Medicare Coverage for Jardiance: Is it Included?
New and Improved: A Peek at Jardiance and Medicare Coverage
Jardiance, a medication used for treating heart failure and type 2 diabetes, is often covered by Medicare Part D prescription drug plans. However, it's essential to note that Part C plans, which combine Medicare benefits (including prescription drug coverage), might vary in their coverage depending on the specific plan.
From the period of June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees forking out an average of $290 out-of-pocket in 2022. But what does this mean for you when it comes to out-of-pocket costs?
Every medication on Medicare comes with its own formulary, or list of covered medications. To secure coverage for Jardiance, a person needs to sign up for a prescription drug plan that has Jardiance on its formulary.
How Much Does Jardiance Cost on Medicare?
According to Optum Perks, the approximate out-of-pocket pharmacy cost for a month's supply (30 tablets) of Jardiance is roughly $600, subject to the dispensing pharmacy. Keep in mind that the share of this cost a person pays depends on their specific insurance plan and the tier Jardiance falls under within the plan. Besides the copayment or coinsurance, an individual will also pay a monthly premium for Medicare Part C and Part D. It's vital to know that the premium for these plans may differ based on the plan.
In addition to these costs, there is usually a deductible to consider before coverage kicks in. For Part D plans in 2025, the deductible cannot surpass $590. Furthermore, an individual's total spending on any medications with Part D comes with an annual cap of $2,000.
Glossary of Medicare Terms
- Out-of-Pocket Cost: The amount an individual pays when Medicare does not cover the whole expense or provides no coverage. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount an individual pays for Medicare coverage.
- Deductible: An annual amount an individual must spend out of pocket within a specific period before Medicare takes over their treatments.
- Coinsurance: The percentage of treatment costs an individual must cover. For Medicare Part B, the coinsurance is 20%.
- Copayment: A fixed dollar amount an individual with insurance pays for certain treatments. For Medicare, this usually applies to prescription drugs.
What Tier is Jardiance with Medicare?
Every Medicare drug plan can list Jardiance in a different tier, and a higher tier typically means a higher cost for the individual after coverage is applied.
Thanks to the Inflation Reduction Act of 2022, the Secretary of Health and Human Services now has the authority to negotiate new prices for Jardiance and several other drugs, making these medications more accessible for Medicare enrollees.
Is There a Cheaper Alternative for Jardiance?
While generic drugs are generally more affordable than brand-name drugs, Jardiance does not yet have a generic version available.
Other Diabetes or Heart Disease Medications Covered
Jardiance belongs to the SGLT2 inhibitor class of drugs. These medications help eliminate excess sugar from the body through urine in the kidneys. Jardiance may have benefits for the heart and kidneys. Whether a plan covers Jardiance or other medications for heart disease or diabetes depends on the specific plan - the same applies for diabetes treatments. Examples of diabetes drugs that might be covered include metformin, nateglinide, acarbose, and glyburide.
While Original Medicare's Part B doesn't typically cover self-administered drugs, it may cover IV medications, like those that can't be taken by the individual themselves.
- despite the high out-of-pocket cost for Jardiance, which is approximately $600 per month, individuals can find coverage for it through Medicare Part D prescription drug plans or Medicare Advantage (Part C) plans that include prescription drug coverage.
- The Inflation Reduction Act of 2022 has granted the Secretary of Health and Human Services the authority to negotiate lower prices for medications like Jardiance, which may make these drugs more affordable for Medicare enrollees in the future.
- As Jardiance is not yet available in a generic form, finding a cheaper alternative might be challenging, and individuals should explore other diabetes and heart disease medications, such as metformin, nateglinide, acarbose, glyburide, or medically administered IV medications covered by Medicare Part B, depending on their specific plan.
