Medicare Coverage for Jardiance: A Look at Eligibility
JARDANCE: A HEART AND DIABETES DRUG ON MEDICARE
Jardiance is a medication commonly prescribed by doctors to treat type 2 diabetes and heart failure. Most Medicare Part D prescription drug plans offer coverage for this drug, with Part C plans providing drug coverage usually including it too, but this depends on the specific plan.
From June 2022 to May 2023, Medicare allocated an impressive $7 billion towards Jardiance, with enrollees averaging around $290 out-of-pocket in 2022.
Every Medicare-approved drug comes with a formulary, a list of covered medications. To secure coverage, you need to enroll in a plan that includes Jardiance on its formulary.
COST OF JARDANCE ON MEDICARE
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance typically ranges around $600, depending on the pharmacy you choose. The share of this cost you'll pay depends on your insurance plan and Jardiance's tier in your plan. Additionally, you'll have to pay a monthly premium for both Part C and Part D, which can differ based on your plan.
Typically, there is also a deductible you must meet before coverage begins. For Part D in 2025, this cannot surpass $590. Furthermore, your total spending on Part D drugs has an annual cap of $2,000.
MEDICARE TERMS EXPLAINED
- Out-of-pocket cost: The portion you pay for healthcare when Medicare does not cover the entire amount. Expenses may include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount you pay for Medicare coverage.
- Deductible: An annual amount you must spend out of pocket before Medicare begins covering your treatments.
- Coinsurance: The percentage of treatment costs you self-fund. For Medicare Part B, this is 20%.
- Copayment: A fixed dollar amount you pay when receiving certain treatments, such as prescription drugs.
JARDANCE TIER WITH MEDICARE
Every Medicare drug plan may categorize Jardiance into a different tier, and higher tiers equate to higher costs. As per 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 9 other drugs, potentially making them more affordable for users.
FREE JARDANCE OPTIONS
Greater savings on Jardiance can be achieved through various financial assistance programs, including:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
CHEAPER ALTERNATIVES TO JARDANCE
Generic drugs usually provide more cost-effective alternatives to brand-name drugs. However, Jardiance does not have a generic equivalent available.
OTHER DIABETES OR HEART DISEASE MEDICATIONS COVERED BY MEDICARE
Jardiance falls under the SGLT2 inhibitor class of drugs. These medications help remove excess sugar from the body by working in the kidneys. Jardiance may provide heart and kidney benefits, but whether your plan covers it or any other heart disease drug or diabetes medication depends on the specific plan. Examples of diabetes treatments that plans may cover include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Remember that Original Medicare's Part B may cover certain drugs that cannot be self-administered, such as IV medications.
DIABETES MEDICATIONS AND MEDICARE
CARDIOVASCULAR DISEASE COVERAGE WITH MEDICARE
[1] Medicare: Jardiance (empagliflozin) and cost
[2] Medicare: What is the Medicare drug list?
[3] Medicare: Does Medicare cover cardiovascular disease?
[4] Medicare: Heart disease drugs
[5] Medicare: Diabetes medications and Medicare
[6] Medicare: How do I get Jardiance for free?
[7] Medicare: How much does Jardiance cost on Medicare?
[8] Medicare: Average Out-of-Pocket Cost for Jardiance
[9] Medicare: Variation by Insurance Plans and Tiers
[10] Medicare: Recent Developments
- Enrollees in Medicare Part D prescription drug plans can access coverage for Jardiance, with Medicare Part C plans often providing drug coverage that includes it as well.
- The out-of-pocket cost for 30 tablets of Jardiance, as per Optum Perks, is typically around $600, but this can vary depending on the pharmacy chosen and the plan's specific tier for Jardiance.
- The Medicare Part D deductible for 2025 cannot exceed $590, and there's an annual cap of $2,000 for total Part D drug spending.
- The Inflation Reduction Act of 2022 gives the Secretary of Health and Human Services (HHS) the authority to negotiate new prices for Jardiance and 9 other drugs, potentially making them more affordable.
- Various financial assistance programs, like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs), can help enrollees save on Jardiance.
