Medicare Coverage for Jardiance: Is It Included?

Chillin' with Jardiance on Medicare: All You Need to Know

Hey there! Let's talk about Jardiance, a medication that helps treat heart failure and type 2 diabetes, often prescribed by doctors. And guess what? Most Medicare Part D prescription drug plans got your back on this one.

But, don't forget about Medicare Part C plans with drug coverage. They're cool too, but remember that coverage can vary between plans.

In the 2022-23 season, Medicare shelled out a cool $7 billion for Jardiance, with enrollees averaging $290 out of pocket. That's a pretty penny, though costs can fluctuate.

Every Medicare drug comes with a formulary, which is a fancy list of covered medications. To get coverage for Jardiance, you gotta enroll in a prescription drug plan that includes it on their list.

You're probably wondering, "How much does Jardiance cost on Medicare?" Well, the out-of-pocket cost for 30 tablets at a retail pharmacy can run you around $600. But, hey, the amount you'll pay depends on your insurance plan and drug tier, and, of course, that monthly premium for parts C and D.

Remember, there's usually a deductible that you've gotta hit before coverage kicks in, but for Part D, that cannot exceed $590 in 2025. Also, your total prescription drug spending has an annual cap of $2,000.

Stay Wise:

Out-of-pocket cost: The amount you gotta fork over for care when Medicare doesn't cover it.
Premium: Money you pay each month for Medicare coverage.
Deductible: An annual amount you must spend out of pocket until Medicare starts funding treatments.
Coinsurance: The percentage of treatment costs you must cover yourself.
Copayment: A fixed amount you pay when receiving treatments with insurance.

On the tier side of things, every Medicare drug plan may have a different tier for Jardiance, and it’s all about the placement. Higher tiers can mean more expense for you after coverage.

In 2022, the Inflation Reduction Act busted onto the scene, allowing the Secretary of Health and Human Services to negotiate new prices for Jardiance and other drugs, making them more affordable for us.

If you're trying to score Jardiance for free or lower costs, options include:

Medicaid
Extra Help
State Pharmaceutical Assistance Programs (SPAPs)

Unfortunately, the generic version of Jardiance isn't available quite yet.

Tips & Tricks:

SGLT2 inhibitors, like Jardiance, work in the kidneys to remove excess sugar through urine, potentially benefiting your heart and kidneys.
Whether a plan covers Jardiance or any other heart disease or diabetes medications depends on the specific plan.
Original Medicare's Part B may cover certain drugs, like IV medications. These are typically drugs you can't self-administer.

Sources:

1.https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn2.https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-2022-faqs-part-d-prescription-drug-spending-limit-excess-cost-shar3.https://www.aaoncologypartners.com/blog/relief-for-cancer-patients-with-expensive-drugs-in-the-next-yr4.https://www.asmusa.org/medicare-prepare/part-d/5.https://www.medicare.gov/what-medicare-covers/part-d/how-part-d-works6.https://www.medicare.gov/drug-limits/pharmacy-cost-sharing-limits

The Medicare Part D prescription drug plans generally cover Jardiance, a medication used for heart failure and type 2 diabetes, but enrollees might have to pay around $290 out of pocket on average.
If you're considering Medicare Part C plans with drug coverage, remember that coverage can vary between plans, so it's essential to check the specific plan's formulary to ensure Jardiance is included.
Science plays a significant role in the pricing of medicines, and in 2022, the Inflation Reduction Act was implemented to allow the Secretary of Health and Human Services to negotiate new, more affordable prices for drugs like Jardiance.