Medicare Drug Coverage and Costs for Jardiance in Heart Failure and Diabetes Care
Jardiance is a medication commonly prescribed for managing heart failure and type 2 diabetes, with widespread coverage under Medicare Part D prescription drug plans. Coverage under Medicare Part C plans that include prescription drugs varies based on the specific plan and formulary details. From June 2022 to May 2023, Medicare expenditures on Jardiance totaled approximately $7 billion, with average out-of-pocket costs for enrollees around $290 in 2022. The medication’s pricing and copayment obligations differ depending on plan structures, formulary tier placement, and deductible requirements, which for Part D plans cannot exceed $590 in 2025 and include an annual out-of-pocket cap of $2,000 for drug spending.
The cost of Jardiance can also be influenced by the dispensing pharmacy, with typical retail prices for a 30-tablet supply reaching around $600 without insurance. While generic alternatives often provide cost savings, Jardiance currently has no generic versions available. It belongs to the SGLT2 inhibitor drug class, which facilitates glucose removal via the kidneys and has benefits for both cardiac and renal health. Plan-specific formularies determine access and cost-sharing for Jardiance and other diabetes or heart failure treatments.
Legislative changes, such as the Inflation Reduction Act of 2022, have empowered the Department of Health and Human Services to negotiate drug prices for Jardiance and select other medications, aimed at enhancing affordability for Medicare beneficiaries. Patients may also access financial assistance programs to mitigate drug expenses.
In addition to Part D coverage, some patients may receive drug coverage through Medicare Part B for medications administered via infusion or injection, typically when self-administration is not feasible. Medicare Advantage Prescription Drug plans consolidate benefits from original Medicare with Part D drug coverage, providing an integrated option for enrollees.
Medicare also offers avenues for beneficiaries to seek enrollment assistance and address questions related to their health coverage options, including resources from CMS and State Health Insurance Assistance Programs. Continuous evaluation through beneficiary surveys helps Medicare gauge service quality and risk factors, supporting policy adjustments and improvements in coverage delivery.