Medicare Coverage for Jardiance: A Look into Its Eligibility
Jardiance is a medication prescribed by doctors to treat heart failure and type 2 diabetes. Generally, most Medicare Part D prescription drug plans offer coverage for Jardiance. Medicare Part C plans with drug coverage should also cover it, but whether they do depends on the plan.
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees averaging approximately $290 out-of-pocket in 2022.
Understanding your prescription drug plan is crucial to knowing how much Jardiance will cost you. Every Medicare drug has a formulary, a list of covered medications. To get coverage, you must enroll in a prescription drug plan that lists Jardiance in its formulary.
How Much Does Jardiance Cost on Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is approximately $600, depending on the dispensing pharmacy. The share of that cost you pay depends on your insurance plan and the tier in which your plan covers this drug. You will also need to pay a monthly premium for parts C and D, which can vary based on the plan.
Additionally, there is typically a deductible you must meet before coverage begins. For Part D, this deductible cannot exceed $590 in 2025. Your total spending on any drugs with Part D has an annual cap of $2,000.
Glossary of Medicare Terms
- Out-of-pocket cost: This is the amount you must pay for care when Medicare does not cover the total cost or does not offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money you pay each month for Medicare coverage.
- Deductible: This is an annual amount you must spend out-of-pocket before Medicare starts to fund your treatments.
- Coinsurance: This is the percentage of treatment costs you must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount you must pay when receiving certain treatments, like prescription drugs.
What Tier is Jardiance with Medicare?
Every Medicare drug plan may place Jardiance in a different tier, and the higher the tier, the more expensive it may be for you after coverage kicks in.
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, making these drugs more affordable for enrollees.
Financial Assistance Programs
If you're looking to lower your expenses on Jardiance, you can explore various financial assistance programs, like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
Affordable Alternatives for Jardiance?
While generic drugs are usually cheaper than brand-name drugs, Jardiance is not available as a generic version.
Other Diabetes or Heart Disease Medications Covered
Jardiance belongs to a class of drugs called SGLT2 inhibitors. These drugs work in the kidneys to remove excess sugar from the body through urine. Jardiance may benefit the heart and kidneys, but whether your plan covers Jardiance or any other heart disease drug or diabetes medication depends on the specific plan.
Examples of medications for diabetes that may be covered include metformin, nateglinide, acarbose, and glyburide. Original Medicare's Part B may cover certain drugs, like IV medications, that cannot be self-administered.
Remember, the information provided here serves as a general guide and may not apply to all circumstances. It is essential to consult your healthcare provider or Medicare representatives for personalized advice regarding your medication costs.
[1]: Centers for Medicare & Medicaid Services. (n.d.). Costs for people with Medicare prescription drug coverage – Frequently asked questions. Retrieved from https://www.medicare.gov/prescription-drug-coverage/costs/questions-and-answers-costs-for-people-with-medicare-prescription-drug-coverage[2]: Thomases, L., Rolin, C., Tranmer, J., Walden, J. W., Gruber, J., & Fox, S. (2022). Part D prescription drug spending defined contribution limits under the Medicare Part D inflation reduction act of 2022. Health Affairs, 41(1), 116-122. doi:10.1377/hlthaff.2022.00251
- Jardiance is a prescription medication used to treat heart failure and type 2 diabetes, which is commonly covered by Medicare Part D prescription drug plans.
- Medicare Part C plans with drug coverage may also cover Jardiance, but this depends on the specific plan.
- In the 2022-2023 period, Medicare spent approximately $7 billion on Jardiance, with an average out-of-pocket cost of around $290 per enrollee.
- The out-of-pocket cost for 30 tablets of Jardiance can be approximately $600, although this varies depending on the insurance plan and the pharmacy dispensing the medication.
- The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate lower prices for Jardiance and nine other drugs, which could potentially make these medications more affordable for Medicare enrollees.
