What Medicare covers for Jardiance

Medicare Part D covers Jardiance (empagliflozin), a diabetes medication, but your out-of-pocket cost depends on which Part D plan you have, which pharmacy you use, and where you fall in the coverage gap. Most plans place Jardiance in a middle tier, meaning you pay a copay or coinsurance rather than the full price. The drug itself costs roughly $250 to $400 per month at retail, but Medicare negotiates lower prices with pharmacies, and your plan's negotiated rate is what determines your bill.

Your actual cost moves through three stages during the calendar year: the deductible stage (if your plan has one), the initial coverage stage where you pay a set copay or percentage, and potentially the coverage gap (the "donut hole") where costs rise temporarily before catastrophic coverage kicks in. Not all Part D plans have a deductible, and some plans cover Jardiance with no deductible at all.

Key Takeaways

  • Jardiance costs between $250 and $400 per month at retail, but Medicare Part D plans negotiate lower prices, usually resulting in a copay of $10 to $50 per month depending on your plan's tier.
  • Your out-of-pocket cost depends entirely on which Part D plan you chose and which pharmacy you use, so comparing plans during open enrollment can save you hundreds of dollars per year.
  • If you fall into the coverage gap (donut hole), your Jardiance cost jumps significantly until you reach catastrophic coverage, but manufacturer coupons may help bridge that gap.
  • You can check your exact copay by logging into your plan's website, calling the plan's customer service number, or using the Medicare Plan Finder tool with your specific medications listed.

How Part D tiers affect your Jardiance cost

Part D plans organize drugs into tiers, and Jardiance's tier placement determines whether you pay a flat copay or a percentage of the cost. Tier 1 drugs (generics) usually cost $5 to $15 per month. Tier 2 (preferred brand-name) drugs typically cost $25 to $50. Tier 3 (non-preferred brand-name) drugs can run $50 to $100 or more. Jardiance usually lands in Tier 2 or Tier 3, depending on the plan.

A Tier 2 plan might charge you $35 per month for Jardiance, while a Tier 3 plan might charge $60 or ask you to pay 25 percent of the negotiated price. The difference between plans can be $200 to $400 per year for the same medication. Some plans also offer preferred pharmacy networks where the copay is lower if you fill at a specific chain.

The coverage gap and what happens there

Once you and your plan have spent $5,850 combined on covered drugs in 2024 (this amount changes yearly), you enter the coverage gap. In the gap, you pay a higher percentage of the drug cost — currently 25 percent for brand-name drugs like Jardiance. This means your monthly bill for Jardiance could jump from $35 to $80 or more until your total out-of-pocket spending reaches $8,550, at which point catastrophic coverage begins and Medicare pays most of the cost.

Not everyone hits the coverage gap. If your monthly Jardiance copay is $35 and you take no other drugs, you would need to fill 167 prescriptions in one year to reach the gap threshold — unlikely for a once-daily medication. But if you take multiple medications or have other health costs, the gap becomes real. Manufacturer coupons for Jardiance can help reduce your cost in the gap, though they cannot be used with Medicare.

Finding your plan's exact copay

The fastest way to find your specific copay is to log into your Part D plan's website and search for Jardiance by name. Most plan websites have a drug search tool that shows your copay at different pharmacy chains. If you do not have online access, call the customer service number on your insurance card and ask for the copay at your preferred pharmacy.

You can also use the Medicare Plan Finder tool at Medicare.gov. Enter your zip code, select your current plan or browse available plans, and add Jardiance to your medication list. The tool will show you the copay for each plan and let you compare total yearly costs. This is especially useful during the annual open enrollment period (October 15 to December 7) when you can switch plans.

Manufacturer coupons and patient information programs

Boehringer Ingelheim, the manufacturer of Jardiance, offers a coupon program that can reduce your copay to as little as $10 per month if you have commercial insurance or are uninsured. However, Medicare rules prohibit using manufacturer coupons to pay your Part D copay — doing so would violate the anti-kickback statute. You cannot use the coupon to supplement your Medicare coverage.

If you are in the coverage gap and facing high out-of-pocket costs, contact Boehringer Ingelheim's patient information program directly to ask about other support options. Some manufacturers offer programs for Medicare patients in the gap, though these are less common than commercial coupons. The program can be reached through the manufacturer's website or by calling 1-800-542-6257.

Comparing plans during open enrollment

Your Part D copay is not fixed — it changes if you switch plans. During open enrollment (October 15 to December 7 each year), you can switch to a different Part D plan, and many people find plans with lower Jardiance copays by doing so. A plan that charged $50 per month last year might charge $40 this year, or a new plan might offer $30.

To compare, use Medicare Plan Finder and enter Jardiance as one of your medications. The tool will rank plans by total yearly cost for your specific drug list, not just by copay. A plan with a $30 copay might cost more overall if it has a high deductible, while a plan with a $40 copay and no deductible might save you money. Review the list of pharmacies in each plan's network too — some plans charge different copays at different chains.

What to do if your copay is too high

If your current plan's Jardiance copay is unaffordable, you have several options. First, check whether a generic version of empagliflozin is available under your plan — generics are usually much cheaper and work the same way. Second, switch plans during open enrollment to one with a lower copay for Jardiance. Third, talk to your doctor about whether a different diabetes medication might work for you and cost less under your plan.

If you are in the coverage gap and facing a sudden cost increase, contact your plan to confirm you are in the gap and ask when you will reach catastrophic coverage. Some people find it helpful to use a prescription discount card (like GoodRx) for one or two months to bridge the gap, though you cannot combine a discount card with Medicare coverage — you must choose one or the other for each fill. Your doctor's office or local health department may also know of pharmaceutical information programs specific to your area.

Frequently Asked Questions

Does Medicare Part B cover Jardiance?

No. Part B covers injectable medications and some oral drugs given in a doctor's office, but Jardiance is a pill you take at home, so it falls under Part D (prescription drug coverage). If you do not have Part D, you are responsible for the full cost unless you are in a Medicare Advantage plan that includes drug coverage.

Can I use a GoodRx coupon with Medicare?

No. Medicare rules prohibit combining discount cards like GoodRx with Part D coverage. You must choose one or the other for each prescription. However, you can compare the GoodRx price to your Part D copay and use whichever is cheaper — just tell the pharmacy which you are using before they process the claim.

What if my plan stops covering Jardiance?

Plans can change their formularies (the list of covered drugs) from year to year. If your plan removes Jardiance or moves it to a higher tier, you can switch to a different Part D plan during open enrollment. You can also ask your doctor to request an exception from your current plan, though approval is not may provide.

Does my copay count toward the out-of-pocket maximum?

Yes. Your Part D copays count toward your yearly out-of-pocket spending limit. Once you reach that limit (currently $8,550 in 2024), catastrophic coverage begins and Medicare pays most of your drug costs for the rest of the year.

Can I get a 90-day supply of Jardiance to save money?

Many Part D plans offer a lower copay for 90-day supplies filled by mail or at certain pharmacies. Check your plan's website or call customer service to see if this option is available and what the copay would be. A 90-day supply might cost $80 instead of three 30-day copays of $35 each.