Medicare Coverage for Jardiance: A Question Answered?
Jardiance on Medicare: How Much It Costs, Tiers, and More
Jardiance is a popular medication for treating type 2 diabetes and heart failure that many Medicare Part D prescription drug plans cover. But how much does it cost, and why can the price vary from one person to another?
During the period from June 2022 to May 2023, Medicare shelled out approximately $7 billion on Jardiance. Individuals, on average, forked over around $290 out-of-pocket in 2022[1]. However, the actual cost of Jardiance for an individual can fluctuate significantly based on several factors.
The Cost Breakdown
Medicare's coverage for Jardiance kicks off with a prescription drug plan that lists the medication in its formulary. The out-of-pocket cost for a 30-tablet supply of Jardiance can range around $600 at a dispensing pharmacy, depending on the negotiation between the pharmacy and the insurance plan[1]. The exact amount a person pays depends on their insurance plan's specific terms and conditions, such as the tier in which Jardiance is placed, coinsurance rate, deductibles, and other factors.
Plan Tiers and Coinsurance
Every Medicare drug plan may categorize Jardiance into a different tier, with higher tiers typically translating to higher out-of-pocket costs for the individual. Thankfully, the Inflation Reduction Act of 2022 enables the Secretary of Health and Human Services (HHS) to negotiate new, more affordable prices for Jardiance and nine other drugs[5].
Those Battling the High Costs
Fortunately, financial assistance programs are available to help individuals lower their Jardiance expenditures. Eligibility requirements vary by program, but examples include Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs)[4].
Generic Alternatives
Currently, there is no generic version of Jardiance available, making it a more expensive option compared to generic medications. Nevertheless, cheaper alternatives for treating diabetes and heart disease may be covered by Medicare, such as metformin, nateglinide, acarbose, glyburide, and others[3].
It's essential to consult with a healthcare provider and Medicare advisor to determine the best course of action when managing the costs of Jardiance and other medications.
Specific Terms
- Out-of-pocket cost: Money paid for care without Medicare's total reimbursement or coverage. Typically includes deductibles, coinsurance, copayments, and premiums.
- Premium: Monthly payment for Medicare coverage.
- Deductible: Annual out-of-pocket amount required to be paid before Medicare starts covered treatments.
- Coinsurance: Percentage of treatment costs covered by the individual. For Medicare Part B, coinsurance is typically 20%.
- Copayment: Fixed dollar amount paid by the insured for specific treatments. Usually applies to drugs under Medicare prescription plans.
[1] https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/understanding-your-part-d-costs/how-does-part-d-cost-your-premiums-deductibles-and-copays
[2] https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/how-does-part-d-cost-your-premiums-deductibles-and-copays/how-does-part-d-cost-coverage-gap
[3] https://www.healthline.com/health/diabetes/alternatives-to-jardiance
[4] https://www.medicare.gov/Pubs/pdf/10148.pdf
[5] https://www.kff.org/medicare/issue-brief/fact-sheet-inflation-reduction-act-of-2022-reconciliated/#medicare-prescription-drug-negotiation
- Despite the average out-of-pocket cost of Jardiance being around $290 in 2022, the actual cost for an individual can greatly vary due to factors like tier placement, coinsurance rate, deductibles, and negotiations between the pharmacy and insurance plan.
- The Inflation Reduction Act of 2022 grants the Secretary of Health and Human Services the ability to negotiate more affordable prices for Jardiance and nine other drugs, potentially reducing the cost for individuals.
- Financial assistance programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs can help individuals lower their Jardiance expenditures, with eligibility requirements varying by program.
