Medicare Coverage for Jardiance: A Review
Hangin' with Jardiance: A Guide to Heart Failure and Type 2 Diabetes Medication Under Medicare
Jardiance, a popular medication for treating heart failure and type 2 diabetes, is typically covered by most Medicare Part D prescription drug plans. However, coverage can be a bit tricky with Part C plans, as it depends on the specific plan.
In the period from June 2022 to May 2023, Medicare shelled out a whopping $7 billion on Jardiance, with an average out-of-pocket cost of around $290 for enrollees in 2022. But what's the real cost of Jardiance on your pocket?
Every Medicare-covered drug comes with a formulary, a list of approved medications. To get coverage for Jardiance, one must enroll in a prescription drug plan that includes it in their formulary.
The Real Cost of Jardiance on Medicare
According to Optum Perks, the pharmacy cost for a 30-tablet pack of Jardiance is about $600, but this can vary based on the pharmacy. The actual cost you pay depends on your insurance plan, the tier in which your plan covers Jardiance, and any additional fees like coinsurance and premiums.
Apart from the pharmacy cost, you'll also need to pay a monthly premium for Medicare Part C and Part D. These premiums can vary, as they're managed by private insurers.
Typically, you'll also encounter a deductible that you need to meet before your coverage kicks in. The maximum deductible for Part D in 2025 is $590. Also, there's an annual cap on total Part D spending, which stands at $2,000.
Medicare 101: Breaking Down the Jargon
- Out-of-pocket cost: The amount you pay for care when Medicare doesn't cover the entire bill. This includes deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee you pay for Medicare coverage.
- Deductible: An annual amount you must spend out of pocket before Medicare starts covering your treatments.
- Coinsurance: The percentage of treatment costs you must pay yourself after Medicare and your insurance cover their share.
- Copayment: A fixed fee you pay for certain treatments when using insurance.
Where Does My Jardiance Land?
The tier for Jardiance in your Medicare drug plan can significantly affect your out-of-pocket costs. The higher the tier, the more you might have to pay after coverage kicks in.
The Inflation Reduction Act of 2022 has allowed the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, potentially making these drugs more affordable for patients.
Lowering the cost of Jardiance
You can lower your Jardiance expenses through various financial assistance programs such as Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
A Cheaper Alternative for Jardiance?
Since Jardiance isn't available as a generic version, finding a cheaper substitute might be a challenge.
Other Diabetes and Heart Disease Medications Under Medicare
Jardiance belongs to the SGLT2 inhibitors, a class of drugs that help the kidneys remove excess sugar from the body through urine. Besides Jardiance, various other drugs for diabetes or heart disease might be covered by your plan. Examples include:
- Metformin (Glumetza)
- Nateglinide (Starlix)
- Acarbose (Precose)
- Glyburide (DiaBeta, Micronase, Glynase)
Remember, Original Medicare's Part B might cover certain IV medications, typically those that can't be self-administered.
For more detailed information about diabetes medications, Medicare coverage for cardiovascular disease, and Jardiance costs, feel free to delve deeper into the resources provided.
[1] Medicare.gov. (n.d.). Part D drug cost for Jardiance. Retrieved from https://www.medicare.gov/ drugs/searchtool/index.aspx?cyear=2025&drugname=Jardiance&click=
[2] Centers for Medicare & Medicaid Services. (2022). 2025 out-of-pocket policy changes. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2025-out-of-pocket-policy-changes
[3] Centers for Medicare & Medicaid Services. (2022). Medicare drug price negotiation and inflation reduction act implementation timeline. Retrieved from https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price-negotiation-inflation-reduction-act-implementation-timeline
[4] Centers for Medicare & Medicaid Services. (2021). 2021 beneficiary premiums for Medicare prescription drug plans. Retrieved from https://www.cms.gov/newsroom/fact-sheets/2021-beneficiary-premiums-medicare-prescription-drug-plans
[5] Centers for Medicare & Medicaid Services. (2021). Medicare coverage of prescription drugs. Retrieved from https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn.html
- It's important to note that the actual cost of Jardiance can vary based on the specific health system and Medicare plan, as well as variables like the pharmacy's price, tier within the plan, additional fees, and out-of-pocket costs.
- In the realm of science and health-and-wellness, Medicare has been significantly investing in medications like Jardiance, spending approximately $7 billion from June 2022 to May 2023, a significant portion of which is borne by Medicare enrollees in the form of out-of-pocket costs.
- As part of the Medicare 101 education, understanding key terms such as 'premium', 'deductible', 'coinsurance', and 'copayment' can help Medicare beneficiaries make informed decisions about their healthcare costs, including the cost of Jardiance.
