for Medicare coverage.
- Deductible: Annual amount you must pay out of pocket before Medicare starts funding.
- Coinsurance: The percentage of treatment costs you must self-fund. For Medicare Part B, it's 20%.
- Copayment: Fixed amount you pay for treatments under insurance. Generally applies to prescription drugs.
Which Tier Lands Jardiance with Medicare?
Each plan puts Jardiance in a different tier, and the higher the tier, the more it costs when coverage ends. The Inflation Reduction Act of 2022 allowed the Secretary of HHS to negotiate new prices for Jardiance and nine other drugs, making them more affordable for enrollees.
Can I Score Jardiance for Free?
Cut your Jardiance costs with financial aid programs like:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is There a More Affordable Swap for Jardiance?
Generic drugs usually cost less than brand-name ones. However, Jardiance isn't available as a generic version, yet.
Learn more: What is the Medicare drug list?
How Can I nab Jardiance for Lesser Bucks?
Various financial assistance programs can help lower your Jardiance expenses. Get details on Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
Is There a Cheaper Swap for Jardiance?
Other SGLT2 inhibitors might be a more affordable alternative for Jardiance. Consult your practitioner to evaluate other possibilities.
Learn more: Jardiance (empagliflozin) and cost
Which Diabetes or Heart Meds are Approved?
Jardiance falls under a group of drugs called SGLT2 inhibitors. These babies work in the kidneys to push excess sugar out of the body via pee.
Jardiance might be beneficial for the heart and kidneys. Whether your plan covers Jardiance or other diabetes or heart meds depends on the specific plan, and that's the case for diabetes treatments like:
- Metformin (Glumetza)
- Nateglinide (Starlix)
- Acarbose (Precose)
- Glyburide (DiaBeta, Micronase, Glynase)
Consider that Original Medicare's Part B may cover certain drugs, like IV medications, that typically can't be self-administered.
Learn more: Diabetes medications and Medicare
Learn more: Does Medicare cover cardiovascular disease?
In 2022, the out-of-pocket cost for a 30-tablet supply of Jardiance can be approximately $600, though this can vary based on an individual's Medicare plan and pharmacy. However, for Medicare enrollees, the actual cost paid is often lower due to coverage, with an average of around $290 in 2022. (Out-of-pocket cost, Jardiance)
Individuals must enroll in a Medicare prescription drug plan that includes Jardiance on its formulary to access coverage. (Formulary, Jardiance coverage)
The Inflation Reduction Act of 2022 allows for the negotiation of new, more affordable prices for Jardiance and other drugs. (Inflation Reduction Act, Jardiance prices)
Financial aid programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) may help lower the cost of Jardiance for eligible individuals. (Financial aid programs, Jardiance cost reduction)
