Medicare Coverage for Jardiance: A Clarification Needed
Taking a closer look at Jardiance and Medicare
Jardiance, a popular medication for managing type 2 diabetes and heart failure, is covered by most Medicare Part D prescription drug plans. You can also find it in Part C plans that include drug coverage, but eligibility depends on the specific 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.
Each Medicare drug has a formulary – a list of covered medications. To secure coverage for Jardiance, you need to enroll in a prescription drug plan that includes it on 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 generally around $600, varying by the dispensing pharmacy. The actual share of this cost you might pay depends significantly on your insurance plan's tier for this drug and your plan's specific benefits. Alongside coinsurance, you'll also need to pay a monthly premium for parts C and D. These premiums vary depending on the plan you've chosen.
Typically, you'll also encounter a deductible before coverage starts. For Part D, this annual deductible cannot surpass $590 in 2025. Moreover, your total drug spending with Part D has an annual cap of $2,000.
Medicare terms demystified
- Out-of-pocket cost: The amount you pay for care when Medicare doesn't cover the entire bill or doesn't offer coverage. Costs can include deductibles, coinsurance, copayments and premiums.
- Premium: The amount of money someone pays each month for Medicare coverage.
- Deductible: An annual amount you must spend out-of-pocket within a certain timeframe before Medicare starts funding your treatments.
- Coinsurance: The percentage of treatment costs you must fund yourself. For Medicare Part B, coinsurance is 20%.
- Copayment: A fixed dollar amount you pay when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Where does Jardiance fall in Medicare's tiers?
Every Medicare drug plan may assign Jardiance to a different tier, and the higher the tier, the more you'll pay after coverage kicks in.
The Inflation Reduction Act of 2022 paved the way for the Secretary of Health and Human Services (HHS) to negotiate lower prices for Jardiance and nine other drugs.
Cutting costs for Jardiance with financial assistance
You can lower your expenses on Jardiance through various financial aid programs:
- Medicaid
- Extra Help (to lessen prescription drug expenses)
- State Pharmaceutical Assistance Programs (SPAPs)
A cheaper alternative to Jardiance?
Since Jardiance is a brand-name drug, there's no generic version available yet. That said, generic drugs generally offer savings compared to brand-name drugs.
covered medications for diabetes and heart disease
Jardiance falls under a class of drugs called SGLT2 inhibitors, which work in the kidneys to flush excess sugar from the body through urine. These drugs can benefit heart and kidney health. Whether your plan covers Jardiance or other heart disease medications or diabetes drugs depends on your specific plan. Here are some common diabetes medications that might be covered:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Another important factor to consider is that Original Medicare's Part B might cover certain intravenous medications, typically those you cannot administer yourself.
- The popular medication Jardiance, used for managing type 2 diabetes and heart failure, is covered by most Medicare Part D prescription drug plans and some Part C plans that include drug coverage.
- In 2022, Medicare spent approximately $7 billion on Jardiance, with enrollees averaging about $290 out-of-pocket.
- For 30 tablets of Jardiance, the out-of-pocket pharmacy cost is generally around $600, although this can vary based on the dispensing pharmacy and your insurance plan's specific benefits.
- The cost you pay for Jardiance on Medicare can also include premiums, deductibles, coinsurance, and copayments.
- As of 2025, the annual Part D deductible cannot exceed $590, and there's an annual cap of $2,000 on total drug spending with Part D.
- Various financial aid programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs can help lower expenses on Jardiance.
