Medicare Coverage for Jardiance: An Inquiry
Medication Guide: Jardiance (Empagliflozin) and Your Medicare Coverage
Get a handle on your healthcare costs with this straightforward guide to Jardiance, a treatment for heart failure and type 2 diabetes, and how it's covered under Medicare.
From June 2022 to May 2023, Medicare splashed out a staggering $7 billion on Jardiance, with enrollees shelling out an average of $290 out of pocket in 2022. But what does this mean for your pocket?
cost breakdown
Every medication under Medicare has a formulary, a list of covered treatments. To secure coverage, you must sign up for a prescription drug plan that includes Jardiance on its formulary.
But how much will you ultimately pay? The out-of-pocket pharmacy cost for 30 tablets of Jardiance, on average, is a hefty $600 - though this can vary based on your dispensing pharmacy.
What you pay depends on your insurance plan's tier for Jardiance and your plan's cost-sharing structure. Additionally, you'll need to budget for monthly premiums for Part C and Part D, which are managed by private insurers and differ from plan to plan.
Your expenses aren't limited to pharmacy costs and premiums, though. Most plans include a deductible you must reach before Medicare starts chipping in. For Part D, this annual deductible cannot exceed $590 in 2025. You'll also face an annual cap of $2,000 on your total drug spending with Part D.
Tiers and Negotiations
Every Medicare drug plan may place Jardiance in a different tier, and the higher the tier, the more you'll pay out-of-pocket. The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable for you.
Lowering Your Expenses
You can reduce your Jardiance expenses through various financial assistance programs, including Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
Substitutes and Similar Treatments
While Jardiance offers unique benefits, you may find generic alternatives more budget-friendly. However, Jardiance is not available in a generic version as of now.
Jardiance belongs to the SGLT2 inhibitor class, which work in the kidneys to eliminate excess sugar from the body through urine. This class also includes dapagliflozin (Farxiga) and canagliflozin (Invokana).
When it comes to coverage, whether your plan covers Jardiance, other SGLT2 inhibitors, heart disease drugs, or diabetes medications depends on the specific plan. Examples of diabetes medications that plans may cover include metformin, glyburide, and sulfonylureas. The key is to find a plan that best suits your treatment needs.
Original Medicare's Part B may cover certain IV medications that you cannot administer yourself.
Implementing a savvy Medicare strategy can help you better manage your healthcare expenses, so make sure to explore your options and seek out financial assistance programs to keep your out-of-pocket costs to a minimum.
Glossary of Medicare terms
- Out-of-pocket cost: The amount you pay when Medicare doesn't fully cover your care expenses, including deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount you pay for Medicare coverage.
- Deductible: The annual amount you must pay out of pocket before Medicare starts funding your treatments.
- Coinsurance: The percentage of treatment costs that you must cover after you've met your deductible.
- Copayment: A fixed dollar amount you pay for certain treatments, typically prescription drugs.
- Under Medicare's coverage, Jardiance, a treatment for heart failure and type 2 diabetes, is listed in a formulary, and one needs to enroll in a prescription drug plan that includes it.
- The average out-of-pocket cost for Jardiance in 2022 was $290, while the out-of-pocket pharmacy cost for 30 tablets of Jardiance is approximately $600.
- The amount you pay for Jardiance depends on your insurance plan's tier for the medication and your plan's cost-sharing structure, which includes monthly premiums for Part C and Part D, deductibles, coinsurance, and copayments.
- Most Medicare plans have an annual deductible for Part D that cannot exceed $590 in 2025, and there is an annual cap of $2,000 on total drug spending with Part D.
- The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, which may make them more affordable for enrollees, and various financial assistance programs, such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs), can help reduce Jardiance expenses.
