Medicare Coverage for Jardiance: An Overview
Medicare Prescription Drug Plans may cover Jardiance, a medication commonly used to treat heart failure and type 2 diabetes, but coverage depends on the specific plan. From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, making up about $290 out-of-pocket for enrollees in 2022.
Every drug covered by Medicare has a formulary, a list of medications that the plan is willing to cover. To get Jardiance covered, a person should enroll in a prescription drug plan that lists it within its formulary. The out-of-pocket cost for 30 tablets of Jardiance may typically cost around $600, though this varies by the pharmacy and insurance plan in question.
There are several factors that influence the cost of Jardiance under a Medicare plan, including the plan's coverage, the tier in which Jardiance is classified within the plan, and any additional deductibles or premiums. Generally, higher tiers for medications mean higher out-of-pocket costs for the enrollee after their coverage kicks in.
A few terms to stay informed about Medicare costs include out-of-pocket cost, premium, deductible, coinsurance, and copayment. It's crucial to understand these when navigating the costs associated with Jardiance or any other medication.
Thanks to the Inflation Reduction Act of 2022, the Secretary of Health and Human Services is now authorized to negotiate new prices for Jardiance, which may make it more affordable for enrollees.
If the cost of Jardiance remains a burden, individuals may seek financial assistance from programs like Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs). It's worth noting that generic drugs are generally more affordable than their brand-name counterparts, but Jardiance is currently not available as a generic version.
Glossary of Medicare terms:
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
By figuring out Jardiance's tier within one's specific Medicare plan and using cost estimation tools like the UnitedHealthcare Drug Cost Estimator, individuals can stay informed about their out-of-pocket costs. Fortunately, the Inflation Reduction Act of 2022 may lead to more affordable prices for Jardiance and other covered drugs.
- Medicare Prescription Drug Plans might cover Jardiance, a medication used for heart failure and type 2 diabetes, but coverage depends on the plan's formulary.
- In 2022, Medicare spent $7 billion on Jardiance, amounting to approximately $290 out-of-pocket for enrollees.
- To get Jardiance covered, one should enroll in a prescription drug plan that lists it within its formulary, and the out-of-pocket cost for 30 tablets may typically be around $600.
- The cost of Jardiance under Medicare is influenced by factors like the plan's coverage, the tier in which Jardiance is classified, and additional deductibles or premiums.
- Key terms to understand when navigating Medicare costs are out-of-pocket cost, premium, deductible, coinsurance, and copayment.
- Thanks to the Inflation Reduction Act of 2022, the Secretary of Health and Human Services can now negotiate new prices for Jardiance, potentially making it more affordable for enrollees.
- If the cost of Jardiance remains a burden, individuals may seek financial assistance from programs like Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs). A glossary of Medicare terms includes out-of-pocket cost, premium, deductible, coinsurance, and copayment. By understanding these terms and using cost estimation tools, individuals can stay informed about their out-of-pocket costs for Jardiance or any other medication.
