Medicare Coverage for Jardiance: A Comprehensive Look
Rewritten Article:
"Hey there! Let's talk about Jardiance, a med that docs often prescribe for managing heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans include coverage for this guy. But hold up, Part C plans with drug coverage might not – it all depends on the plan you got.
From June 2022 to May 2023, Medicare doled out a whopping $7 billion for Jardiance, with users typically shelling out an average of $290 out of pocket in 2022.
Each Medicare drug has what's called a formulary – a list of covered medications. To have Jardiance covered, you gotta enroll in a prescription drug plan that's got it listed.
So, how much does Jardiance cost on Medicare, you ask?
Well, according to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is around $600, but this can change depending on the drugstore you go to. Keep in mind that the share of that cost you'll pay depends on your insurance plan and the insurance plan's tier for this drug. Oh, and don't forget that, along with these coverage costs, you'll also need to pay a monthly premium for parts C and D. The premium depends on your plan, but remember, insurers manage these plans, so premiums can vary.
Typically, there's a deductible you gotta meet before coverage begins. In 2022, for Part D, this couldn't exceed $590. Also, there's a limit on your total spending for Part D – your out-of-pocket costs for any drugs with Part D can't exceed $2,000 annually.
Here's a quick rundown of key Medicare terms:
- Out-of-Pocket Cost: This is the amount you gotta shell out of your own pocket when Medicare doesn't cover the total amount or doesn't offer coverage. This includes deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money you pay monthly for Medicare coverage.
- Deductible: This is an annual amount you gotta spend out of pocket before Medicare starts covering your treatments.
- Coinsurance: This is the percentage of treatment costs you gotta fund yourself. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount you pay when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
What tier is Jardiance with Medicare?
Every Medicare drug plan can place Jardiance in a different tier, and the higher the tier, the more it might cost after the coverage starts.
The Inflation Reduction Act of 2022 enables the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable for enrollees.
Want to know how to get Jardiance for free?
You can lower your expenses by availing of financial assistance programs like Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs).
Is there a cheaper substitute for Jardiance?
While generic drugs are usually cheaper than brand-name drugs, Jardiance isn't available as a generic version.
Looking for other diabetes or heart disease meds that Medicare might cover?
Jardiance belongs to a group of drugs called SGLT2 inhibitors. These meds work in the kidneys to remove excess sugar from the body through urine.
Jardiance might benefit the heart and kidneys. Whether a plan covers Jardiance or any other heart disease meds, or meds for managing diabetes, depends on the specific plan. To name a few, medication for diabetes that plans may cover could include metformin, nateglinide, acarbose, and glyburide.
Remember that Original Medicare's Part B may cover certain drugs, such as IV medications, that a person can't administer themselves."
[1] https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/how-your-drug-costs-are-determined
[2] https://www.cms.gov/apps/files/upload/Premium percent tables--FFY 2023.pdf
[3] https://www.cms.gov/Newsroom/Fact-sheets/Internet-Only-IBs/2022-Out-of-Pocket-Threshold-and-Annual-Doughnut-Hole-Cost-Sharing-Amounts
[4] https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/GagClauses
[5] https://www.whitehouse.gov/briefing-room/statements-releases/2022/07/26/president-biden-announces-major-steps-to-lower-costs-for-americans-with- Medicare/
- The Inflation Reduction Act of 2022 empowers the Secretary of Health and Human Services (HHS) to negotiate new, potentially more affordable prices for Medicare-covered drugs such as Jardiance and nine others.
- The out-of-pocket cost for 30 tablets of Jardiance can vary, with Optum Perks estimating around $600, but this amount may change depending on the pharmacy chosen and the specific insurance plan's tier for this drug.
- Medicare healthsystems may offer coverage for other diabetes or heart disease medications such as metformin, nateglinide, acarbose, and glyburide, but the specific coverage depends on the individual plan.
