Medicare Coverage for Jardiance: A Review
Hey there! Let's dive into the topic of Jardiance, a medication that doctors often prescribe for heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans cover Jardiance, and many Medicare Advantage (Part C) plans with drug coverage should as well, but it depends on the specific plan.
From June 2022 to May 2023, Medicare shelled out a whopping $7 billion on Jardiance, with enrollees averaging around $290 out of pocket in 2022.
Every Medi-care drug has a formulary, a list of covered medications. To get coverage for Jardazine, a person must enroll in a prescription drug plan that lists it in its formulary.
So, how much does Jardiance cost on Medicare? A study by Optum Perks shows the out-of-pocket pharmacy cost for 30 tablets may be approximately $600, depending on the pharmacy and the plan.
The cost a person pays depends on their insurance plan's tier for this drug, and additional factors such as coinsurance, a monthly premium for parts C and D, and a deductible. Typically, a deductible is an annual amount a person must pay out of pocket before Medicare begins to pay for treatments. The maximum Part D deductible in 2025 is set at $590.
In addition, a person's total spending on any medications through Part D has an annual cap of $2,000. Don't forget that as private insurers manage these plans, premiums can vary greatly due to the plan selected.
Out-of-Pocket Cost Glossary:
- Out-of-pocket cost: The amount a person pays for care when Medicare does not cover the total cost.
- Premium: The monthly amount someone pays for Medicare coverage.
- Deductible: An annual amount a person must pay out of pocket before Medicare starts to cover their treatments.
- Coinsurance: The percentage of treatment costs that a person must pay themselves.
- Copayment: A fixed dollar amount a person pays for certain treatments with insurance.
Jardiance may be listed in a different tier in every Medicare drug plan, and the higher the tier, the more expensive it might be for the patient post-coverage. The Inflation Reduction Act of 2022 granted the Secretary of Health and Human Services (HHS) the authority to negotiate new prices for Jardiance and nine other drugs, making these drugs more affordable for enrollees.
Financial Assistance Programs:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Cheaper Substitutes for Jardiance:
Though Jardiance isn't available as a generic, gen-eric drugs are generally more affordable than brand-name drugs.
Tier and Covered Diabetes or Heart Disease Medications:
Jardiance belongs to a class of drugs called SGLT2 inhibitors. These medications work in the kidneys to eliminate excess sugar from the body through urine. Jardiance might benefit the heart and kidneys. Coverage of diabetes or heart disease medications varies depending on the specific plan. Examples of medications for diabetes that plans may cover include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
If you need further assistance, consider exploring resources like "What is the Medicare drug list?" and "Diabetes medications and Medicare" to learn more. Stay healthy!
- Despite the average out-of-pocket cost for Jardiance being around $290 in 2022, the out-of-pocket pharmacy cost for 30 tablets may be approximately $600, depending on the pharmacy and the plan.
- Deductibles can be an annual amount a person must pay out of pocket before Medicare begins to pay for treatments, and the maximum Part D deductible in 2025 is set at $590.
- If a person needs financial assistance with the cost of medications like Jardiance, they may consider exploring programs such as Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs).
