Medicare Coverage for Jardiance: A Question Answered
Medicare's Jardiance Breakdown: Affordability, Tiers, and Cost
Jardiance is a medication prescribed for heart failure, type 2 diabetes, or both. Most Medicare Part D prescription drug plans offer coverage for Jardiance, while Part C plans with drug coverage should as well, though this can depend on the specific plan.
Between June 2022 and May 2023, Medicare spent a whopping $7 billion on Jardiance, with beneficiaries averaging an out-of-pocket cost of roughly $290 in 2022 [1]. The price can fluctuate depending on the plan and coverage.
Every Medicare drug has a formulary, a list of covered medications. To obtain coverage, a person must enroll in a prescription drug plan that includes Jardiance in their formulary.
Jardiance's Cost Under Medicare
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance can reach about $600 [2]. The amount a person pays out-of-pocket depends on their insurance plan and the tier in which their plan covers the drug. Additionally, they'll need to pay a monthly premium for parts C and D, whose amounts can vary among plans.
Typically, there's a deductible to be met before coverage begins. For Part D, this annual amount cannot surpass $590 in 2025 [4]. Furthermore, a patient's total spending on any Part D drugs has an annual cap of $2,000.
Medicare Terms and Definitions
- Out-of-pocket cost: The amount you pay for healthcare services when Medicare does not cover the entire cost.
- Premium: The monthly amount you pay for Medicare coverage.
- Deductible: The annual amount you must pay out-of-pocket before Medicare starts funding treatments.
- Coinsurance: The percentage of treatment costs you must fund yourself.
- Copayment: A fixed, dollar amount you pay for specific treatments, common with prescription drugs.
Jardiance's Tier Under Medicare
Every Medicare drug plan can place Jardiance in a different tier, with higher tiers making the medication more expensive for users after coverage kicks in. The Inflation Reduction Act of 2022 enables the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable for enrollees.
Getting Jardiance for Free or Lower Costs
- Medicaid: This government-funded healthcare program offers extensive coverage, including medication.
- Extra Help: This program, based on income and resources, helps Medicare beneficiaries pay for their prescription drugs.
- State Pharmaceutical Assistance Programs (SPAPs): These state and non-profit programs provide assistance with prescription drug costs.
- Manufacturer Assistance Programs: Jardiance's manufacturer, Eli Lilly and Company, often offers financial assistance programs like copay cards or patient assistance programs to reduce out-of-pocket costs for eligible patients.
- Medicare's Financial Protections: Starting in 2025, Medicare will limit out-of-pocket costs for Part D drugs with an annual cap of $2,000.
These programs may vary for each individual, so it's essential to check with your specific plan and medication manufacturers for any available assistance.
Alternatives to Jardiance
While there are no generic versions of Jardiance, similar SGLT2 inhibitors may be covered by your plan. These drugs work in the kidneys to remove excess sugar from the body through urine and can benefit the heart and kidneys. Examples of diabetes medications that plans may cover include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
It's recommendable to consult your healthcare provider or insurance company to determine if your plan covers Jardiance or any other diabetes or heart disease medication.
[1] Average Out-of-Pocket Cost for Jardiance Under Medicare Plans: Multiple factors affect the average out-of-pocket cost for Jardiance under Medicare plans, such as the specific plan and coverage. Historically, Medicare beneficiaries have averaged around $290 out-of-pocket for Jardiance in 2022 [1], but the cost can be higher depending on the plan's formulary tier and the beneficiary's insurance coverage.
[2] Out-of-Pocket Pharmacy Cost for Jardiance: According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance can reach about $600 [2], depending on the dispensing pharmacy.
[4] Medicare's Financial Protections: Starting in 2025, Medicare has implemented a $2,000 annual cap on out-of-pocket costs for Part D drugs, which can help limit expenses for beneficiaries [4].
- The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new prices for Jardiance, which could potentially make it more affordable for Medicare enrollees.
- Jardiance's manufacturer, Eli Lilly and Company, offers financial assistance programs like copay cards or patient assistance programs to reduce out-of-pocket costs for eligible patients.
- Under Medicare's Financial Protections, starting in 2025, there will be a $2,000 annual cap on out-of-pocket costs for Part D drugs, which can help limit expenses for beneficiaries.
For more information about Medicare drug plans, tiers, and costs, visit the official Medicare website.
Additionally, some alternative diabetes medications like metformin (Glumetza), nateglinide (Starlix), acarbose (Precose), and glyburide (DiaBeta, Micronase, Glynase) may be covered under their Medicare plans, as they are SGLT2 inhibitors similar to Jardiance.
