Medicare Coverage for Jardiance: An Examination
Jardiance: A Medication for Heart Failure and Type 2 Diabetes
Jardiance is a popular medicine prescribed by doctors to handle heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans include coverage for Jardiance, with Medicare Advantage plans offering coverage too, but it's important to note plan-specific differences.
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with the average out-of-pocket expense in 2022 reaching $290 for enrollees.
Every prescription medication under Medicare has a formulary, a list of covered meds. To access coverage, one must enroll in a prescription drug plan that lists Jardiance on its formulary.
Cost of Jardiance on Medicare
As per Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance can range between $500 and $750, depending on the chosen pharmacy. The individual's coverage and the drug tier in their plan will determine the specific share they pay. Apart from co-insurance, one must also pay a monthly premium for Parts C and D, and there's usually a deductible that needs to be met before coverage begins.
Medicare Terms
- Out-of-pocket cost: The amount a person must pay from their pocket when Medicare does not fully cover the expenses or does not offer coverage. This might include deductibles, co-insurance, co-payments, and premiums.
- Premium: The monthly amount a person pays for Medicare coverage.
- Deductible: The annual expenses a person must cover before Medicare starts taking care of their treatments.
- Co-insurance: The percentage of treatment costs that the person must pay out-of-pocket. For Medicare Part B, the co-insurance is 20%.
- Co-payment: A fixed dollar amount a person pays when accessing certain treatments, typically for prescription drugs covered under Medicare.
Tier of Jardiance with Medicare
Jardiance may be assigned to different tiers by various Medicare drug plans, with higher tiers leading to increased out-of-pocket expenses post coverage start. The Inflation Reduction Act of 2022 granted the Secretary of Health and Human Services (HHS) the authority to negotiate new prices for Jardiance and many other medications, potentially making them more affordable for enrollees.
Financial assistance programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) can help lower the expenses for Jardiance. Since there's no generic equivalent available for Jardiance, cheaper alternatives aren't readily available.
Other Covered Diabetes or Heart Disease Medications
Jardiance belongs to the class of SGLT2 inhibitors working in kidneys to eliminate excess sugar from the body via urine. Although coverage for Jardiance will depend on the plan, several other heart disease or diabetes medications might be covered as well, including:
- SGLT2 inhibitors (e.g., Invokana, Farxiga)
- Metformin
- Nateglinide
- Acarbose
- Glyburide
Original Medicare's Part B may also cover IV medications that cannot be self-administered. To learn more about different diabetes medications, their costs, and Medicare coverage, visit here and here.
- Jardiance, a medication for heart failure and type 2 diabetes, is often covered under Medicare Part D, with Medicare Advantage plans providing coverage as well, though plan-specific differences should be noted.
- The average out-of-pocket expense for Jardiance in 2022 was $290 for Medicare enrollees.
- Depending on the chosen pharmacy and the individual's coverage, the out-of-pocket cost for a 30-tablet supply of Jardiance can range from $500 to $750.
- To access coverage for Jardiance, enrollment in a prescription drug plan that lists it on the formulary is required.
- The Inflation Reduction Act of 2022 gave the Secretary of Health and Human Services the power to negotiate new prices for Jardiance and other medications, potentially making them more affordable for enrollees.
