Medicare Coverage for Jardiance: An Examination
Chilling with Jardiance: Drug Costs and Medicare Coverage
Jardiance is a medication many doctors prescribe for managing heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans cover Jardiance. However, whether you're eligible for coverage depends on the plan you've enrolled in and whether Jardiance is on that plan's list of covered medications, known as the formulary.
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees averaging $290 out of pocket in 2022.
How Much Does Jardiance Cost With Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance hovers around $600, although this can vary depending on your dispensing pharmacy. The actual amount you pay depends on your insurance plan's tier placement for this drug, as well as the coinsurance or copayments. Keep in mind you'll also need to pay a monthly premium for parts C and D, which can vary depending on your chosen plan.
Typically, you'll also find a deductible you'll need to meet before your coverage kicks in. In 2025, the deductible for Part D cannot be higher than $590. Additionally, your total spending on any drugs with Part D is capped at a much lower $2,000 annually starting in 2025, compared to the $8,000 cap in 2024.
What's the Lowdown on Medicare Terms?
- Out-of-pocket cost: The amount you pay for care not covered or partially covered by Medicare.
- Premium: The monthly fee you pay for Medicare coverage.
- Deductible: An annual amount you must spend out of pocket before Medicare starts to fund your treatments.
- Coinsurance: The percentage of treatment costs you must self-fund.
- Copayment: A fixed dollar amount you pay when receiving certain treatments.
Jardiance's Tier in Medicare
Every Medicare drug plan places Jardiance in a different tier, and the higher the tier, the more you'll pay for it after coverage begins. However, the Inflation Reduction Act of 2022 now allows the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, making these drugs more affordable for Medicare enrollees.
Lower Your Expenses on Jardiance
You can lower your expenses on Jardiance through various financial assistance programs, such as Medicaid, Extra Help, or State Pharmaceutical Assistance Programs. It's worth noting that a cheaper substitute for Jardiance may not be available since it's not on the market as a generic version.
What About Other Diabetes or Heart Disease Medications?
Jardiance belongs to the SGLT2 inhibitors class of drugs and functions to eliminate excess sugar from the body via urine in the kidneys. Other medications for heart disease and diabetes that might be covered by your plan include metformin, certain nateglinides, acarbose, glyburide, and various IV medications under Part B.
Stay informed about medicare coverage for your health needs by exploring these resources:
- "What is the Medicare drug list?"
- "Jardiance (empagliflozin) and cost"
- "Diabetes medications and Medicare"
- "Does Medicare cover cardiovascular disease?"
- Despite Jardiance being a common prescription for managing heart failure and type 2 diabetes, the out-of-pocket cost for 30 tablets can be as high as $600, depending on the pharmacy dispensed.
- Enrollees in Medicare Part D prescription drug plans, on average, paid $290 out of pocket for Jardiance in 2022, with Medicare spending a total of $7 billion on the drug from June 2022 to May 2023.
- Understanding Medicare terms like premium, deductible, coinsurance, and copayments is essential to know your potential costs with Jardiance and other medicines.
- The Secretary of Health and Human Services, due to the Inflation Reduction Act of 2022, can now negotiate new prices for Jardiance and nine other drugs, aiming to make them more affordable for Medicare enrollees starting in 2022.
- Financial assistance programs such as Medicaid, Extra Help, or State Pharmaceutical Assistance Programs can help lower your expenses on Jardiance, although a generic substitute might not be available since Jardiance is not on the market as a generic version.
- Other diagnostics or heart disease medicines that may be covered by your plan include metformin, certain nateglinides, acarbose, glyburide, various IV medications under Part B, and other diabetes medications of the SGLT2 inhibitors class like Jardiance.
