Medicare Coverage for Jardiance: A Case Study
A Quick Take on Jardiance and Its Medicare Coverage
Jardiance is a medication frequently prescribed for treating heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans offer coverage for this medication, with Part C plans that include drug coverage being no exception, though this can depend on the plan.
Let's delve into the numbers: from June 2022 to May 2023, Medicare shelled out an impressive $7 billion on Jardiance, with each enrollee averaging $290 out of pocket in 2022.
But, question is, how much will this life-changing drug cost you, specifically?
Optum Perks estimates the out-of-pocket pharmacy cost for 30 tablets of Jardiance to be approximately $600. However, the exact cost can vary depending on the dispensing pharmacy and your insurance plan's tier covering this drug.
The cost-sharing for Jardiance may be influenced by different aspects, such as coinsurance, premiums (monthly fees), and the deductible - an annual amount you must spend before Medicare begins covering your treatments. If the cost doesn't scare you, remember that the total out-of-pocket spending on any drugs with Part D has an annual cap of $2,000.
Glossary of Medicare Terms
- Out-of-pocket cost: This is the portion of medical costs that you, the patient, are expected to cover.
- Premium: This is the monthly fee you pay for Medicare coverage.
- Deductible: This is the amount you must spend annually before Medicare starts funding your treatments.
- Coinsurance: This is the percentage of treatment costs that you must personally shoulder.
- Copayment: This is a predetermined fee you pay for certain treatments, typically prescription drugs.
Jardiance's Medicare Tier
The tier at which Jardiance falls under each Medicare drug plan can differ significantly, with a higher tier potentially resulting in higher costs after coverage begins. The Inflation Reduction Act of 2022 enabled the Secretary of Health and Human Services to negotiate new, more affordable prices for Jardiance and other selected drugs.
Lowering Jardiance Expenses
Various financial assistance programs can help you reduce your Jardiance expenses. Some options to explore include Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
A Cheaper Alternative?
Jardiance does not have a generic version available yet. However, generic drugs are generally more affordable than brand-name drugs.
Jardiance belongs to a class of drugs called SGLT2 inhibitors, which work in the kidneys to eliminate excess sugar from the body through urine. By taking Jardiance, you might benefit your heart and kidneys. Whether a particular plan covers Jardiance or any other heart disease drug or diabetes medication depends on the specific plan.
In summary, the cost of Jardiance under Medicare Part D and Part C plans can vary based on numerous factors, such as your insurance plan, coinsurance rates, deductibles, prior authorization requirements, and network pharmacies. To discover the precise cost, it is vital to examine the specifics of your Medicare plan.
- The cost of Jardiance can vary depending on factors like the dispensing pharmacy, your insurance plan's tier, and out-of-pocket expenses, such as coinsurance, premiums, and the deductible, which are part of the health-and-wellness expenses.
- The Inflation Reduction Act of 2022 allowed the Secretary of Health and Human Services to negotiate new, more affordable prices for Jardiance and other selected drugs, making it possible for healthsystems to offer this medication at lower uncategorized costs in the future.
- For individuals who may struggle with the out-of-pocket cost of Jardiance, there are financial assistance programs available, such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs), that can help reduce expenses associated with therapies-and-treatments like this drug.
