Medicare Coverage for Jardiance: Is it Included?
Jardiance: A Breakdown of Costs on Medicare
Embrace the know-how on the popular diabetes and heart failure medication, Jardiance, often prescribed by the docs. Majority of Medicare Part D prescription drug plans provide coverage for Jardiance. This also applies to Medicare Advantage (Part C) plans, although coverage might vary among plans.
From the June 2022 to May 2023 period, Medicare shelled out a whopping $7 billion on Jardiance, with enrolled individuals averaging around $290 out-of-pocket in 2022.
Each Medicare drug boasts a formulary, essentially a list of prescribed medications. To secure coverage, one must enlist in a prescription drug plan that showcases Jardiance in its formulary.
So, how much would Jardiance cost you on Medicare? Per Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance hovers around $600, depending on the pharmacy dispensing it.
The exact amount you pay depends on your plan and the tier designation for Jardiance. Besides the coinsurance, there'll be a monthly premium for parts C and D that varies based on the plan. In addition, there is usually a deductible you must meet before Medicare chips in. Keep in mind, the maximum deductible for Part D is $590 in 2025. Furthermore, the total yearly spending on drugs via Part D bears an annual cap of $2,000.
Glossary of Medicare jargon
- Out-of-pocket cost: This is the amount you'll fork out-of-pocket for healthcare when Medicare doesn't cover the entire bill. Costs may entail deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount you shell out every month for Medicare coverage.
- Deductible: This is an annual amount you must shell out of your own pocket prior to Medicare stepping in to fund your treatments.
- Coinsurance: This is the percentage of treatment costs you need to cover yourself. In the case of Medicare Part B, coinsurance amounts to 20%.
- Copayment: This is a fixed dollar amount you'll pay for specific treatments when you have insurance. In the context of Medicare, this charge usually pertains to prescriptions.
Jardiance's tier designation in Medicare
Every Medicare drug plan might assign Jardiance to a different tier, with higher tiers translating to pricier costs for you post-coverage. However, the Inflation Reduction Act of 2022 enabled the Secretary of Health and Human Services to negotiate new, more affordable prices for Jardiance and nine other drugs, consequently making them more financially manageable for enrollees.
Gaining access to Jardiance for zero bucks
You can reduce your Jardiance-related expenses by leveraging several financial aid programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
A cheaper alternative for Jardiance?
Generics typically come at a lower cost compared to brand-name drugs. Unfortunately, as of now, Jardiance doesn't have a generic version.
Medicare-approved diabetes or heart disease medications
Jardiance falls under the SGLT2 inhibitors category, drugs that work in the kidneys to eradicate excess sugar from the body via urine. By doing so, Jardiance may offer heart and kidney benefits.
Whether your plan covers Jardiance or any other heart disease medication depends on the specific plan, and this is also the case for diabetes medications. Examples of diabetes drugs that plans may cover include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Note that Medicare Part B may cover certain drugs, typically IV medications, that the patient cannot self-administer.
Diabetes medications and Medicare
Does Medicare cover cardiovascular disease?
- Jardiance, a popular diabetes and heart failure medication, is covered by the majority of Medicare Part D prescription drug plans, along with Medicare Advantage (Part C) plans, although coverage may vary between plans.
- On average, Medicare enrollees paid around $290 out-of-pocket for Jardiance in 2022, but out-of-pocket pharmacy cost for 30 tablets of Jardiance can reach approximately $600 depending on the pharmacy.
- The exact cost of Jardiance on Medicare depends on the individual's plan and the tier designation for Jardiance, with higher tiers resulting in higher post-coverage costs, but the Inflation Reduction Act of 2022 may help negotiate lower prices for enrollees.
- To gain access to Jardiance for zero dollars, financial aid programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can be leveraged.
- Some Medicare-approved diabetes medications that may be covered include metformin, nateglinide, acarbose, and glyburide, while coverage for cardiovascular disease medications varies depending on the specific plan.
