Medicare Coverage for Jardiance: A Look at Eligibility
Laidback Lowdown on Jardiance Costs Under Medicare
Jardiance is a medication commonly prescribed for managing heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans will cover Jardiance, alongside some Part C plans with drug coverage, but it depends on the specifics of the plan.
From June 2022 to May 2023, Medicare spent roughly $7 billion on Jardiance, with enrollees typically paying an average of $290 out-of-pocket in 2022.
Every Medicare-approved drug comes with a formulary, a list of covered medications. To snag coverage, you'll need to enroll in a plan that lists Jardiance on its formulary.
Budgeting Jardiance: How Much Will It Cost on Medicare?
According to Optum Perks, a single 30-tablet box of Jardiance may cost around $600, largely depending on the pharmacy you choose. The amount you fork out-of-pocket depends on your coverage plan and the tier it places the drug in.
Apart from the coinsurance portion, you'll need to pay a monthly premium for both Part C and Part D. These premiums can vary based on your plan, as they are managed by private insurers.
Generally, you'll also need to meet a deductible before coverage begins, and for Part D, this cannot surpass $590 in 2025. Alongside that, there's an annual cap of $2,000 on your total spending on any prescription drugs with Part D.
Medicare Jargon Explained: Don't Get Caught Off Guard!
- Out-of-pocket cost: The buck you dish out of your pocket when Medicare doesn't meet the entire payment or cover the treatment. Costs might include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount you pay each month to keep your Medicare coverage rolling.
- Deductible: The annual amount you need to shell out-of-pocket before Medicare starts to chip in for your treatments.
- Coinsurance: The percentage of treatment costs you need to foot yourself. For Medicare Part B, this comes to 20%.
- Copayment: A fixed dollar amount you pay when you pick up certain treatments. For Medicare, usually this applies to prescription drugs.
What tier is Jardiance with Medicare?
Each Medicare plan might place Jardiance in a different tier, with higher tiers generally meaning higher out-of-pocket costs after coverage kicks in. 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 these medications more affordable for enrollees.
Scoring Jardiance for Free: Cost Reduction Options
You can lower your expenses on Jardiance by exploring several financial assistance programs, including:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
A More Affordable Option: Cheaper Swaps for Jardiance?
Generic drugs typically cost less than brand-name drugs, but Jardiance isn’t available in a generic form.
When It Comes to Diabetes or Heart Disease Medications: What Else Is Covered?
Jardiance belongs to a class of drugs called SGLT2 inhibitors, which work in the kidneys to remove excess sugar from the body via urine. These drugs may benefit heart and kidney health.
Whether a plan covers Jardiance or other diabetes or heart disease drugs depends on the specific plan. Plans might offer coverage for drugs like:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Original Medicare's Part B: Covering IV Drugs
When it comes to Part B, Original Medicare might cover certain intravenous (IV) drugs, usually those that patients cannot self-administer.
Finding More Information: From Diabetes Medications to Cardiovascular Disease
- "Learn more: What is the Medicare drug list?"
- "Learn more: Jardiance (empagliflozin) and cost"
- "Learn more: Diabetes medications and Medicare"
- "Learn more: Does Medicare cover cardiovascular disease?"
- Jardiance is often prescribed for managing both heart failure and type 2 diabetes, and it is usually covered under Medicare Part D prescription drug plans and some Part C plans with drug coverage.
- To ensure Jardiance is covered by your Medicare plan, you need to find a plan with the medication listed on its formulary and meet the plan's specific requirements.
- Medicare costs for Jardiance vary based on factors such as the plan's tier, deductibles, coinsurance, copayments, and premiums, which can change monthly and are influenced by the private insurer managing the plan.
- You can reduce Jardiance costs through programs like Medicaid, Extra Help, or State Pharmaceutical Assistance Programs (SPAPs).
- Generic drugs usually cost less than brand-name drugs, but since Jardiance isn't available in a generic form, exploring these cost reduction options can help manage expenses.
