Medicare Coverage for Jardiance: A Question Answered
Rewritten Article:
Jump on the Jardiance bandwagon - a med your doc might prescribe for battling heart failure and type 2 diabetes. Most Medicare Part D prescription drug plans provide coverage for this wonder pill. Part C plans with drug coverage shouldn't be left out either, but it depends on the specific plan.
From June 2022 to May 2023, Medicare splurged a whopping $7 billion on Jardiance, with an average customer shelling out $290 from their own pockets in 2022.
Every Medicare-approved drug has a formulary, a list of covered medications. To get the coverage, simply sign up for a prescription drug plan that includes Jardiance on its formulary list.
How much will Jardiance cost me on Medicare?
According to Optum Perks, the pharmacy cost for a 30-tablet Jardiance prescription is approximately $600, depending on the pharmacy. The amount you'll shell out depends on your insurance plan and the tier your plan assigns to this drug. Apart from the coinsurance, you'll also pay a monthly premium for Part C and D. Since these plans are managed by private insurers, premiums can vary according to the plan.
Typically, there's also a deductible before coverage begins. For Part D, this can't exceed $590 in 2025. Additionally, your total spending on any drugs under Part D has an annual cap of $2,000.
Glossary of Medicare terms:
- Out-of-pocket cost: The amount you'll pay for healthcare when Medicare doesn't cover the entire bill or provides no coverage at all. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee someone pays for Medicare coverage.
- Deductible: An annual amount a person must spend out of pocket before Medicare starts funding their treatments.
- Coinsurance: The percentage of healthcare costs you'll have to pay yourself after Medicare steps in. For Medicare Part B, coinsurance is 20%.
- Copayment: A fixed dollar amount you'll pay for certain treatments, usually associated with prescription drugs under Medicare.
In which tier does Jardiance fall with Medicare?
Different Medicare drug plans may place Jardiance in varying tiers, and the higher the tier, the more it costs when coverage kicks in.
The Inflation Reduction Act of 2022 enabled the Secretary of Health and Human Services (HHS) to negotiate new prices for Jardiance and nine other drugs, making these drugs more affordable for enrollees.
Can I score Jardiance for free?
You can lessen the financial strain of Jardiance through various financial assistance programs. These include:
- Medicaid
- Extra Help
- State Pharmaceutical Assistance Programs (SPAPs)
Is there a cheaper alternative to Jardiance?
Generic drugs are generally more affordable than brand-name drugs. However, as of now, Jardiance isn’t available in a generic version.
What other diabetes or heart disease meds are covered under Medicare?
Jardiance belongs to the SGLT2 inhibitor family, which work in your kidneys to eliminate excess sugar via urine. This could potentially benefit your heart and kidneys. Whether your plan covers Jardiance or any other heart disease drug depends on the specific plan, and the same goes for diabetes drugs. Examples of diabetes meds that may be covered include:
- metformin
- nateglinide
- acarbose
- glyburide
A person might also want to know that Original Medicare's Part B covers some drugs that can't be self-administered, such as IV medications.
Might want to check these out:
- Diabetes medications and Medicare
- Does Medicare cover cardiovascular disease?
- Jardiance, a medication often prescribed for managing heart failure and type 2 diabetes, falls under the coverage of most Medicare Part D prescription drug plans.
- The average out-of-pocket cost for a 30-tablet Jardiance prescription in 2022 was approximately $290, although this can vary depending on the prescription drug plan and the assigned tier for this drug.
- To get coverage for Jardiance, one should sign up for a Medicare prescription drug plan that includes it on its formulary list.
- The Inflation Reduction Act of 2022 allows for negotiations on new prices for Jardiance and nine other drugs, potentially making them more affordable for Medicare enrollees.
