Medicare Coverage for Jardiance: An Examination
Jardiance: Breaking Down Costs and Coverage on Medicare
Wondering about the costs of Jardiance, a medicine for treating heart failure and type 2 diabetes, under Medicare? This guide lays it all out for you.
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees averaging $290 out of pocket in 2022. But how much will it cost you specifically?
Every Medicare-listed drug comes with its own formulary, a list of covered medications. To get coverage for Jardiance, you need to enroll in a prescription drug plan that has it on their list.
Understanding Jardiance's Costs
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is roughly $600, depending on the pharmacy. The amount you'll truly pay, however, depends on your insurance plan and the tier Jardiance is assigned to.
Alongside this cost, you'll have to pay a monthly premium for Part C and Part D, the cost of which varies based on your chosen plan. There's usually also a deductible that you must meet before coverage begins, capped at $590 in 2025 for Part D. Additionally, the total amount you spend on Part D drugs has an annual cap of $2,000.
Terminology Explained
- Out-of-pocket cost: This is the amount you pay when Medicare doesn't cover the full amount or provides no coverage. Costs could include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the monthly sum you pay for Medicare coverage.
- Deductible: This is an annual amount you must spend out-of-pocket before Medicare starts funding treatments.
- Coinsurance: This is the percentage of treatment costs that you must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed payment you make when receiving certain treatments, commonly applicable to prescription drugs under Medicare.
Finding Jardiance's Tier
Each Medicare drug plan may categorize Jardiance into a different tier, with higher tiers translating to potentially higher costs for you post-coverage.
The Inflation Reduction Act of 2022 allowed the Secretary of Health and Human Services (HHS) to negotiate new, lower prices for Jardiance and nine other drugs, making them more affordable for enrollees.
Lowering Jardiance Expenses
You can trim your expenses on Jardiance via various financial assistance programs such as:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Searching for an Affordable Alternative
While generic medications typically tend to be more affordable than brand-name options, Jardiance doesn't have a generic version available at the moment.
Other Medicare-Covered Diabetes or Heart Disease Drugs
Jardiance belongs to a class of drugs called SGLT2 inhibitors, which work in the kidneys to eliminate excess sugar from the body through urine. These medications might benefit the heart and kidneys. Whether your plan covers Jardiance or any other heart disease drug, as well as diabetes drugs, depends on the specific plan.
Examples of diabetes medications that plans may cover include metformin (Glumetza), nateglinide (Starlix), acarbose (Precose), and glyburide (DiaBeta, Micronase, Glynase).
Learn more about the cost of Jardiance, Medicare coverage for diabetes medications and coverage for cardiovascular diseases.
- Despite the out-of-pocket pharmacy cost for 30 tablets of Jardiance being around $600, your actual cost will depend on your Medicare-assigned insurance plan and the tier Jardiance falls into.
- To find coverage for Jardiance, it's crucial to enroll in a prescription drug plan that includes it in their formulary, a list of covered medications under Medicare.
- The Inflation Reduction Act of 2022 has enabled the Secretary of Health and Human Services to negotiate lower prices for Jardiance, potentially making it more affordable for Medicare enrollees.
