Medicare Coverage for Jardiance: A Look into Possibilities
Refreshed Take on Jardiance: Costs, Coverage, and Assistance on Medicare
Jardiance, a popular medication for treating heart failure and type 2 diabetes, often finds its way into Medicare Part D prescription drug plans. However, coverage can slightly differ between Part C plans with drug coverage and the user's specific plan.
From June 2022 to May 2023, Medicare spent an astounding $7 billion on Jardiance, with the average Medicare enrollee coughing up approximately $290 out of pocket in 2022.
Every Medicare-coverable drug has a formulary, a tidy list of medications included in the plan. To get Jardiance on the insurance, one must enroll in a prescription drug plan that lists this marvel in its formulary.
How much does Jardiance cost on Medicare, you ask?
The out-of-pocket pharmacy cost for 30 tablets of Jardiance typically hovers around $600, depending on the specific pharmacy. Yet, the actual amount you'll pay depends on your insurance plan, the tier assigned to Jardiance, and the ever-lazy monthly premiums.
Naturally, Parts C and D come with deductibles. For Part D, this often can't top $590 in 2025. A unique aspect of Part D coverage is the annual cap: your total spending on medications in a year is restricted to $2,000.
Simplified Medicare Language
- Out-of-pocket cost: The cash you shell out for healthcare costs that Medicare doesn't cover, including deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee for Medicare coverage.
- Deductible: The annual chunk of cash you have to fork over before Medicare starts contributing to your treatments.
- Coinsurance: The percentage of healthcare costs that you have to foot; for Medicare Part B, this is 20%.
- Copayment: A fixed fee you pay for specific treatments, usually prescription drugs.
Tier placement and Jardiance
Every Medicare drug plan might relegate Jardiance to a unique tier, and higher tiers often equate to a pricier bill for you after coverage.
The Inflation Reduction Act of 2022 has granted the Secretary of Health and Human Services (HHS) the power to negotiate new, sensible prices for Jardiance and nine other drugs, lowering costs for enrollees.
Curious about getting Jardiance gratis?
Financial assistance programs can go a long way in cutting your Jardiance bill. These include:
- Medicaid: Those eligible can expect to have lower out-of-pocket costs or no copays for medications, including Jardiance.
- Extra Help (Low-Income Subsidy): Limited income and resources might make you eligible for Extra Help, which shrinks the cost of Medicare Part D prescription drugs.
- State Pharmaceutical Assistance Programs (SPAPs): These programs offer extra financial support for medications and can further reduce out-of-pocket costs.
Sayonara to Expensive Jardiance?
Regrettably, Jardiance isn't available as a generic alternative, making it pricier than off-brand options.
Learn more: What is the Medicare drug list?
Jardiance or Other Diabetes or Heart Disease Medications: Which Ones Are Covered?
Jardiance belongs to the SGLT2 inhibitor clan of drugs, operating in the kidneys to eliminate excess sugar from the body via the pee. These benefits can enhance the heart and kidneys' functionality.
Whether a plan covers Jardiance or any other heart disease drugs or diabetes medications depends on the specific plan, with examples of possible diabetes medications that may be covered including:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Some treatments, like injectable drugs, might be covered by Original Medicare's Part B.
Learn more: Diabetes medications and Medicare
Learn more: Does Medicare cover cardiovascular disease?
- The out-of-pocket cost for Jardiance on Medicare can vary depending on the specific pharmacy, insurance plan, and tier assigned to Jardiance, but it typically hovers around $600 for 30 tablets.
- Medicare drug plans often relegate Jardiance to a unique tier, and higher tiers may result in a higher out-of-pocket cost for the patient.
- Financial assistance programs such as Medicaid, Extra Help (Low-Income Subsidy), and State Pharmaceutical Assistance Programs (SPAPs) can help reduce the cost of Jardiance for eligible individuals.
