Medicare Coverage for Jardiance: Is it Included?
Rewritten Article:
Hey there! Let's talk about Jardiance, a medication used for heart failure and type 2 diabetes treatment. Most Medicare Part D prescription drug plans cover Jardiance, while Part C plans with drug coverage should also include it, but this varies based on the plan.
From June 2022 to May 2023, Medicare doled out a pretty hefty sum of about $7 billion for Jardiance, with users shelling out an average of approximately $290 out-of-pocket in 2022.
Every Medicare-covered drug has a formulary, a list of meds covered under the plan. To get Jardiance covered, you've gotta enroll in a plan that includes Jardiance on its formulary.
How much does Jardiance cost on Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for a 30-tablet supply of Jardiance is around $600, depending on the pharmacy where it's dispensed. The amount you end up paying for this medication depends on your insurance plan and the tier your plan assigned to Jardiance. Apart from coinsurance, you'll also need to pay a monthly premium for parts C and D.
Typically, out-of-pocket costs aren't the whole picture. You'll also likely see a deductible that you must meet before coverage begins. The maximum deductible for Part D is $590 in 2025. Moreover, your total spending for any drugs with Part D has an annual cap of $2,000.
Glossary of Medicare terms
- Out-of-pocket cost: This is the chunk of change you'll have to shell out yourself when Medicare does not cover the full cost or does not provide coverage at all.
- Premium: This is the amount of hard-earned cash you pay each month for your Medicare coverage.
- Deductible: This is an annual amount you have to spend out of pocket before Medicare starts chipping in for treatments.
- Coinsurance: This is the percentage of treatments costs you have to self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed amount you'll have to fork over when receiving certain treatments, usually prescription drugs.
What tier is Jardiance with Medicare?
The tier for Jardiance in Medicare drug plans can vary, and a higher tier means the medication might cost you more after coverage kicks in.
The Inflation Reduction Act of 2022 enabled the Secretary of Health and Human Services (HHS) to negotiate new, more affordable prices for Jardiance and nine other drugs.
Financial Assistance Programs
Don't despair if Jardiance's costs seem steep. You can lower your expenses with various financial aid programs, such as:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is there a cheaper substitute for Jardiance?
Generic drugs generally come with a lower price tag than brand-name drugs. However, Jardiance is only available in brand form.
What other medications for diabetes or heart disease are covered?
Jardiance belongs to a class of drugs known as SGLT2 inhibitors, which work in the kidneys to remove excess sugar from the body via urine. These drugs might benefit the heart and kidneys. Whether your plan covers Jardiance or any other heart disease medication (or diabetes drugs) depends on the specifics of your plan.
Examples of diabetes medications thatYour plan may coverinclude:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Part B might cover certain diabetes medications, such as IV medications, if you can't administer them yourself.
Learn more:
- What is the Medicare drug list?
- Jardiance (empagliflozin) and cost
- Diabetes medications and Medicare
- Does Medicare cover cardiovascular disease?
- The cost of a 30-tablet supply of Jardiance at a pharmacy can be around $600, but this amount can vary based on the insurance plan and the pharmacy where it's dispensed.
- The out-of-pocket cost for Jardiance, which is the chunk of change individuals have to pay themselves when Medicare does not cover the full cost, can be approximately $290 per year, as recorded in 2022.
- Apart from the out-of-pocket cost, users also need to pay a monthly premium for parts C and D of Medicare, and may also have to meet an annual deductible before coverage begins, with the maximum deductible for Part D being $590 in 2025.
