Medicare Coverage for Jardiance: An Exploration
Medicare's Justice, aka Jardiance, is a medication docs recommend for dealing with heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans cover Jardiance, along with Medicare Part C plans that include drug coverage, but it depends on your specific plan.
From the start of June 2022 to May 31, 2023, Medicare doled out a whopping $7 billion on Jardiance, with enrollees dropping around $290 out of pocket in 2022.
Every medication on Medicare comes with a list of covered treatments, known as a formulary. To get coverage, you gotta join a prescription drug plan that lists Jardiance in its formulary.
How much does Jardiance set you back on Medicare?
According to Optum Perks, the out-of-pocket cost for 30 tablets of Jardiance can hit around $600, but it varies by pharmacy and insurance plan. The actual amount you pay depends on your plan's coverage tier for this drug, coinsurance, or copayments, and any deductibles or premiums.
Glossary of Medicare jargon:
- Out-of-pocket cost: Money you fork over for healthcare when Medicare doesn't pay the full amount or offer coverage. Costs include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount you give each month for Medicare coverage.
- Deductible: An annual amount you must pay for healthcare before Medicare begins to foot the bill.
- Coinsurance: The percentage of the cost you have to cover yourself after you meet the deductible.
- Copayment: A fixed dollar amount you pay for certain treatments when you have insurance.
What tier is Jardiance in Medicare?
Each Medicare drug plan might place Jardiance in a different tier, and the higher the tier, the costlier it becomes after coverage kicks in. The Inflation Reduction Act of 2022 allowed HHS to negotiate new prices for Jardiance and nine other meds, making these drugs more budget-friendly for enrollees.
Can I nab Jardiance for free?
There are various financial assistance programs to lower your Jardiance expenses like:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is there a cheaper Jardiance stand-in?
Generic drugs are often more affordable than brand-name drugs, but Jardiance doesn't have a generic version yet.
Other diabetes or heart disease treatments covered by Medicare:
Jardiance belongs to the SGLT2 inhibitors clan, which operate in the kidneys to boot excess sugar from the body through pee. These drugs might help the heart and kidneys. Whether your plan covers Jardiance or any other heart disease drug depends on the specific plan, as does coverage for diabetes treatments. Examples of diabetes treatments that plans might cover include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Original Medicare's Part B may cover certain drugs, such as IV medications that you can't administer yourself.
- The out-of-pocket cost for 30 tablets of Jardiance on Medicare can range around $600, but it may vary depending on the pharmacy and insurance plan.
- The actual amount you pay for Jardiance depends on your plan's coverage tier for this drug, coinsurance, copayments, and any deductibles or premiums.
- Each Medicare drug plan might place Jardiance in a different tier, and the higher the tier, the costlier it becomes after coverage kicks in.
- The Inflation Reduction Act of 2022 allowed the Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other meds, making these drugs more budget-friendly for enrollees.
- There are financial assistance programs to lower Jardiance expenses, such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
- Jardiance belongs to the SGLT2 inhibitors class, a group of therapies and treatments that might help the heart and kidneys, and other diabetes treatments like metformin, nateglinide, acarbose, and glyburide may be covered by Medicare, depending on the specific plan.
