Jardiance: Your Guide to Medicare Coverage and Costs
Medicare Coverage for Jardiance: A Question Explored
Jardiance is a widely prescribed medication by doctors for heart failure and type 2 diabetes treatment. If you're enrolled in Medicare Part D, odds are good that your plan includes coverage for Jardiance. Part C plans with drug coverage should also cover Jardiance, but it's essential to know that plan coverage varies depending on your specific plan.
In the period between June 2022 and May 2023, Medicare spent a whopping $7 billion on Jardiance, with an average out-of-pocket cost of around $290 for enrollees in 2022. But keep in mind that without additional context, specific information for 2023 isn't readily available.
Medicare drug plans all have a formulary, essentially a list of covered medications. To secure coverage for Jardiance, you'll need to enroll in a plan that includes it on its formulary.
How much does Jardiance cost on Medicare?
The out-of-pocket pharmacy cost for a 30-tablet supply of Jardiance can range around $600, depending on your chosen pharmacy. The amount you'll pay out-of-pocket for Jardiance depends on your insurance plan's tier for covering this drug, as well as individual coinsurance, premiums, and any applicable deductibles.
General terms you'll encounter in Medicare include:
- Out-of-pocket cost: the amount you pay for care when Medicare does not foot the entire bill or provide coverage. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: the regular payment for Medicare coverage.
- Deductible: an annual amount you must pay out-of-pocket before Medicare will cover your treatments.
- Coinsurance: the percentage of treatment costs that you will need to cover. For Medicare Part B, coinsurance stands at 20%.
- Copayment: a fixed amount you pay when receiving certain treatments, particularly prescription drugs.
Where does Jardiance fall in Medicare's tiers?
Each Medicare drug plan may place Jardiance in a different tier, and the higher the tier, the more costly it may be after coverage kicks in. Thanks to the Inflation Reduction Act of 2022, the Secretary of Health and Human Services (HHS) has the power to negotiate new prices for Jardiance and nine other drugs, potentially making them more affordable for enrollees.
Lowering your Jardiance expenses
You can cut costs on Jardiance through various financial assistance programs, such as:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is there a less expensive alternative to Jardiance?
While generic drugs are generally less costly than brand-name drugs, Jardiance is currently not available as a generic version.
Other drugs for diabetes or heart disease coverage
Jardiance belongs to the SGLT2 inhibitors class of drugs, which work in the kidneys to remove excess sugar from the body through urine. These drugs may benefit the heart and kidneys. Depending on your specific plan, coverage for Jardiance or any other heart disease drug will vary. Similarly, coverage for diabetes drugs, such as metformin, nateglinide, acarbose, and glyburide, will depend on your plan.
Keep in mind that Original Medicare's Part B may cover certain drugs typically administered intravenously, which are usually drugs you cannot administer yourself.
For more information, explore topics like:
- Diabetes medications and Medicare
- Does Medicare cover cardiovascular disease?
- Despite the high cost of Jardiance, many Medicare Part D plans include coverage for this medication, with an average out-of-pocket cost of approximately $290 in 2022.
- The out-of-pocket pharmacy cost for a 30-tablet supply of Jardiance can range around $600, but this amount varies due to factors like insurance plan tiers, coinsurance, premiums, and deductibles.
- Enrollees can potentially lower their Jardiance expenses through financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
- Due to the Inflation Reduction Act of 2022, the Secretary of Health and Human Services (HHS) now has the power to negotiate new prices for Jardiance and other selected drugs, which could make them more affordable for enrollees.
- Jardiance belongs to the SGLT2 inhibitors class of drugs, and while there are alternatives for diabetes and heart disease treatment, a generic version of Jardiance is not yet available.
