Medicare Coverage for Jardiance: A Look into Insurance Criteria
Channeling Your Medicine Savvy: Navigating Jardiance Costs on Medicare
Jardiance, prescribed for heart failure and type 2 diabetes, is commonly covered by Medicare Part D and some Medicare Advantage Plans (Part C), but always check your specific plan to be sure.
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees shelling out an average of $290 out-of-pocket in 2022.[1]
Every drug covered by Medicare, like Jardiance, has its own formulary, a list of approved medications. To receive coverage, you must enroll in a prescription drug plan that carries Jardiance in its formulary.
How Much Does Jardiance Cost on Medicare?
The out-of-pocket pharmacy cost for 30 tablets of Jardiance can range around $600, depending on the pharmacy and your insurance plan’s tier.[1] Remember, the expenses you shoulder depend on your plan's coinsurance, premiums, and deductibles.
Typically, there's an annual deductible you must meet before coverage kicks in. For Part D, this can't exceed $590 in 2025, and you'll be responsible for 25% of the drug's cost for the remainder of the year, up to an out-of-pocket spending limit of $2,000.[3]
Crucial Medicare Terms, Explained:
- Out-of-Pocket Cost: These are the costs you pay for care when Medicare doesn't cover the entire amount or provides no coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the monthly fee you pay for Medicare coverage.
- Deductible: This is the annual amount you need to spend out-of-pocket before Medicare starts funding your treatments.
- Coinsurance: This is the percentage of treatment costs that you must pay out-of-pocket.
- Copayment: This is a fixed fee you pay when receiving certain treatments.
Jardiance's Medication Tier with Medicare
Depending on your plan, insurance providers may put Jardiance in a different tier. Generally, the higher the tier, the more expensive Jardiance can be after coverage begins. The Inflation Reduction Act of 2022 allowed the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and other drugs, making them more affordable for enrollees.[4]
Lowering Your Jardiance Expenses
Financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can help reduce your expenses on Jardiance.[5]
Looking for a Cheaper Substitute?
As of now, Jardiance isn't available as a generic drug, so there's no cheaper alternative option to consider.
Similar Drugs Covered by Medicare
Jardiance belongs to the SGLT2 inhibitors class, which work in the kidneys to eliminate excess sugar from the body through urine. Medications for diabetes and heart disease, like glyburide, nateglinide, acarbose, metformin, and other similar drugs, may be covered by Medicare too.[6]
Original Medicare's Part B can sometimes cover IV drugs, which aren't self-administered.[7]
[1] https://www.kff.org/medicare/issue-brief/the-cost-of-prescription-drugs-covered-under-medicare-part-d/[2] https://www.medicare.gov/drugs/part-d-costs/[3] https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/PartD-Annual- limitingCatastrophic.pdf[4] https://www.cms.gov/pricing-and-data/reimbursement/medicare-advantage-rate-ocs/2023-medicare-advantage-and-part-d-rate-book-files[5] https://www.military.com/daily-news/2021/03/22/the-cheapest-way-get-free-drugs-medicare.html[6] https://www.aarp.org/health/medicare-insurance/info-2022/frequent-questions-about-medicare-covered-diabetes-drugs.html[7] https://www.vitals.com/learn/article/does-my-medicare-cover-diabetes-medications
- Jardiance, a medication for heart failure and type 2 diabetes, is commonly covered by Medicare Part D and some Medicare Advantage Plans, but it's crucial to verify coverage for your specific plan.
- Medicare spent $7 billion on Jardiance from June 2022 to May 2023, with enrollees paying an average of $290 out-of-pocket in 2022.
- The cost for 30 tablets of Jardiance can range around $600, depending on the pharmacy and your insurance plan’s tier, while the out-of-pocket pharmacy cost may be affected by premiums, deductibles, and coinsurance.
- A notable term in Medicare is 'Out-of-Pocket Cost,' which includes deductibles, coinsurance, copayments, and premiums that enrollees pay for care that Medicare doesn't cover completely.
- Financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can help lower the expenses enrollees face when using Jardiance.
