Medicare Coverage for Jardiance: A look into eligibility
Revamped Guide to Jardiance Costs in Medicare
Hey there! Ready to dive into the nitty-gritty of Jardiance costs on Medicare? Let's break it down.
Jardiance, prescribed for heart failure, type 2 diabetes, or both, is often covered under Medicare Part D prescription drug plans. Some Medicare Advantage (Part C) plans with drug coverage should also include it, but coverage may vary depending on the plan.
Between June 2022 and May 2023, Medicare shelled out a hefty $7 billion on Jardiance, with the average Medicare enrollee shelling out approximately $290 out-of-pocket in 2022.
But, what exactly is the out-of-pocket cost for a 30-tab pack of Jardiance? According to Optum Perks, it's roughly $600, though it may fluctuate based on your pharmacy. This amount could be lower depending on your insurance plan's coverage and the tier position of Jardiance within that plan. Don't forget, you'll also be shelling out a monthly premium for Part C and Part D, which can vary depending on the plan you've chosen.
Typically, you'll encounter some upfront costs like a deductible before coverage kicks in. For Part D, the deductible shouldn't exceed $590 in 2025. In addition, your total spending on Part D drugs has an annual cap of $2,000.
Now, let's get a little more technical here! Here's a crash course on some essential Medicare terms:
- Out-of-pocket cost: What you pay for care when Medicare doesn't cover the full amount or provides no coverage. Tolls can include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount of money you fork over each month for Medicare coverage.
- Deductible: The annual sum you must shell out of pocket before Medicare foots the bill for your treatments.
- Coinsurance: The percentage of treatment costs you must pay yourself. For Medicare Part B, that's 20%.
- Copayment: A fixed dollar amount you pay for specific treatments, often applicable to prescription drugs under Medicare.
Did you find Jardiance in a higher tier in your Medicare plan? Remember, that could peg the price tag higher for you after coverage takes effect. The Inflation Reduction Act of 2022 allowed the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, making these drugs more budget-friendly for enrollees.
Want to avoid shelling out cash for Jardiance? Consider financial assistance programs such as Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs). And guess what? Jardiance isn't the only affordable diabetes or heart disease medication out there. While the coverage depends on your plan, Medicare may pay for drugs such as metformin, nateglinide, acarbose, glyburide, or insulin.
Interested in learning more about how Medicare handles diabetes drugs and cardiovascular disease? Dive into our learning resources!
Sources:
[1] AARP - Medicare Advantage: What You Need to Know[2] UnitedHealthcare - Medication Cost Estimator[3] CMS - 2025 Part D Benefit Parameters Announcement[4] Forbes – Healthcare Inflation Reduction Act[5] Medicare Rights Center – Medicare Part D Premiums – What To Know And Expect In 2025
- The Inflation Reduction Act of 2022 has allowed the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance, potentially making it more budget-friendly under Medicare.
- Some financial assistance programs, such as Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs), may help reduce out-of-pocket costs for Medicare enrollees seeking Jardiance.
- In addition to Jardiance, Medicare may cover other affordable diabetes or heart disease medications, such as metformin, nateglinide, acarbose, glyburide, or insulin, though coverage may depend on the specific plan.
