Medicare Coverage for Jardiance: A Look at the Insurance Scenario
Straight Talk on Jardiance Costs in Medicare Part D Plans
Jardiance, a go-to medication for managing heart failure and type 2 diabetes, is typically covered by most Medicare Part D plans. However, the cost varies depending on the plan and its formulary tier placement.
How Much Does Jardiance Cost on Medicare?
Without insurance, a 30-tablet dose of Jardiance can set you back around $600, depending on the pharmacy[1]. But fret not! With a Medicare Part D plan, the out-of-pocket cost is subject to the plan's formulary tier.
In the 2022 fiscal year, Medicare enrollees, on average, paid $290 out-of-pocket for Jardiance[1].
The Lowdown on Formulary Tiers and Costs
Budget-Friendly Assistance and Tier Placement
- Medicare Extra Help: This program, designed for low-income Medicare beneficiaries, assists with Part D costs, such as covering premiums, deductibles, and copays[5].
- Patient Assistance Programs: These programs, like the BI Cares Patient Assistance Program, offer financial aid to uninsured or underinsured individuals, including those with Medicare Part D[2].
- State Pharmaceutical Assistance Programs (SPAPs): These state-run programs provide financial relief to certain populations for prescription costs, but coverage varies from state to state[4].
Different Tiers, Different Costs
Part D plans sort medications into different tiers based on cost and formulary status. These tiers typically include:
- Tier 1: Affordable generic drugs, usually with the lowest copay.
- Tier 2: Preferred brand drugs, moderately priced.
- Tier 3: More expensive non-preferred brand drugs, with higher copays.
- Tier 4: Specialty drugs, with the highest copays or coinsurance[1].
Placement in a higher tier can significantly increase out-of-pocket costs. For instance, if Jardiance is on Tier 3, the copay will be higher than if it were on Tier 2.
Keeping Costs in Check
- Deductible and Annual Cap: Part D plans come with a deductible ($590 in 2025) and an annual spending cap of $2,000[1].
- Medigap Plans: Although these supplementary plans do not directly cover Part D costs, they can help with other out-of-pocket expenses related to Medicare Parts A and B[5].
In a nutshell, the cost of Jardiance under Medicare Part D depends on the plan's formulary tier placement and your eligibility for financial assistance programs.
- Many Medicare Part D plans cover Jardiance, a medication used for managing heart failure and type 2 diabetes, but the cost can vary based on the plan's formulary tier.
- In the 2022 fiscal year, Medicare enrollees paid an average of $290 out-of-pocket for Jardiance under Medicare Part D.
- To assist with Part D costs, programs like Medicare Extra Help, Patient Assistance Programs, and State Pharmaceutical Assistance Programs (SPAPs) are available for low-income beneficiaries or those with high prescription costs.
- Part D plans categorize medications into different tiers, such as Tier 1 for affordable generics, Tier 2 for preferred brand drugs, Tier 3 for more expensive non-preferred brand drugs, and Tier 4 for specialty drugs like Jardiance.
- To keep costs in check for Jardiance under Medicare Part D, enrollees should be aware of the plan's deductible ($590 in 2025), annual spending cap of $2,000, and potential financial assistance programs.
