Medicare Coverage for Jardiance: An Examination
Jumping on Jardiance: What Costs to Expect on Medicare
Jardiance (empagliflozin) is a medication your doctor might prescribe for managing heart failure and type 2 diabetes. Good news for most Medicare beneficiaries, Jardiance is typically included in Medicare Part D prescription drug plans and some Medicare Advantage (Part C) plans with prescription coverage. But, the cost variation can be substantial depending on the specific plan and the insurer managing it.
Up from June 2022 to May 2023, Medicare pumped out a whopping $7 billion for Jardiance, and the average out-of-pocket expense for enrollees in 2022 hit $290.
Every drug Medicare covers has a formulary, a list of covered medications. To get insurance coverage, a person needs to enroll in a plan that lists Jardiance in its formulary.
So, how much will Jardiance cost you on Medicare?
As stated by Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is in the ballpark of $600, which can fluctuate based on the pharmacy you choose. However, this cost may differ depending on the insurance plan's tier for Jardiance and the coinsurance you're responsible for. Additionally, you'll need to pay a monthly premium for Part C and Part D, as well as meeting any deductibles and copayments that apply.
Ordinarily, Medicare Part D has a deductible that can't surpass $590 yearly in 2025, and the annual drug spending cap is set at $2,000 per year.
Unmasking Medicare Terms
- Out-of-pocket cost: The amount you pay when Medicare doesn't cover the entire cost, including deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee you pay for Medicare coverage.
- Deductible: An annual amount you must pay out-of-pocket before Medicare starts covering your treatments.
- Coinsurance: The percentage of treatment costs you must pay after meeting the deductible. For Medicare Part B, it's 20%.
- Copayment: A fixed amount you pay for certain treatments under Medicare, often when it comes to prescription drugs.
Which tier is Jardiance assigned with Medicare?
Every plan may classify Jardiance in a different tier, and as the tier increases, the cost to you may escalate. The Inflation Reduction Act of 2022 gave the Secretary of Health and Human Services the green light to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable for enrollees.
Lowering your Jardiance expenses
You can scale back your Jardiance expenses through various financial assistance programs, such as:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
A cheaper alternative to Jardiance?
While generic drugs are usually less costly than brand-name drugs, at present, Jardiance doesn't have a generic version available.
More on Jardiance, diabetes, and heart disease medications
Jardiance belongs to the SGLT2 inhibitors class of drugs, which work in the kidneys to excrete excess sugar from the body via urine. Jardiance may have heart and kidney health benefits. Whether a plan covers Jardiance or any other heart disease or diabetes medications depends on the specific plan. Examples of diabetes drugs that may be included are metformin, nateglinide, acarbose, and glyburide. Choose your plan carefully to ensure you're getting coverage for the medications you need.
[1] Kaiser Family Foundation, "Medicare Drug Benefit: Premiums, Cost Sharing, and Benefit Design under Medicare Advantage and Medicare Prescription Drug Plans," Accessed Feb 2023, link
[2] CMS.gov, "Medicare Part D Income-Related Monthly Adjustment Amount," Accessed Feb 2023, link
[3] GoodRx, "Jardiance Cost," Accessed Feb 2023, link
- The out-of-pocket pharmacy cost for 30 tablets of Jardiance, according to Optum Perks, can range around $600, but this cost may be influenced by the insurance plan's tier for Jardiance, the coinsurance, and the choice of pharmacy.
- Every Medicare Part D plan may assign Jardiance to a different tier, and as the tier increases, the cost to the enrollee may escalate. The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new prices for Jardiance and other drugs, which could potentially make them more affordable for Medicare enrollees.
- Financial assistance programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can help reduce the expenses for Jardiance, but a person needs to enroll in a plan that lists Jardiance in its formulary to get insurance coverage.
