Medicare Coverage for Jardiance: A Look into its Inclusion
Juicing up Your Medicare Coverage: A Guide to Jardiance
Jardiance, a medication used to treat type 2 diabetes and heart failure, is on most Medicare Part D prescription drug plans' coverage list. Part C plans, inclusive of drug coverage, should also cover it, but this depends on the specific plan.
From June 2022 to May 2023, Medicare shelled out a whopping $7 billion for Jardiance, with enrollees averaging around $290 out-of-pocket in 2022.
Every drug under Medicare has a formulary, essentially a catalog of covered medications. To secure coverage for Jardiance, you'll need to join a plan that features the med on its list.
How Much Does Jardiance Cost Me on Medicare?
The out-of-pocket pharmacy cost for 30 tablets of Jardiance is roughly $600, subject to change based on the dispensing pharmacy. The amount you pay depends on your insurance plan's tier for Jardiance and deductibles, coinsurance, and premiums that your specific plan dictates.
Typically, a Part C or D premium sets you back each month, while Part B comes with a base premium of $185 in 2025. You'll usually also face a deductible before coverage kicks in, with a cap of $590 for Part D in 2025. Moreover, the total spending on prescription drugs with Part D is capped at $2,000 annually.
Cracking the Code: Medicare Terms
- Out-of-Pocket Cost: The amount you pay when Medicare doesn't cover the total cost or anything at all. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The periodic payment—typically monthly—you make for Medicare coverage.
- Deductible: An annual sum you need to pay for treatments before Medicare starts chipping in.
- Coinsurance: The percentage of treatment costs you foot after meeting the deductible.
- Copayment: A fixed amount you pay when undergoing certain treatments, often applying to prescription drugs with Medicare.
Which Tier is Jardiance with Medicare?
Every plan may place Jardiance in a different tier, and higher tiers may mean higher costs for you after insurance coverage starts. The Inflation Reduction Act of 2022 gives the Secretary of Health and Human Services (HHS) the power to negotiate new, more affordable prices for Jardiance and 9 other drugs.
Free Medication: A Helping Hand
You can reduce your expenses on Jardiance through financial assistance programs, including:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is There a More Affordable Alternative for Jardiance?
While generic equivalents generally cost less, Jardiance isn't available in a generic version.
SGLT2 Inhibitors and Beyond
Jardiance belongs to a class of drugs called SGLT2 inhibitors, which work in the kidneys to eliminate extra sugar from the body through urine. Jardiance may benefit the heart and kidneys. Whether your plan covers Jardiance or other drugs for heart disease or diabetes—such as metformin, nateglinide, acarbose, or glyburide—depends on the specific plan.
You might want to know Original Medicare's Part B covers certain medications, such as IV medications, typically drugs patients can't self-administer.
For more information on diabetes medications and Medicare, or the coverage of cardiovascular diseases, visit the corresponding links below.
[1] Medicare.gov: How Much Does Medicare Pay for Prescription Drugs?
[2] Medicare.gov: Drug Coverage (Part D) Donut Hole (Coverage Gap)
[3] Medicare.gov: What Medicare Part C Plans Cover: Costs, Benefits, and Coverage
[4] Medicare Interactive: Private Insurance Companies and Medicare
[5] Medicare Interactive: How Medicare Advantage Plans (Medicare Part C) Work
[6] Verywell Health: Jardiance (Empagliflozin) Cost, Savings & Copay Cards
[7] Verywell Health: Does Medicare Cover Costs for Heart Disease and Stroke?
[8] Verywell Health: Diabetes Medications and Medicare
[9] Medicare.gov: How Does Medicare Work with Job-Based Health Coverage?
[10] Medicare.gov: How Does Medicare Work with TRICARE?
[11] Medicare.gov: How Does Medicare Work with Military Service Benefits?
[12] Medicare.gov: Medicare for Young People (MEP) & Medicare Savings Programs
[13] Social Security Administration: Extra Help with Medicare Prescription Drug Plan Costs
[14] SSA.gov: State Pharmaceutical Assistance Programs (SPAP)
[15] Centers for Medicare and Medicaid Services: Reducing Out-of-Pocket Prescription Drug Costs in Medicare Part D
[16] Medicare Rights: Understanding Medicare's Prescription Drug Coverage Gap (Donut Hole)
- Jardiance, a medication used for type 2 diabetes and heart failure, is typically covered by Medicare Part D prescription drug plans, although Part C plans may also cover it depending on the specific plan.
- The out-of-pocket cost for 30 tablets of Jardiance is approximately $600, which can vary based on a combination of the plan's tier for Jardiance, deductibles, coinsurance, and premiums.
- To determine whether Jardiance is covered under your Medicare plan and to understand the associated expenses, it's crucial to familiarize yourself with Medicare terms like out-of-pocket cost, premium, deductible, coinsurance, and copayment.
- As Jardiance may be priced higher in higher tiers, understanding the negotiation power granted by the Inflation Reduction Act of 2022 could potentially lead to more affordable prices for this medication.
- Reducing your prescription drug costs can be achieved by exploring financial assistance programs, such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
