Does Medicare Cover Jardiance? 

According to statistics provided by the Centers for Disease Control and Prevention (CDC), there are over 37 million people in the U.S. who have been diagnosed with diabetes. Over 90 percent of those people have type two diabetes. The American Diabetes Association (ADA) reports that 50 percent of Americans who are over 65 have prediabetes and have an elevated risk of developing type two diabetes.  

Your risk of getting type two diabetes is higher in the following instances: 

• You’re prediabetic
• You’re overweight
• You’re 45 or older
• You have a parent or sibling with type two diabetes
• You aren’t physically active (less than three times per week)
• You’ve had gestational diabetes or have given birth to a baby heavier than nine pounds
• You’re African American, Hispanic, American Indian, or Alaskan Native
• You have non-alcoholic fatty liver disease

Type two diabetes occurs when you have insulin resistance.  Your cells don’t use insulin properly and your pancreas tries to keep up with the resistance by producing more and more insulin. When the pancreas can no longer produce enough insulin, blood sugar levels rise, and prediabetes or type two diabetes can be the result. If you don’t control high blood sugar levels you put your health at risk for heart disease, vision loss, kidney failure, and other serious problems.  

Fortunately, it’s possible to prevent or put off getting type two diabetes if you make lifestyle changes like losing weight, exercising more, and eating healthy. However, for many people, even these changes aren’t enough, and they need to take insulin or oral medications like Jardiance to improve their glucose control. If your physician has prescribed Jardiance, Medicare insurance can help you cover some of your expenses. 

Does Medicare cover Jardiance? 

Jardiance is a brand name form of the drug empagliflozin, an oral antidiabetic medication that helps regulate blood glucose levels in people who have type two diabetes. If your health care provider, who accepts Medicare assignment, prescribes Jardiance because they feel it’s medically necessary to treat your medical condition, you may be eligible for coverage. Because Jardiance is an oral tablet that you take yourself at home, it is only covered by a Medicare Part D prescription drug coverage. 

You can get Medicare prescription drug coverage by purchasing a stand-alone Part D plan from a private insurance provider if you have Original Medicare Parts A and B. If you prefer Medicare Advantage (Part C), you can enroll in a plan that offers additional coverage for prescription drugs, called an MA-PD plan. 

All Medicare prescription drug plans are required to cover certain prescription drugs that Medicare beneficiaries commonly use, but they also have the option to cover other drugs on their formularies (lists of covered drugs), so Jardiance might not be on some plans’ formularies. If you already take Jardiance and are comparing plans, check the formularies of available Part D plans in your service area before enrolling. 

How much you pay for Jardiance depends on the type of Medicare Part D plan you have, how much your plan charges for coinsurance or copayments, and on what tier your plan categorizes Jardiance. Most Medicare prescription drug plans categorize Jardiance as a tier-three (preferred brand-name) drug that carries a high copayment. If you aren’t sure about the copayment amount, you can ask a plan representative for details. 

How much does Jardiance cost without Medicare prescription drug coverage? 

Depending on where you live and what pharmacy you shop at, you can expect to pay between $600 and $675 for 30 tablets of 10 mg, or around $758 for 30 tablets of 25 mg of Jardiance. The national average price for a 30-day supply of Jardiance is $742.50. If you don’t have insurance for prescription drugs, you might be eligible for other assistance or discount programs, or you may find local pharmacies that offer coupons for Jardiance.