Published on: May 27, 2025
Introduction
Managing type 2 diabetes can be overwhelming—not just medically, but financially. Jardiance, a powerful medication known for regulating blood sugar and protecting heart health, has become a go-to treatment. But if you’re on Medicare, you may be wondering: Will my plan cover Jardiance? How much will I actually pay out of pocket?
This guide breaks down everything you need to know about Medicare coverage for Jardiance—costs, coverage rules, assistance options, and expert tips to help you save.
What Is Jardiance and How Does It Work?
Understanding Jardiance (Empagliflozin)
Jardiance (empagliflozin) is part of the SGLT2 inhibitor drug class. It lowers blood sugar by helping the kidneys remove excess glucose through urine. Approved for adults with type 2 diabetes, Jardiance is also praised for its ability to reduce the risk of heart failure and kidney disease.
Benefits for Diabetes and Heart Health
Beyond blood sugar control, Jardiance delivers real health benefits:
-
Lowers risk of cardiovascular death
-
Supports weight loss
-
Helps reduce blood pressure
These combined effects make it a preferred option for patients who need multi-condition management.
Potential Side Effects
Like all prescription drugs, Jardiance comes with potential side effects:
-
Common: urinary tract infections, frequent urination, low blood pressure
-
Rare but serious: ketoacidosis, dehydration
Talk to your healthcare provider to see if Jardiance is right for you based on your health history.
Medicare and Prescription Drug Coverage: How It Works
Medicare Part D and Advantage Plans
Medicare covers most prescription drugs through:
-
Part D (Prescription Drug Plans) – Standalone plans that work with Original Medicare
-
Medicare Advantage (Part C) – Includes prescription coverage bundled with hospital and medical services
Plans are offered by private insurers approved by Medicare.
What Affects Coverage for Drugs Like Jardiance?
Each Medicare drug plan has a formulary—a list of covered drugs divided into “tiers.” Lower tiers (Tier 1 or 2) mean lower copays, while higher tiers (like Tier 3 or 4) can get expensive. Jardiance, being a brand-name drug, is usually placed in Tier 3 or higher.
Plans may also require:
-
Prior authorization
-
Step therapy
-
Quantity limits
Does Medicare Cover Jardiance?
Yes, But Coverage Varies
Most Medicare Part D and Medicare Advantage plans include Jardiance on their formularies. However, costs and access rules vary significantly between plans.
Steps to Check Coverage
To confirm whether your plan covers Jardiance:
-
Review your plan’s formulary – Look online or request a printed copy.
-
Use the Medicare Plan Finder tool at Medicare.gov.
-
Call your plan provider or speak to your pharmacist or doctor.
How Much Will You Pay for Jardiance Under Medicare?
Average Monthly Cost
If Jardiance is covered by your plan, you’ll typically pay:
-
$10–$50/month with standard copayments or coinsurance
Exact cost depends on: -
Plan tier placement
-
Whether you’ve met your Part D deductible
-
If you’re in the coverage gap (the “donut hole”)
Tips to Reduce Out-of-Pocket Costs
-
Choose a plan where Jardiance is in a lower tier
-
Compare plans annually during Medicare Open Enrollment (Oct 15–Dec 7)
-
Ask your doctor about switching to a lower-cost alternative, if suitable
Assistance Programs That Help Pay for Jardiance
Manufacturer and Pharmacy Discounts
The manufacturer, Boehringer Ingelheim, offers a savings card and co-pay assistance program that can help reduce out-of-pocket costs for those who qualify. Some retail pharmacies also provide discounted cash prices.
Medicare Extra Help (LIS Program)
If you’re a low-income Medicare beneficiary, you may qualify for Extra Help, which:
-
Lowers premiums and deductibles
-
Caps drug costs at a low fixed amount
Apply at SSA.gov/extrahelp or through your local Medicaid office.
Charity and Nonprofit Assistance
Some diabetes-focused nonprofits offer grants or assistance for medication costs. Your doctor or social worker may help connect you with these programs.
What If Jardiance Isn’t Covered by Your Plan?
-
Ask for a formulary exception – Your doctor can submit a request explaining why Jardiance is medically necessary.
-
Explore therapeutic alternatives – Some generic SGLT2 inhibitors may be covered at a lower cost.
-
Use discount programs like GoodRx – While not usable with Medicare, these can provide insight into market prices.
Real Patient Stories & Expert Advice
“I only found out Jardiance was covered by switching to a different Medicare Advantage plan. I now pay just $15 a month,” says one patient from Florida.
Endocrinologists stress the importance of proactive planning:
“Don’t assume coverage—check early and compare plans,” advises Dr. R. Chang, an internal medicine physician.
Conclusion: Make Medicare Work for You
Jardiance is a powerful tool in managing diabetes and protecting heart health—but understanding your Medicare plan is key to affording it.
✔ Check your plan’s formulary
✔ Use the Medicare Plan Finder
✔ Explore savings programs and alternatives
Taking these steps ensures you get the medication you need—without breaking the bank.