Medicare Coverage for Jardiance: A Determination
Medicare's pricy new med Jardiance, prescribed for heart failure and type 2 diabetes, doesn't come cheap. Yet, many Part D plans offer coverage for it. But, it's crucial to pick a plan that lists Jardiance in its drug list (y'know, the formulary thing).
From June 2022 to May 2023, Medicare spent a whopping $7 billion on Jardiance, with enrollees shelling out an average of $290 out of pocket in 2022.
The out-of-pocket cost for a month's supply of Jardiance at a pharmacy can stretch up to $600 without insurance, but the actual amount a person pays depends on their insurance plan's tier placement for Jardiance, coinsurance rules, and other factors like premiums and deductibles. Remember, you'll also need to pay a monthly premium for Part C and Part D.
Typically, there's a deductible you must meet before coverage kicks in. For Part D, this deductible can't exceed $590 in 2025. Additionally, your total spending on any drugs with Part D has an annual cap of $2,000.
Glossary of Medicare Terms
- Out-of-Pocket Cost: Amount a person pays when Medicare doesn't cover the full cost or provides no coverage. This includes deductibles, coinsurance, copayments, and premiums.
- Premium: Monthly amount someone pays for Medicare coverage.
- Deductible: Annual amount a person must spend out of pocket within a certain period before Medicare starts funding treatments.
- Coinsurance: Percentage of treatment costs a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: Fixed dollar amount a person with insurance pays for certain treatments. For Medicare, this usually applies to prescription drugs.
What Tier is Jardiance with Medicare?
Each Medicare drug plan may place Jardiance in a different tier, and the higher the tier, the more you'll pay after coverage starts. The Inflation Reduction Act of 2022 permitted the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, making them more affordable for enrollees.
How to Get Jardiance for Free?
To lower expenses on Jardiance, consider financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs).
Cheaper Substitute for Jardiance?
Since Jardiance isn't available as a generic, it's pricey. But, generic versions of other diabetes medications may be less costly.
Other Diabetes or Heart Disease Medications Covered?
Jardiance is a SGLT2 inhibitor, a class of drugs that works in the kidneys to eliminate excess sugar from the body through urine. Jardiance may benefit the heart and kidneys. Whether a plan covers Jardiance or any other heart disease drug or diabetes medication depends on the specific plan. Examples of medications for diabetes that plans may cover include metformin, nateglinide, acarbose, and glyburide.
Inquiry further about Jardiance, diabetes medications, and cardiovascular disease coverage with Medicare here!
- Despite Jardiance being a pricy addition to Medicare's health systems, many Part D plans list it in their formulary (or drug list).
- The Inflation Reduction Act of 2022 allowed the Secretary of Health and Human Services to negotiate new prices for Jardiance, making it potentially more affordable for Medicare enrollees.
- In 2022, Medicare spent an overwhelming $7 billion on Jardiance, with enrollees paying an average of $290 out of pocket.
- To help lower expenses on Jardiance, financial assistance programs like Medicaid, Extra Help, and State Pharmaceutical Assistance Programs (SPAPs) may be considered.
- Jardiance, a SGLT2 inhibitor, is a class of drugs that works in the kidneys to eliminate excess sugar, but whether a plan covers it or other diabetes medications like metformin, nateglinide, acarbose, or glyburide depends on the specific plan and its categorization (tier) within that plan.
