Medicare Coverage for Jardiance: A Clarification
Jardiance is a medication used to treat heart failure and type 2 diabetes, often covered under Medicare Part D prescription drug plans. However, coverage may also be found in Medicare Advantage plans with drug coverage.
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees forking out around $290 out-of-pocket in 2022. But how much does Jardiance actually cost on Medicare?
Well, according to Optum Perks, the cost for 30 tablets of Jardiance in a retail pharmacy hovers around $600. Yet, the amount a person pays depends on the plan's tier structure, deductible, and coinsurance, among other factors.
Usually, there's a monthly premium to pay for Medicare Part C and Part D, and private insurers determine these charges. A deductible must also be met before Medicare begins funding treatments. In 2025, this deductible cannot exceed $590.
Besides these costs, there's also a cap of $2,000 on a person's total drug spending with Part D, providing a financial safety net against catastrophic drug expenses.
Glossary of Medicare Terms
- Out-of-pocket cost: The amount a person pays for care when Medicare doesn't cover everything. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount someone pays for Medicare coverage.
- Deductible: An annual amount a person must spend out-of-pocket before Medicare starts funding treatments.
- Coinsurance: The percentage of treatment costs a person must pay themselves.
- Copayment: A fixed dollar amount a person with insurance must pay for receiving certain treatments.
Jardiance falls into a specific tier within each Medicare drug plan's formulary, and the higher the tier, the more expensive it may be for a person after coverage kicks in. Fortunately, the Inflation Reduction Act of 2022 allows the Secretary of Health and Human Services to negotiate new prices for Jardiance and nine other drugs, making these medications more affordable for enrollees.
To lower expenses on Jardiance, consider financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs). However, a cheaper substitute for Jardiance isn't available as it's a brand-name drug without a generic version currently.
Jardiance belongs to the SGLT2 inhibitor class, which works in the kidneys to remove excess sugar from the body through urine. This medication may offer benefits to the heart and kidneys. Whether a person's plan covers Jardiance or other diabetes or heart disease drugs depends on the specific plan. Some examples of diabetes medications that may be covered include metformin, nateglinide, acarbose, and glyburide. To learn more about these and other related topics, check out our guides on diabetes medications and Medicare, as well as whether Medicare covers cardiovascular disease.
- Jardiance, falling under a specific tier in each Medicare drug plan's formulary, might be costlier for an individual after coverage kicks in due to its tier placement.
- The Inflation Reduction Act of 2022 enables the Secretary of Health and Human Services to negotiate lower prices for Jardiance and nine other drugs, potentially making these medications more affordable for Medicare enrollees.
- To offset expenses on Jardiance, one can explore financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs), although a generic substitute for Jardiance, which is a brand-name drug, currently does not exist.
