Medicare Coverage for Jardiance: Examining the Insurance Scenario
Let's Talk Jardiance: Cost, Coverage, and Save Big
Jardiance is a popular med for heart failure and type 2 diabetes, often prescribed by docs. Majority of Medicare Part D prescription drug plans offer coverage for Jardiance, but Part C plans that include drug coverage? You bet, but there's a catch - coverage depends on the plan.
Between June 2022 and May 2023, Medicare dropped around $7 billion on Jardiance, with enrollees spending an average of $290 out of pocket in 2022. But what's the real cost? According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance hovers around $600, though the actual cost depends on the pharmacy.
The amount you pay for Jardiance depends on your insurance plan and the tier it falls under. Generally, plans place Jardiance in a higher tier, meaning costlier copays or coinsurance rates for you. But don't panic! Medicare introduced an annual cap of $2,000 on out-of-pocket spending for covered medications, offering protection against high drug costs.
Worried about the cost? No worries! You can bring down your expenses through financial assistance programs like Medicaid, Extra Help, State Pharmaceutical Assistance Programs (SPAPs), and more.
Glossary of Medicare Terms- Out-of-pocket cost: The amount you fork over for care when Medicare doesn't cover the entire amount or offer coverage- Premium: The monthly amount you pay for Medicare coverage- Deductible: An annual amount you have to spend out of pocket before Medicare starts to cover your treatments- Coinsurance: The percentage of treatment costs you have to self-fund- Copayment: A fixed dollar amount you pay when receiving certain treatments
What tier is Jardiance with Medicare?
Every Medicare drug plan may place Jardiance in a different tier, and a higher tier means a pricier Jardiance for you. But fret not, the Inflation Reduction Act of 2022 now allows the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, making these drugs more affordable for Medicare enrollees.
Learn more:- What is the Medicare drug list?- How do I get Jardiance for free?
Is there a cheaper substitute for Jardiance?
Sadly, no generic version of Jardiance exists, but keep hope alive! Generics are usually more affordable than brand-name drugs, so there's a chance cheaper substitutes might be developed in the future. Stay tuned!
What other medications for diabetes or heart disease are covered?
Jardiance belongs to a group called SGLT2 inhibitors, which work wonders in the kidneys by removing excess sugar from the body through urine. This class of drugs can benefit the heart and kidneys. Whether your plan covers Jardiance or any other heart disease drug or diabetes medication depends on the specific plan. Check out examples of diabetes drugs your plan might cover, like:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Don't forget, Original Medicare's Part B might cover certain drugs, particularly IV medications that you can't administer yourself.
Learn more:- Diabetes medications and Medicare- Does Medicare cover cardiovascular disease?
- The out-of-pocket cost for Jardiance can vary depending on the Medicare drug plan, as every plan may place it in a different tier, with a higher tier meaning a more expensive Jardiance for the enrollee.
- 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, aiming to make these drugs more affordable for Medicare enrollees.
- Currently, there is no generic version of Jardiance, but in the future, cheaper substitutes might be developed, as generics are typically more cost-effective than brand-name drugs.
