Diabetes is common in the US. 11.6% of the total population and 29.2% of the senior population has diabetes. Type 2 diabetes is more common and people with type 2 diabetes have a higher risk of hospitalization for heart and kidney complications caused by high blood sugar.

Luckily, there are medications that help manage type 2 diabetes and prevent life-threatening situations. Farxiga is one diabetes prescription that stabilizes the amount of sugar in your blood. 

90% of Medicare drug plans cover Farxiga, but this will change in the future to include more plans. We’ll discuss how much Farxiga costs with Medicare, alternatives to Farxiga (like Jardiance), and other diabetes-related services that Medicare covers. 

Key takeaways:

  • 90% of Medicare drug plans cover Farxiga, a tablet that helps people with Type 2 diabetes regulate their blood sugar levels.

  • What you’ll pay for Farxiga depends on your plan’s cost structure. Check your policy’s summary of benefits to get a sense of what you’ll pay.

  • The average cost for Farxiga is $38.82 for a month’s supply with coverage.

  • The Inflation Reduction Act allows Medicare to negotiate pricing for some prescription drugs, including Farxiga. This will help make the drug more affordable in the future.

What is Farxiga?

Farxiga is a drug that people with type 2 diabetes use to manage blood sugar levels.

The generic name for Farxiga is dapaglifozin, which is its main ingredient. Farixiga reduces high blood sugar in two ways:

  • It blocks a protein in the kidney responsible for putting sugar back into your blood after a filtering process. 

  • It flushes excess sugar during urination. 

By regulating blood sugar, Faxiga prevents the risk of hospitalization for heart and kidney problems in people with type 2 diabetes.

Does Medicare cover Farxiga?

90% of Medicare drug plans cover Farxiga. You can confirm your coverage by checking your drug plan’s formulary, which lists all covered drugs. Most prescription drug (Part D) plans help pay for common drugs, including Farxiga. If you find your drug coverage doesn’t include Farxiga, you can take one of the following steps to get the drug coverage you need:

  • Discuss other alternatives for medication with your doctor. One alternative, Jardiance, is covered by every Medicare prescription drug plan.

  • Submit a formal request to add Farxiga drug to your plan’s formulary with a formulary exception. A healthcare provider has to approve a formulary exception.

  • Switch your Medicare Part D plan during the Annual Enrollment Period. From October 15 to December 7, you can choose a drug plan that suits your needs better than your current Part D policy. You may also be eligible to switch today through a Special Enrollment Period. Chat with a licensed Medicare Advisor to compare plans, understand Medicare, and talk through what’s best for your health and financial wellness. Call us today at 855-900-2427 or book an appointment to see if you’re eligible to switch today.

There are upcoming initiatives to make Farxiga and other common prescriptions more affordable. Through the Inflation Reduction Act, Medicare is able to negotiate the price of some prescription drugs to make them more accessible and less costly. Farxiga is one of the first ten drugs that Medicare will negotiate prices for. 

Does Medicare Part D cover Farxiga?

Though most Medicare Part D plans cover Farxiga, you may still owe out-of-pocket costs. including: 

  • A monthly premium for your prescription drug plan

  • An annual deductible—Medicare Part D deductibles can’t exceed $545 in 2024 and some plans have no deductibles

  • A copay or coinsurance—the average copay for Farxiga is $38.82 for a month’s supply

Your specific out-of-pocket expenses will depend on your plan. Check your formulary and contact your plan’s carrier if you have questions about how much you’ll pay for Farxiga. 

Medicare coverage for diabetes-related services

Medicare’s coverage for diabetes extends beyond medication. Medicare covers supplies, screenings, and other services for diabetes as well. Here are some examples of what’s generally covered:

  • Blood sugar testing supplies like glucose monitors, test strips, and lancets

  • Insulin pumps and insulin

  • Therapeutic shoes or inserts

  • Oral medications

  • Preventative services, including the Medicare Diabetes Prevention Program 

  • Nutrition therapy services

Understanding your Medicare coverage is important for helping you get quality, affordable care.  Our licensed Medicare advisors are here to help! Call us today at 855-900-2427 or schedule an appointment for free, personalized support.

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