Medicare Coverage for Jardiance: A Question of Reimbursement
Revamped Exploration of Jardiance Costs Under Medicare
Jardiance, a medication that doctors prescribe for heart failure and type 2 diabetes, finds a home in most Medicare Part D prescription drug plans. But, the story doesn't end there. Medicare Advantage plans with drug coverage should also include it, although it depends on the specific plan.
In the fiscal year from June 2022 to May 2023, Medicare shelled out a staggering $7 billion on Jardiance. In 2022, Medicare enrollees chipped in around $290 out of their own pockets.
Every medication under Medicare has a formulary, a list of covered treatments. To qualify for coverage, a person needs to sign up for a prescription drug plan that includes Jardiance on its formulary.
So, How Much Does Jardiance Cost on Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets can hover around $600, although this might vary with different pharmacies. The actual amount a person pays depends on their insurance plan and the tier in which the drug is placed in that plan. Alongside the coinsurance, a person is required to pay a monthly premium for Part C and Part D, with the premium dependent on the specific plan.
Usually, there's a deductible a person has to achieve before coverage kicks in. For Part D, this cannot be higher than $590 in 2025. Also, a person's total spending on any Part D drugs has an annual cap of $2,000 in 2025.
Glossary of Medicare Terms
- Out-of-pocket cost: This represents the amount a person pays for care when Medicare does not cover the full amount. Expenses may include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money an individual pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must shell out of their own pocket within a certain period before Medicare starts covering their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must cover themselves. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person pays when they receive certain treatments. Usually, this applies to prescription drugs under Medicare.
What Tier is Jardiance with Medicare?
Each Medicare drug plan might place Jardiance in a different tier, and the higher the tier, the pricier the medication may be after coverage applies.
The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and several other drugs, making these drugs more budget-friendly for enrollees.
How do I Get Jardiance for Free?
Individuals can reduce their expenses on Jardiance through financial assistance programs such as:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is There a Cheaper Substitute for Jardiance?
Generic drugs tend to be more affordable than brand-name drugs. However, as of now, Jardiance does not have a generic version.
What Other Diabetes or Heart Disease Medications are Covered?
Jardiance belongs to the SGLT2 inhibitors class of drugs, which work in the kidneys to eliminate excess sugar through urine. These drugs may have benefits for the heart and kidneys. Whether a plan covers Jardiance or other heart disease medications or diabetes drugs depends on the plan in question. Examples of diabetes medications that might be covered include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
A person may want to know that Original Medicare's Part B might cover certain medications, particularly IV medications that individuals cannot administer themselves.
[1] https://www.medicare.gov/drugs/part-d-costs-and-coverage/understanding-your-part-d-costs/understanding-your-costs.html[2] https://www.medicare.gov/Medicare-Drug-Payment-Modernization-Act/index.html[3] https://www.drugs.com/ppag/jardiance.html
- Under Medicare, the out-of-pocket pharmacy cost for 30 tablets of Jardiance can range around $600, which could vary depending on the pharmacy, and is influenced by the individual's insurance plan and the tier assignment of the medication within the plan.
- The Inflation Reduction Act of 2022 empowers the Secretary of Health and Human Services (HHS) to negotiate new, more affordable prices for Jardiance and certain other drugs, aiming to make these medications more accessible to Medicare enrollees.
- Financial assistance programs, such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs), can help individuals reduce their expenses on Jardiance, potentially making the medication more affordable.
