Medicare Coverage for Jardiance: A Look at Eligibility
Medicare Jardiance Coverage Breakdown: Understanding the Costs and Uncovering Savings
Jardiance, a medication prescribed for heart failure and type 2 diabetes, is included in most Medicare Part D prescription drug plans. But is it affordable? Let's decipher the costs and explore potential savings.
Jardiance Costs on Medicare: An In-depth Look
During the fiscal year 2022-23, Medicare shelled out an impressive $7 billion on Jardiance. Enrollees, on average, footed approximately $290 out of pocket in 2022.
Every Medicare drug boasts its own formulary, a list of medications covered by the plan. To secure coverage for Jardiance, enroll in a prescription drug plan that has Jardiance on its formulary.
Out-of-pocket expenses for Jardiance depend on various factors, such as insurance plans and the drug tier designation. As per Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is about $600, variable according to the dispensing pharmacy.
Key Medicare Terminology Explained
- Out-of-pocket cost: The amount an individual spends for healthcare expenses when Medicare doesn't pay the full amount or cover the treatment. This may include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly sum an individual pays for Medicare coverage.
- Deductible: The amount an individual must spend out-of-pocket towards healthcare expenses within a specific period before Medicare starts funding treatments.
- Coinsurance: A percentage of treatment costs that an individual is responsible for paying. For Medicare Part B, coinsurance is 20%.
- Copayment: A fixed dollar amount an individual pays for specific treatments, like prescription drugs.
Jardiance's Tier in Medicare: What Does it Mean?
Each Medicare drug plan may allocate Jardiance to a different tier, and the higher the tier, the greater the cost to an individual after coverage kicks in. The Inflation Reduction Act of 2022 empowers the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and several other drugs, potentially making these medications more affordable for enrollees.
Lowering Jardiance Expenses: Financial Assistance Programs
Individuals can reduce their expenses on Jardiance via various financial assistance programs:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Affordable Substitutes for Jardiance: Exploring Options
Though Jardiance doesn't have a generic version, exploring alternatives may help manage costs. Discuss potential substitutes with your healthcare provider.
Other Diabetes and Heart Disease Medications: Coverage Insights
Jardiance falls under the category of SGLT2 inhibitors. These drugs aid kidneys in eliminating excess sugar from the body through urine. Jardiance may offer benefits to the heart and kidneys. Coverage for Jardiance—or any other heart disease or diabetes medication—hinges on the specific plan.
Examples of diabetes medications that plans may cover include metformin, nateglinide, acarbose, and glyburide. Original Medicare's Part B may cover certain drugs, like IV medications, that an individual cannot self-administer.
Sources
[1] "Jardiance costs on Medicare: What to expect and how to save." U.S. News & World Report. https://health.usnews.com/drugs/jardiance/cost[2] "Inflation Reduction Act and Medicare Prescription Drug Prices." Medicare.gov. https://www.medicare.gov/news/inflation-reduction-act-and-medicare-prescription-drug-prices[3] "Medicare Part D Coverage Gap." Medicare.gov. https://www.medicare.gov/your-medicare-costs/part-d-costs/medicare-part-d-coverage-gap
- Enrollees in Medicare Part D prescription drug plans are jointly responsible for spending approximately $290 on average for Jardiance in 2022, as Medicare spent $7 billion on Jardiance during the 2022-23 fiscal year.
- To receive coverage for Jardiance, it's essential to join a Medicare drug plan that includes Jardiance on its formulary, the list of medications covered by a plan.
- The out-of-pocket costs of 30 tablets of Jardiance may approximately cost $600, depending on factors like the insurance plan and drug tier allocation.
- Financial assistance programs, such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs), can help lower Jardiance expenses for individuals.
- Though Jardiance doesn't yet have a generic counterpart, exploring alternative SGLT2 inhibitor medications, like metformin, nateglinide, acarbose, glyburide, or others, may help manage costs and benefit from adequate diabetes and heart disease treatment.
