Medicare Coverage for Jardiance: A Question Answered
Jump on board and learn all about Jardiance, a medication that doctors often prescribe for heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans include coverage for Jardiance, with Part C plans featuring drug coverage being no exception - although coverage might differ depending on the specific plan.
In the fiscal year spanning June 2022 to May 2023, Medicare splashed out a whopping $7 billion on Jardiance, with enrollees coughing up an average of $290 out of pocket during the preceding year. Each medicine under Medicare has its own list, known as a formulary, of covered medications. To get coverage for Jardiance, an individual must sign up for a prescription drug plan that includes this medication on its formulary.
How much does Jardiance cost on Medicare?
According to Optum Perks, the cash price for 30 tablets of Jardiance in a pharmacy hovers around the $600 mark, subject to variations based on the pharmacy. Exactly how much an individual pays out-of-pocket depends on their insurance plan and the plan's tier for this particular drug. Besides the coinsurance, folks have to budget for a monthly premium for Medicare Part C and D. Because private insurance firms manage these plans, the premiums are determined by the specific plan.
Usually, there is a deductible that must be met before Medicare starts contributing to treatment costs. For Part D, the maximum yearly deductible is capped at $590 in 2025, and the total spending on drugs covered under Part D comes with an annual limit of $2,000.
Cost-Related Terms Demystified
- Out-of-pocket cost: The sum a person must part with for care when Medicare doesn't bear the entire expense or offer coverage. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount of money someone pays monthly for Medicare coverage.
- Deductible: An annual fee a person must pay out of pocket before Medicare begins wrapping their treatment costs.
- Coinsurance: The percentage of treatment costs a person must shoulder themselves. For Medicare Part B, coinsurance amounts to 20%.
- Copayment: A fixed dollar amount a person with insurance pays when receiving certain treatments, like prescription drugs.
What tier is Jardiance with Medicare?
Each Medicare drug plan might allocate Jardiance to a different tier, and the higher the tier, the pricier the drug may be for the end-user after coverage kicks in. Thanks to the Inflation Reduction Act of 2022, the Secretary of Health and Human Services is now empowered to negotiate new prices for Jardiance and nine other drugs, potentially making these medications more affordable for enrollees.
Slashing Jardiance Costs: Strategies and Savings Plans
An individual can lower their Jardiance expenses through various financial assistance programs. These programs include:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is there an affordable alternative to Jardiance?
Generically produced medications are typically more affordable compared to brand-name drugs. Regrettably, Jardiance does not exist in a generic version.
Diabetes and Heart Disease Meds: Coverage and Alternatives
Jardiance belongs to a category of drugs known as SGLT2 inhibitors. These drugs work wonders in the kidneys, helping expel excess sugar from the body via urine. Jardiance shows promise for both heart and kidney health. Whether a plan covers Jardiance or any other medication for heart disease, or treatments for diabetes, depends on the specific plan.
Examples of diabetes medications that might be covered include:
- metformin (Glumetza)
- nateglinide (Starlix)
- acarbose (Precose)
- glyburide (DiaBeta, Micronase, Glynase)
Medicare's Part B might cover certain drugs, like IV medications, typically administered in hospitals and cannot be self-administered.
- The costs of Jardiance for an individual on Medicare can vary, depending on factors like the specific insurance plan, the plan's tier for this medication, and out-of-pocket expenses such as premiums, deductibles, coinsurance, and copayments.
- To get coverage for Jardiance, an individual must sign up for a prescription drug plan that includes this medication on its formulary, as each medicine under Medicare has its own list of covered medications.
- The Inflation Reduction Act of 2022 gives the Secretary of Health and Human Services the power to negotiate new prices for Jardiance and nine other drugs, potentially making these medications more affordable for Medicare enrollees.
