While diabetes is common across the US and at every age, you’re at a higher risk for diabetes when you’re older. About one in five Medicare beneficiaries aged 65 and over has been diagnosed with type 2 diabetes. 

Managing type 2 diabetes involves a careful diet, regular exercise, and a proper medication routine. Medicare covers Jardiance and other medications, like Ozempic, to manage type 2 diabetes. Jardiance is the brand name for Empagliflozin, a drug used to control high blood sugar and treat people with type 2 diabetes.

Learn what you’ll pay for Jardiance with a Medicare Part D plan in this article. 

Key takeaways:

  • 99% of prescription drug plans cover Jardiance.

  • All Part D plans have premiums, deductibles, and copays/coinsurance.

  • Copays for Jardiance could be between $0 and $20, depending on your plan.

  • The Inflation Reduction Act enabled Medicare to negotiate pricing for some prescription drugs on behalf of Medicare beneficiaries. Jardiance is one of the first ten drugs that Medicare is negotiating prices for.

What is Jardiance?

Type 2 diabetes occurs when you have too much sugar in your blood and your body isn’t able to effectively use insulin to regulate your  blood sugar levels. Insulin resistance and too much blood sugar can be dangerous for your health. Having diabetes can increase the risk of nerve damage, heart disease, kidney disease, skin conditions, eye damage, and other serious conditions. 

Doctors can prescribe medications as part of a plan to treat type 2 diabetes and prevent further health complications. Jardiance is a common drug used to treat diabetes, and you’d typically take a pill once a day. 

Jardiance targets a specific protein in the kidneys responsible for reabsorbing sugar back into the bloodstream. It also reduces blood sugar by promoting excess sugar to pass through urination. In addition to controlling blood sugar, the drug minimizes your risk for experiencing  heart attacks and strokes. Your healthcare provider may recommend Jardiance for chronic kidney disease as well.

Does Medicare cover Jardiance?

The vast majority (99%) of Medicare drug plans cover Jardiance. Medicare drug plans, or Part D, always come with a formulary that lists covered medications. Most prescription drug plans usually include the most common drugs. 

In the unlikely event that your plan doesn’t pay Jardiance, you have a couple of different options:

  • You can discuss other medication options that your plan covers with your doctor.

  • You can request a formulary exception, a formal request to add a drug to your plan’s formulary. Keep in mind that your healthcare provider must approve a formulary exception.

  • You can switch your Medicare Part D plan during the Annual Enrollment Period to one that covers Jardiance. If your healthcare needs change, you can always pick a plan that suits your needs better. 

Does Medicare Part D cover Jardiance?

While most Medicare Part D plans cover Jardiance, specific plan formularies and out-of-pocket costs vary. 

Prescription drug plans come with different costs, including monthly premiums, annual deductibles, copayments, and coinsurance.  

Here’s a general breakdown of how much you’re likely to pay for Jardiance:

  • Monthly premium: varies depending on your drug plan

  • Deductible: varies depending on your plan, but can’t exceed $545

  • Copayment or coinsurance: $0-$20

The good news is that because of the Inflation Reduction Act, Medicare lawmakers are working to save you money and improve access to common treatments. Jardiance is one of ten drugs that Medicare will negotiate to lower the price for to improve access to necessary treatments. 

People with type 2 diabetes should know what else their Part D plan covers:

  • People with type 2 diabetes are more likely to be immunocompromised. Your Part D plan covers vaccines like shingles and RSV. If you pay for a shot that you need, you can also contact your plan to get reimbursed.

  • Your prescription drug plan can’t charge you more than $35 for any insulin that’s covered by your plan. You also don’t have to pay a deductible for insulin. 

What other services does Medicare cover for diabetes?

Medicare has comprehensive coverage for diabetes. Here are some of the most common devices, medications, and services that Medicare covers:

  • 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

This list doesn’t include everything that Medicare helps pay for. If you have diabetes, you know that taking care of your health involves the right mix of treatments and lifestyle changes. Choosing the right Medicare plan that meets your needs can save you money, giving you peace of mind so you can focus on your health. 

Our Medicare Advocates and licensed Advisors can help you learn about your Medicare options and use all of your plan benefits. Have questions? Pick a time to meet with us or call us at 855-900-2427 today.

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