Medicare Coverage for Jardiance: A Look into Its Eligibility
Rewritten Article:
Jardiance is a popular medication for treating heart failure and type 2 diabetes. A majority of Medicare Part D prescription drug plans cover this medication, along with some Medicare Advantage plans with drug coverage (Part C). However, the specific costs can vary between these plans.
From June 2022 to May 2023, Medicare spend a staggering $7 billion on Jardiance, with the average enrollee shelling out $290 out of pocket during the same year.
Every Medicare-approved drug has a formulary, a list of covered medications. To get coverage for Jardiance, you need to enroll in a plan that includes it in their formulary.
Want to know how much Jardiance costs under Medicare?
It's tricky to give an exact figure, as costs depend on the plan's formulary tier, the dispensing pharmacy, and your insurance coverage. According to Optum Perks, out-of-pocket pharmacy costs for a 30-tablet supply of Jardiance can be around $600, but this isn't set in stone.
The amount you personally pay depends on your plan's coverage, the drug tier, and any additional fees like premiums and deductibles. The coinsurance percentage you pay for Part B treatment is typically 20%, but this might vary.
On top of these fees, you'll be responsible for a monthly premium for Parts C and D. Since these plans are managed by private insurers, the premiums can differ significantly from one plan to another.
Yes, there is usually a deductible you must meet before coverage begins. For Part D, this cannot exceed $590 in 2025. Also, your total annual spending on Part D drugs has an annual cap of $2,000 in 2025, which puts a limit on your expenses.
Need to brush up on Medicare terms? Here's a quick guide:
- Out-of-pocket cost: The amount paid out of your pocket when Medicare doesn't cover the full cost or provide coverage.
- Premium: The monthly amount paid for Medicare coverage.
- Deductible: An annual amount you must pay out of pocket before Medicare starts footing the bill.
- Coinsurance: The percentage of the total cost you must pay after your deductible has been met.
- Copayment: A fixed amount paid for certain treatments, typically prescription drugs.
So, what tier is Jardiance with Medicare?
The tier placement can differ between plans, and higher tiers usually mean higher costs. The Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, potentially making them less expensive for enrollees.
Is there a cheaper alternative to Jardiance?
While generic drugs are usually more affordable, Jardiance isn't available as a generic yet. However, there are financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) that can help lower your expenses.
Any cheaper alternatives for diabetes or heart disease treatments?
Jardiance belongs to the SGLT2 inhibitors class, which work by removing excess sugar from the body through urine in the kidneys. These drugs can benefit your heart and kidneys. Whether a plan covers Jardiance or any other heart disease drug depends on your specific plan. For diabetes treatments, plans might cover alternatives like metformin, nateglinide, acarbose, or glyburide.
Remember, Original Medicare's Part B may cover certain drugs that you can't administer yourself, like IV medications.
Learn more: What is the Medicare drug list? | Diabetes medications and Medicare | Does Medicare cover cardiovascular disease?
Sources:1. Centers for Medicare & Medicaid Services, Medicare Part D prescription drug plans and costs [Accessed: 01 March 2023]2. Centers for Medicare & Medicaid Services, Lower Costs: Medicare Prescription Drug Plans [Accessed: 01 March 2023]
- Although Jardiance is covered by many Medicare Part D prescription drug plans, the exact cost can vary due to factors such as formulary tier and dispensing pharmacy.
- Under Medicare, the specific costs for Jardiance can be influenced by factors like coinsurance, copayments, and premiums for both Part C and Part D, in addition to potential fees like deductibles.
- In some cases, enrollees might pay an out-of-pocket cost of around $600 for a 30-tablet supply of Jardiance, but this amount can change depending on various factors such as the plan's coverage and drug tier.
