Medicare Coverage for Jardiance: An Overview
Breaking Down Jardiance Costs on Medicare
Jardiance is a popular medication for treating heart failure and type 2 diabetes, often covered by Medicare Part D and Part C plans. But understanding its cost can be tricky!
The total Medicare spending on Jardiance from June 2022 to May 2023 was a whopping $7 billion. And while the average out-of-pocket expense for Jardiance in 2022 hovered around $290, these numbers may vary based on an individual's plan and medications taken.
Every drug covered by Medicare has a formulary, a list of medications that the plan will cover. To secure coverage for Jardiance, it's essential to enroll in a prescription drug plan with Jardiance in its formulary.
But what does that cost look like? According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance can reach roughly $600 at a regular pharmacy. However, this price can depend on the dispensing pharmacy.
The proportion of that cost paid out of pocket will depend on your insurance plan and the tier placement of the Jardiance coverage. Keep in mind that you'll also have to foot the bill for monthly premiums for both Parts C and D. The premiums can vary based on the plan.
Usually, there is also a deductible that must be met before coverage begins. For Part D, this cannot exceed $590 in 2025. Additionally, any total spending for Part D drugs is capped at $2,000 annually.
Key Terminology
- Out-of-pocket cost: The amount a person must pay for care when Medicare does not cover the total cost or provide coverage. This may include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount paid for Medicare coverage.
- Deductible: An annual amount that a person must spend out of pocket before Medicare starts funds treatments.
- Coinsurance: The percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: A fixed dollar amount paid for certain treatments when a person has insurance. Generally, this applies to prescription drugs under Medicare.
Jardiance's Tier Placement and Affordability
Every Medicare drug plan may place Jardiance in a different tier, and as a result, the cost to the patient may vary. Higher tiers might mean higher out-of-pocket costs after insurance coverage kicks in.
Luckily, the Inflation Reduction Act of 2022 enabled the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and several other high-cost drugs. This development may help make these drugs more affordable for enrollees.
Lowering Your Expenses with Jardiance
There are a few ways to lower your Jardiance expenses. Some include:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
And if you are unable to afford a brand-name drug like Jardiance, generic alternatives may be available to reduce costs. However, as of now, Jardiance is not available as a generic.
Other Diabetes and Heart Disease Medications Covered by Medicare
Jardiance belongs to the SGLT2 inhibitors class, a type of drug that works in the kidneys to remove excess sugar from the body through urine. These drugs can benefit the heart and kidneys.
The extent of coverage for Jardiance or alternative heart disease drugs and diabetes treatments varies between plans. Examples of prescription drugs covered by some diabetes plans may include:
- metformin
- nateglinide
- acarbose
- glyburide
It's important to note that Original Medicare’s Part B may cover certain drugs, such as IV medications, that beneficiaries aren't able to self-administer.
For more information on diabetes medications covered by Medicare, check out our resources.
Sources:
[1] Medicare.gov
[4] AARP]
[5] Beneschlaw.com
- The out-of-pocket cost for Jardiance, a medication used to treat heart failure and type 2 diabetes, can vary significantly based on an individual's Medicare plan, drug tier placement, and the pharmacy used.
- Understanding the costs associated with Jardiance under Medicare Part D and Part C plans can be complex, as factors such as deductibles, premiums, coinsurance, and copayments can influence the overall expense.
- The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new, potentially more affordable prices for Jardiance and other high-cost drugs, which may benefit enrollees.
