Medicare Coverage for Jardiance: Is it Included?
Let's Talk Jardiance on Medicare
Jardiance is a poppin' medication for 'handlin' heart failure and type 2 diabetes. Now, most Medicare Part D prescription drug plans include coverage for this bad boy. If you're rockin' a Part C plan with drug coverage, it should cover Jardiance too, but remember, it depends on the plan.
From June 2022 to May 2023, Medicare dropped a cool $7 billion on Jardiance, and enrollees on average forked out $290 outta pocket in 2022.
Every Medicare drug 've got a formulary, a fancy list of covered meds. To get coverage for Jardiance, you gotta enroll in a prescription drug plan that lists it in the formulary.
How Much Does Jardiance Slap You for on Medicare?
According to Optum Perks, the OOP pharmacy cost for 30 tablets of Jardiance is roughly $600, but it ain't the same everywhere. The amount you gotta pay depends on your insurance plan and the drug's tier. Don't forget, you gotta pay a monthly premium for Parts C and D too, and the premium price varies by plan.
Typically, there's a deductible you gotta hit before coverage kicks in, but for Part D it can't be more than $590 in 2025. You're also capped at spending a total of $2,000 on any drugs with Part D every year.
Medicare Glossary
- Out-of-pocket cost: What ya gotta pay for healthcare that Medicare don't cover. Costs include deductibles, coinsurance, copayments, and premiums.
- Premium: What ya pay each month for Medicare coverage.
- Deductible: An annual amount ya gotta pay outta pocket before Medicare starts shellin' out.
- Coinsurance: The percentage ya gotta pay yerself for treatment costs. In Medicare Part B, it's 20%.
- Copayment: A fixed dollar amount ya pay when receivin' certain treatments, like prescription drugs in Medicare.
Jardiance's Tier with Medicare
Every Medicare drug plan could place Jardiance in a different tier, and a higher tier means it gets pricier for ya after coverage starts. The gov'ment got the power to negotiate new prices for Jardiance through the Inflation Reduction Act of 2022, makin' it more affordable for enrollees.
Learn More:
- What is the Medicare drug list?
- How do I get Jardiance for free? (Financial assistance programs like Medicaid, Extra Help, State Pharmaceutical Assistance Programs)
Is There a Cheaper Alternative for Jardiance?
Generic drugs tend to be cheaper, but Jardiance ain't got a generic version yet.
Other Diabetes and Heart Disease Medications Covered
Jardiance falls under the sweet class of drugs called SGLT2 inhibitors, which work on the kidneys to remove excess sugar from the body through urine. This magical med may do wonders for the heart and kidneys. Whether a plan covers Jardiance or any other heart disease drug depends on the specific plan (e.g., metformin, nateglinide, acarbose, glyburide).
Original Medicare's Part B may cover certain IV drugs, but remember those ya can't self-administer.
Enrichment Data:- Jardiance is covered by most Medicare Part D prescription drug plans, and some Medicare Part C plans (with drug coverage) as well, but the specific out-of-pocket costs depend on the plan and the drug's tier.- Medicare spent approximately $7 billion on Jardiance from June 2022 to May 2023, and enrollees paid around $290 out-of-pocket in 2022.- Jardiance is placed in a different tier by each Medicare drug plan, with higher tiers associated with higher out-of-pocket costs after coverage kicks in.- The Inflation Reduction Act allows the Secretary of Health and Human Services to negotiate new prices for certain drugs, but Jardiance isn't explicitly mentioned as part of the initial negotiation agreements as of early 2025.- Various financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs can help lower expenses on Jardiance.- Jardiance is not available as a generic version, but generic drugs are generally cheaper than brand-name drugs.- Jardiance belongs to a class of drugs called SGLT2 inhibitors, which work in the kidneys to eliminate excess sugar through urine and may improve heart and kidney health.- Medicare Part D plans cover prescription drugs, while Part C (Medicare Advantage) may also cover drugs if they include Part D coverage, but the specifics depend on the plan's design and formulary.- Medicare Part D has a deductible that cannot exceed $590 in 2025, and an out-of-pocket spending cap of $2,000 annually starting in 2025.
- Jardiance, a medication for heart failure and type 2 diabetes, is covered by most Medicare Part D prescription drug plans and some Medicare Part C plans with drug coverage, but the specific out-of-pocket costs depend on the plan and the drug's tier.
- In 2022, Medicare spent approximately $7 billion on Jardiance, and enrollees paid around $290 out-of-pocket.
- Each Medicare drug plan places Jardiance in a different tier, with higher tiers associated with higher out-of-pocket costs after coverage kicks in.
- The Inflation Reduction Act allows the Secretary of Health and Human Services to negotiate new prices for certain drugs, but Jardiance isn't explicitly mentioned as part of the initial negotiation agreements as of early 2025. Various financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs can help lower expenses on Jardiance.
