Medicare and Jardiance Coverage: A Look into Insurance Benefits
Jardiance, a drug used to treat heart failure and type 2 diabetes, is covered by most Medicare Part D prescription drug plans. But with Part C and Part D, coverage depends on the specific plan.
From June 2022 to May 2023, Medicare spent an eye-watering $7 billion on Jardiance. Enrollees kicked in an average of $290 out of pocket in 2022.
Every Medicare drug has a formulary, a list of covered medications. To get coverage, a person must enroll in a prescription drug plan that includes Jardiance on its formulary.
What's the Deal with Jardiance Costs on Medicare?
According to Optum Perks, the cash price for 30 tablets of Jardiance at a pharmacy comes to around $600, depending on the pharmacy. However, the amount a person pays out-of-pocket depends on their insurance plan and the tier in which their plan covers Jardiance.
There's usually a deductible and coinsurance, copayments, and monthly premiums to pay. In 2025, the maximum deductible for Part D can't be higher than $590. There's also an annual cap of $2,000 on a person's total spending on drugs with Part D.
Medicare Terms Explained
- Out-of-pocket cost: The amount a person must pay for care when Medicare doesn't cover everything.
- Premium: The monthly fee someone pays for Medicare coverage.
- Deductible: The annual amount a person must spend out of pocket before Medicare starts funding their treatments.
- Coinsurance: The percentage of treatment costs a person must cover themselves.
- Copayment: A fixed cost a person with insurance pays for certain treatments.
Where Does Jardiance Fit in with Medicare?
Different Medicare drug plans can place Jardiance in different tiers, and the higher the tier, the more a person pays after coverage kicks in. The Inflation Reduction Act of 2022 allowed the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable.
Getting Jardiance for Free
People can lower their expenses on Jardiance through various financial assistance programs, like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
Cheaper Substitutes for Jardiance?
Generic drugs are often cheaper than brand-name drugs. However, Jardiance is not available as a generic.
Need more info on how to get Jardiance through Medicare, the cost breakdown, or substitutes? Check out these resources:
- "What is the Medicare drug list?"
- "Jardiance (empagliflozin) and cost"
- "Diabetes medications and Medicare"
- "Does Medicare cover cardiovascular disease?"
- Jardiance, a drug used to treat heart failure and type 2 diabetes, is covered by Medicare Part D prescription drug plans.
- Understand that different Medicare drug plans may include Jardiance in different tiers, and the higher the tier, the more a person pays after coverage kicks in.
- To lower expenses on Jardiance, various financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can be utilized.
- Unlike generic drugs, Jardiance is not available as a generic, which may cause higher costs compared to cheaper generic alternatives.
