Medicare Coverage for Jardiance: An Overview
Revamped Guide on Jardiance: Cost and Coverage for Medicare Users
STRAightforward advice on Jardiance, a common treatment for heart failure and type 2 diabetes, and its cost implications under Medicare.
Approximately $7 billion was spent on Jardiance by Medicare from June 2022 to May 2023, with enrollees coughing up an average of $290 out of pocket in 2022. But, exactly how much does this medication set you back? Let's break it down.
Jardiance's Medicare Price Tag
According to Optum Perks, the out-of-pocket pharmacy cost for a 30-tablet pack of Jardiance comes roughly to $600, depending on the pharmacy you choose. However, this figure can vary significantly depending on the plan's formulary tier placement for Jardiance.
Beyond the Prescription Cost: Understanding Medicare Jargon
- Out-of-Pocket Cost: This is the amount a person must shell out for care when Medicare doesn't cover the entire amount or doesn't provide coverage. This could include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the monthly sum a person pays for Medicare coverage.
- Deductible: This is the annual amount a person must pay out of pocket before Medicare starts funding their treatments.
- Coinsurance: This is the percentage of treatment costs a person must cover themselves. For Medicare Part B, this is 20%.
- Copayment: This is a fixed fee a person with insurance pays for certain treatments, particularly for prescription drugs.
Part C vs Part D: Navigating Medicare's Drug Plans
Most Medicare Part D prescription drug plans include coverage for Jardiance. Some Medicare Advantage (Part C) plans with drug coverage might also cover it, but coverage depends on the specific plan.
The Inflation Reduction Act and Jardiance's Future Costs
In 2022, the Inflation Reduction Act granted the Secretary of Health and Human Services (HHS) the authority to negotiate prices for Jardiance and nine other drugs, potentially making these medications more affordable for Medicare recipients.
Jardiance on the Medicare Drug List: Making It Affordable
Financial aid programs can help lower expenses on Jardiance:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Looking for a More Affordable Alternative?
Generic drugs are usually cheaper than branded drugs. However, Jardiance is not yet available as a generic version.
Expanding Your Horizons: Coverage for Other Diabetes and Heart Disease Medications
Jardiance belongs to the class of drugs called SGLT2 inhibitors. These medications work by eliminating excess sugar from the body through urine in the kidneys. They might benefit the heart and kidneys.
Whether your plan covers Jardiance or other heart disease drugs, or treatments for diabetes, depends on the specific plan. For example, plans may cover:
- metformin
- nateglinide
- acarbose
- glyburide
Original Medicare's Part B may cover certain drugs, like IV medications, which are typically drugs a person cannot self-administer.
For further details, check out our learning resources:
- Diabetes medications and Medicare
- Does Medicare cover cardiovascular disease?
- Although Jardiance is a common treatment for heart failure and type 2 diabetes, it may be categorized as an 'uncategorized' expense for some individuals under Medicare, considering the high out-of-pocket costs associated with it.
- To ensure comprehensive coverage for Jardiance under Medicare, beneficiaries might need to enroll in a supplementary Medicare Advantage (Part C) plan that includes prescription drug coverage or a standalone Medicare Part D plan.
- As science advances, the affordability of medications like Jardiance for health-and-wellness may improve, possibly through measures such as drug price negotiations by the Secretary of Health and Human Services, as stated in the Inflation Reduction Act.
