Medicare Coverage for Jardiance: A Question Answered
Talkin' 'Bout That Jardiance: Breakin' Down Costs on Medicare
Here's the scoop on Jardiance, that medicine docs dish out for treatin' heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans offer coverage for Jardiance, but it's a different story with Part C plans; they might cover it, but it depends on the plan.
From June 2022 to May 2023, Medicare doled out a hefty $7 billion on Jardiance, with enrollees shelling out an average $290 out-of-pocket in 2022.
Every Medicare drug's got a formulary, a list of their faves. You need to enroll in a prescription drug plan that has Jardiance in its formulary to get coverage.
How Much Does Jardiance Cost on Medicare?
According to Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance is roughly $600, depending on the pharmacy. But what you pay depends on your insurance plan and the drug's tier. Yep, there's a tier system, and the higher the tier, the more it'll cost after coverage kicks in.
On top of the coinsurance, you've got to pay a monthly premium for Part C and D. The premiums can vary like crazy since private insurers are managezin' these plans. Plus, there's usually a deductible you gotta meet before coverage begins, and for Part D, this can't be higher than $590 in 2025.
Glossary of Medicare Terms
- Out-of-pocket cost: The amount you pay when Medicare doesn't cover the total cost. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The money you pay each month for Medicare coverage.
- Deductible: An annual amount you gotta spend out of pocket before Medicare starts to cover your treatments.
- Coinsurance: The percentage of the treatment costs you gotta cover yourself. For Medicare Part B, it's 20%.
- Copayment: A fixed dollar amount you pay when you receive certain treatments, usually for prescription drugs.
What Tier is Jardiance with Medicare?
Jardiance might be found in different tiers by each Medicare drug plan. The higher the tier, the pricier it can get after coverage. The Inflation Reduction Act of 2022 gave the Secretary of HHS the power to negotiate new prices for Jardiance and other drugs, so they'll be more affordable for enrollees.
Can I Get Jardiance for Free?
You can lower your expenses by checkin' out financial assistance programs like Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs).
Is There a Cheaper Substitute for Jardiance?
Since Jardiance ain't got a generic version yet, other options might be more budget-friendly.
What Other Diabetes or Heart Disease Meds Are Covered?
Jardiance belongs to the SGLT2 inhibitors family, which work in the kidneys to boot excess sugar from the body. These medications can be a boon for your heart and kidneys. Wether your plan covers Jardiance or any other heart disease drug depends on the plan, and this applies to drugs for diabetes too. Some diabetes meds that plans might cover include metformin, nateglinide, acarbose, and glyburide.
Know that Original Medicare's Part B might cover certain drugs, like IV medications that you can't administer yourself.
[1] Source: Medicare Improvements for Patients and Providers Act (MIPPA) of 2008: Patient Relief and educational information for Medicare beneficiaries https://www.medicare.gov/Pubs/pdf/11236-Medicare-Improvements-Patients-and-Providers-Act-of-2008.pdf
[2] Source: Bagshaw, M. (2022). The cost of jardiance: out-of-pocket drug expenditures among Medicare Part D enrollees https://onlinelibrary.wiley.com/doi/10.1002/jmd.12224
[3] Source: Centers for Medicare & Medicaid Services (n.d.) Medicare Part D Catastrophic Coverage https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Catastrophic-Coverage
[4] Source: Centers for Medicare & Medicaid Services (n.d.) How to Save Money on Prescription Drugs https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/How-to-Save-Money-on-Prescription-Drugs
[5] Source: Boehringer Ingelheim (n.d.) Boehringer Ingelheim Cares Patient Assistance Program https://ussupport.boehringer-ingelheim.com/ottuserver/_gui/_VerpflichteterLinks/VAHome-redirect.cgi?projectname=GastroIntestinal&targeturl=https%3A%2F%2Fus.boehringer-ingelheim.com%2Fus-ci-cares%2F
[6] Source: SingleCare (n.d.) Prescription Discount Cards https://www.singlecare.com/questions/answers/what-are-prescription-discount-cards
[7] Source: Centers for Medicare & Medicaid Services (n.d.) Alerts and Important Information about Medicare Part D Drug Limits https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/ Downloads/Medicare-Drug-Limits-All-Beneficiaries.pdf
- The Medicare spending on Jardiance, a treatment for heart failure and type 2 diabetes, exceeded $7 billion from June 2022 to May 2023, with enrollees averaging an out-of-pocket expense of $290 in 2022.
- To get coverage for Jardiance, which is a pharmaceutical listed in the formulary of Medicare drug plans, one must enroll in a prescription drug plan that includes it.
- As per Optum Perks, the out-of-pocket pharmacy cost for 30 tablets of Jardiance may be around $600, but this depends on the insurance plan and the drug's tier in the plan.
- There are various financial assistance programs like Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs) that can help lower expenses for Medicare enrollees, and these programs should be explored for saving costs on medications like Jardiance, which doesn't have a generic version at the moment.
