Medicare Coverage for Jardiance: A Review
Ready to get your heart and diabetes under control with Jardiance? Most Medicare prescription drug plans got ya covered!
Jardiance is the medication your doctor prescribes to manage heart failure and type 2 diabetes. As of 2022, Medicare spent a whopping $7 billion on Jardiance, with an average out-of-pocket expense of $290 for enrollees.
Every medicine on Medicare has a formulary, a list of covered medications. To get coverage, you gotta enroll in a plan that has Jardiance on their list.
What's the Cost of Jardiance Under Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance hovers around $600, depending on the pharmacy. The actual amount you shell out depends on your insurance plan and the tier it covers Jardiance in.
In addition to the coinsurance, you've got to tackle a monthly premium for Medicare Part C and Part D. Because these plans are managed by private insurers, their premiums vary.
Typically, you'll also hit a deductible before coverage kicks in. For Part D, this cannot be higher than $590 in 2025, and your total drug spending under Part D has an annual cap of $2,000.
Medicare Terms Decoded
- Out-of-pocket cost: Money you pay out of pocket when Medicare doesn't cover or fund the entire amount.
- Premium: The monthly amount you pay for Medicare coverage.
- Deductible: The annual amount you must spend out-of-pocket before Medicare starts paying for your treatments.
- Coinsurance: The percentage of treatment costs you self-fund after meeting your deductible. In the case of Medicare Part B, that's 20%.
- Copayment: A fixed dollar amount you pay for certain treatments when you have insurance. Usually, this applies to prescription drugs.
Tier Level of Jardiance with Medicare
Every Medicare drug plan can place Jardiance in a different tier, and the higher the tier, the more costly it may be for you after coverage starts. The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more budget-friendly for you!
Lower Your Jardiance Expenses
Looking to save a few bucks on Jardiance? Check out financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
A Cheaper Alternative for Jardiance?
[Unfortunately, Jardiance is not available as a generic version.]
Other Diabetes and Heart Disease Medications
Jardiance is part of the SGLT2 inhibitor class. This drug works in your kidneys to remove excess sugar through urine, benefiting your heart and kidneys. If your plan covers Jardiance, it may also cover other heart disease and diabetes medications. Examples include:
- Metformin (Glumetza)
- Nateglinide (Starlix)
- Acarbose (Precose)
- Glyburide (DiaBeta, Micronase, Glynase)
Curious about what else Medicare covers? Check out our guide to diabetes medications and Medicare or learn about Medicare coverage for cardiovascular disease.
[1] Source: Centers for Medicare and Medicaid Services. 2022 Medicare Part D Drug Costs for Typical Beneficiaries. https://www.cms.gov/research-statistics-data-systems/research/medicare-current-statistics/part-d/part-d-annual-report-of-benchmark-premiums-and-industry-benchmark.html.[2] Source: Medicaid.gov. Eligibility and Premiums. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/consumers/income-limits.html.[3] Source: SSA.gov. Extra Help with Medicare Prescription Drug Costs. https://www.ssa.gov/benefits/prescriptionhelp/.[4] Source: AARP.org. A Guide to Pharmaceutical Assistance Programs. https://www.aarp.org/health/drugs-supplements/info-2019/pharmaceutical-assistance-programs-drug-assistance-programs.html.[5] Source: Medicare.gov. Medicare Costs at a Glance. https://www.medicare.gov/what-medicare-covers/costs-for-medicare-services/medicare-costs-at-a-glance.[5] Source: Medicare.gov. 2023 Changes to Medicare Costs. https://www.medicare.gov/your-medicare-costs/downloads/Part-D-2023-Deductible-Announcement.pdf.
- The out-of-pocket cost for Jardiance under Medicare Part D depends on the insurance plan's tier for the medication and can vary significantly.
- Medicare enrollees should consider financial assistance programs like Medicaid, Extra Help, and SPAPs to lower their expenses on Jardiance, which does not have a generic version available.
- Medicare may cover other heart disease and diabetes medications in the same class as Jardiance, such as Metformin, Nateglinide, Acarbose, and Glyburide, making it important to understand the overall health-and-wellness and medicare coverage landscape for effective management of these conditions.
