Medicare Coverage for Jardiance: An Explanation
Jumpin' Jardiance: A Guide to Government-Funded Diabetes and Heart Failure Treatment
No sugarcoating, just the facts!
Jardiance is a medicine prescribed to treat heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans include coverage for Jardiance. Part C plans, though, with drug coverage, may or may not cover it - it all depends on the specific plan.
From June 2022 to May 2023, Medicare pumped a whopping $7 billion into Jardiance, with enrollees forking over around $290 out of pocket in 2022.
Every Medicare drug has a formulary – a list of covered medications. To get Jardiance coverage, you've got to sign up for a prescription plan that includes it on the formulary list.
What's the Damn Cost of Jardiance on Medicare?
According to Optum Perks, the pharmacy price for 30 Jardiance tablets usually hovers around $600, but this can vary depending on the pharmacy. Your out-of-pocket cost will mainly fall on how your insurance plan arranges its drug tiers. Plus, you gotta pay a monthly premium for both Part C and Part D plans. These premiums can vary wildly, depending on your plan.
Besides your coinsurance, you'll typically have to shell out a deductible before Medicare coverage begins. The maximum deductible for Part D in 2025 is $590. And hey, watch out for the coverage gap (also known as the "donut hole"), where you'll be responsible for a larger portion of the drug cost. Fortunately, there's an annual cap on your total drug spending with Part D – it maxes out at $2,000.
Medicare Terms Decoded
- Out-of-pocket cost: The amount you gotta cough up when Medicare doesn't cover the full bill or simply refuses to pay. Costs can involve deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee you pay for Medicare coverage.
- Deductible: An annual amount you must pay before Medicare starts covering your treatments.
- Coinsurance: The percentage of treatment costs you need to cover yourself. For Medicare Part B, it's 20%.
- Copayment: A fixed dollar amount you'll pay for certain treatments when you have insurance. In most cases, this applies to prescription drugs.
Tier Dilemma: Where Does Jardiance Hang Out?
Jardiance's position in the Medicare drug tier can vary among plans, and a higher tier can mean higher expenses. The Inflation Reduction Act allowed the Secretary of Health and Human Services (HHS) to employ their bargaining skills to negotiate new prices for Jardiance (and several other pricey medications), making these drugs cheaper for insurance holders.
How Can I Grab Jardiance For Free?
Want to save some cash on Jardiance? You can reduce your expenses through various financial assistance programs. These include:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is There a Cheaper Sub for Jardiance?
Unfortunately, Jardiance isn't available as a generic version. But, hey, if you're looking to save a buck, don't forget that generic drugs are usually cheaper than their brand-name counterparts.
Other Diabetes and Heart Disease Treatments – On the Coverage List?
Jardiance falls under the class of drugs called SGLT2 inhibitors. These drugs work in the kidneys to flush excess sugar from the body through urine, potentially benefiting your heart and kidneys.
Whether your plan covers Jardiance or other diabetes or heart disease drugs will depend on the specific plan. For instance, Original Medicare Part B might cover certain drugs, like IV medications that you can't self-administer. Other medicines for diabetes that may be covered under various plans include:
- Metformin (Glumetza)
- Nateglinide (Starlix)
- Acarbose (Precose)
- Glyburide (DiaBeta, Micronase, Glynase)
And remember: Original Medicare doesn't typically cover prescription drugs like Jardiance – you'll need Part D for that coverage.
Sources:
- [1] Medicare: Prescription Drug Coverage (Part D) | how it works | what's covered | premiums. (n.d.). Retrieved March 15, 2023, from https://www.medicare.gov/drug-coverage-part-d/
- [2] Silva, J. R. (2016, January 1). Medicare Prescription Drug Plans: How to Shop for a Part D Plan. Retrieved March 15, 2023, from https://www.aarp.org/health/medicare-insurance/info-01-2016/medicare-drug-plan-guide.html
- [3] Baumgaertel, A., & Hussar, N. (2021, June 28). Empagliflozin. In StatPearls [Int'l]. Retrieved March 15, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK542297/
- [4] Medicare Drug Pricing Reform Legislation: Summary and Analysis. (2021, March 23). Retrieved March 15, 2023, from https://www.kff.org/health-reform/issue-brief/medicare-drug-pricingreformlegislation-summary-and-analysis/
- [5] How Much Does Empagliflozin (Jardiance) Cost with Medicare in 2022? | eligibility, cost-savings, related drugs, safety. (2022, March 16). Retrieved March 15, 2023, from https://www.goodrx.com/empagliflozin
- Despite Medicare spending a significant amount on Jardiance, enrollees may still need to pay approximately $290 out of pocket due to their insurance plan's drug tiers and monthly premiums.
- As Jardiance is not available as a generic version, those seeking to save money on this medication may look into financial assistance programs such as Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs).
- Medicare coverage for diabetes treatments like Jardiance is not guaranteed and may require the use of Medicare Part D, with other drugs like Metformin, Nateglinide, Acarbose, and Glyburide potentially being covered under various plans.
