Is Medicare coverage an option for Jardiance prescriptions?
Medicare's got you covered if you're taking Jardiance for heart failure or type 2 diabetes. Most prescription drug plans under Part D offer coverage for this medication, plus many Part C plans with drug coverage too, but make sure to check yours, 'cause it depends on the plan.
From June 2022 to May 2023, Medicare shelled out a cool $7 billion on Jardiance, with an average out-of-pocket cost of $290 for enrollees in 2022. Each Medicare drug has a formulary, a list of covered medications. To get coverage for Jardiance, you gotta enroll in a plan that lists it in their formulary.
Now, just how much you pay out of pocket depends on your insurance plan and the tier it's in. According to Optum Perks, the pharmacy cost for 30 tablets of Jardiance is roughly $600, but it can vary depending on the pharmacy.
With Part C and Part D, there's usually a deductible you gotta meet before coverage begins, and that can't be higher than $590 in 2025 for Part D. Also, your total spending on Part D drugs has an annual cap of $2,000.
Glossary of Medicare terms
- Out-of-pocket cost: Whatever you pay for care when Medicare doesn't. It includes deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly payment for Medicare coverage.
- Deductible: The annual amount you pay out of pocket within a certain period before Medicare starts footing the bill.
- Coinsurance: The percentage of treatment costs you pay yourself (20% for Part B, in most cases).
- Copayment: A fixed amount you pay for certain treatments - generally applies to prescription drugs.
Jardiance might be placed in a different tier by each Medicare drug plan, and the higher the tier, the more you end up paying after coverage kicks in.
Good news! The Inflation Reduction Act of 2022 gave the Secretary of Health and Human Services (HHS) the power to negotiate new prices for Jardiance and nine other drugs, potentially saving enrollees a bundle!
So, how can you get Jardiance for free or at a lower cost? You can apply for Medicaid, Extra Help (Low-Income Subsidy), or State Pharmaceutical Assistance Programs (SPAPs) if you qualify.
Wondering if there's a cheaper substitute for Jardiance? Unfortunately, it's not available as a generic version. Jardiance is a part of the SGLT2 inhibitor class, which work in the kidneys to expel excess sugar from the body through urine. These drugs may help your heart and kidneys too.
Keep in mind that whether your plan covers Jardiance or any other diabetes or heart disease drug depends on the specific plan. Examples of medications for diabetes that may be covered include metformin, nateglinide, acarbose, and glyburide.
SSS tip: Original Medicare's Part B may cover some IV medications, typically ones you can't administer yourself.
- Medicare's Part D and many Part C plans offer coverage for Jardiance, but it's essential to confirm with your specific plan due to varying coverages.
- In 2022, Medicare spent approximately $7 billion on Jardiance, with an average out-of-pocket cost of $290 for enrollees.
- Each Medicare drug has a formulary, a list of covered medications, and to get coverage for Jardiance, one must enroll in a plan that includes it.
- The pharmacy cost for 30 tablets of Jardiance is roughly $600, but this can vary depending on the pharmacy.
- Your out-of-pocket cost for Jardiance depends on your insurance plan and the tier it's in, with higher tiers resulting in higher costs after coverage kicks in.
- The Inflation Reduction Act of 2022 grants the Secretary of Health and Human Services the power to negotiate new prices for Jardiance and nine other drugs, which could potentially save enrollees significant costs.
