Medicare coverage for Jardiance depends on which Medicare plan you have and your specific situation

Jardiance (empagliflozin) is a diabetes medication that Medicare may cover, but the answer is not the same for everyone. Original Medicare (Part B) does not cover outpatient prescription drugs at all — that coverage comes through Part D, a separate prescription drug plan you choose yourself. If you have a Medicare Advantage plan (Part C), that plan includes drug coverage, but what it covers and what you pay varies by plan. The only way to know for certain is to check your specific plan's formulary, which is the official list of drugs your plan will pay for.

Key Takeaways

  • Original Medicare Part B does not cover any outpatient prescription drugs; you need Part D or a Medicare Advantage plan for Jardiance coverage.
  • Each Part D plan and Medicare Advantage plan maintains its own formulary, and Jardiance may be covered by some plans but not others.
  • You can search your plan's formulary on Medicare.gov, call your plan directly, or ask your pharmacist to check coverage before you fill a prescription.
  • If your plan does not cover Jardiance, you may be able to request a coverage exception, or your doctor can prescribe an alternative diabetes medication that is covered.
  • Your coverage can change each year during the annual enrollment period, so it is worth checking again in the fall even if Jardiance was covered last year.

How to check if your plan covers Jardiance

The fastest way is to call your plan's customer service number, which is on the back of your insurance card. Tell them you take Jardiance and ask whether it is on their formulary and what your out-of-pocket cost would be. They can answer in minutes.

If you prefer to check yourself, go to Medicare.gov and use the Plan Finder tool. Enter your zip code, income, and current medications (including Jardiance), and it will show you which plans in your area cover it and what the costs would be. You can also search your plan's formulary directly on its website if you already know which plan you have.

Your pharmacist can also check coverage for you. When you pick up a prescription, the pharmacy's system will tell them when ready whether your plan covers it and what your copay is. If you are not yet taking Jardiance but your doctor has recommended it, ask the pharmacist to check before your doctor writes the prescription.

What "covered" actually means for your costs

Even if Medicare covers Jardiance, you will still pay something out of pocket. Most Part D plans and Medicare Advantage plans place Jardiance on a tier — usually Tier 2 or Tier 3 — which means you pay a copay (a flat amount like $15 or $50) or coinsurance (a percentage of the drug's cost). The exact amount depends on your plan.

You also need to know about the coverage gap, sometimes called the "donut hole." Once you and your plan have spent a certain amount on covered drugs in a calendar year, you enter the gap and pay a higher percentage of the drug cost until you reach the out-of-pocket spending limit. For 2024, that threshold varies by plan, but your plan's summary of benefits will tell you the exact amount. After you hit the limit, Medicare pays most of the cost for the rest of the year.

If the copay or coinsurance is more than you can afford, ask your doctor whether a generic alternative is available. Metformin and other older diabetes drugs are often cheaper or free on many plans. You can also ask your doctor to request a coverage exception, which is a formal request to your plan to cover a drug it normally would not or to lower your copay.

What to do if your plan does not cover Jardiance

If your current plan's formulary does not include Jardiance, you have three options. First, you can switch plans during the annual enrollment period (October 15 to December 7 each year) and choose a plan that does cover it. Use the Plan Finder tool to see which plans in your area include Jardiance and compare the total costs, including premiums and copays.

Second, you can ask your plan for a coverage exception. Your doctor will need to submit a written request explaining why Jardiance is medically necessary for you — for example, if you have tried other diabetes drugs and they did not work or caused side effects. Some plans approve these requests, though it can take one to two weeks. Ask your doctor's office to submit the request; they handle this regularly.

Third, your doctor can prescribe a different diabetes medication that your plan does cover. Many plans cover metformin, sulfonylureas, or other older diabetes drugs at a lower cost than Jardiance. Your doctor can help you decide whether an alternative is right for your situation.

Changes to coverage each year

Medicare drug coverage changes every January 1. A drug your plan covered last year might not be covered this year, or the copay might go up. Conversely, a drug your plan did not cover might be added. This is why it is important to check your coverage again in the fall, before the new year starts.

During the annual enrollment period (October 15 to December 7), you can switch to a different Part D plan or Medicare Advantage plan if your current plan no longer covers Jardiance or if the cost has become too high. You do not have to wait until next year to make a change — you can switch plans once per year during this window.

Questions to ask your doctor and pharmacist

Before your doctor prescribes Jardiance, ask whether it is the best option for your situation or whether a covered alternative might work just as well. Ask what the typical out-of-pocket cost is and whether there are patient information programs that could help lower it. Some drug manufacturers offer copay cards or discounts for people with Medicare.

When you fill the prescription, ask your pharmacist what your copay is and whether it will change once you hit the coverage gap. Ask whether a generic version is available (there is not one yet for Jardiance, but this can change). If the cost is higher than expected, ask the pharmacist to contact your doctor about alternatives before you pay.

Frequently Asked Questions

Does Original Medicare Part B cover Jardiance?

No. Part B covers doctor visits and some medical equipment, but not outpatient prescription drugs. You need Part D or a Medicare Advantage plan to have any prescription drug coverage at all, including for Jardiance.

Can I use a GoodRx coupon or discount card with Medicare?

You cannot use GoodRx or similar discount cards if you have Medicare Part D or Medicare Advantage, because doing so means you are not using your insurance. However, some drug manufacturers offer copay information cards specifically for Medicare patients, and your pharmacist can help you find them.

What if I cannot afford the copay for Jardiance?

Talk to your doctor about whether a cheaper alternative diabetes drug would work for you. You can also ask your doctor to request a coverage exception to lower your copay, or ask whether the drug manufacturer offers a copay information program. Some nonprofits also help seniors pay for medications.

Will my Jardiance coverage change if I switch from Original Medicare to Medicare Advantage?

It might. Each Medicare Advantage plan has its own formulary and copays. Before you switch, use the Plan Finder tool to check whether the new plan covers Jardiance and what your cost would be. You can switch plans once per year during the annual enrollment period.

How do I request a coverage exception for Jardiance?

Ask your doctor to submit a written request to your plan explaining why Jardiance is medically necessary for you. Your doctor's office usually handles this. The plan has 72 hours to respond, though it may take longer. Ask your plan's customer service line what documents your doctor needs to include.