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Average cost of Farxiga on Medicare

Everything you need to know about Medicare Farxiga coverage
Leandra Beabout
By | Jun. 6, 2024 Medically reviewed by Karen Berger, Pharm.D. & Scott Dershowitz, LMSW, CMC
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Farxiga (dapagliflozin) is a brand-name prescription medication that has been approved by the Food & Drug Administration (FDA) for several indications. For adults with chronic kidney disease (CKD), it’s approved to reduce the risk of kidney disease progression, hospitalization for heart failure, and death due to cardiovascular disease. For adults with heart failure, it’s prescribed to reduce the risk of hospitalization for heart failure and urgent heart failure visits as well as cardiovascular death. For adults with Type 2 diabetes and heart disease or risk factors for heart disease, it’s approved to reduce the risk of hospital visits. It is also used in people with Type 2 diabetes to improve blood sugar control, along with diet and exercise. 

RELATED: What is Farxiga used for?

Farxiga is part of a class of drugs called sodium-glucose cotransporter 2 (SGLT2) inhibitors, which inhibit the body’s absorption of glucose, according to Angela Ginn-Meadow, a registered dietitian and certified diabetes educator. It’s an integral part of many Type 2 diabetes patients’ daily treatment plans. That’s why many Medicare and health insurance plans cover the drug. With Medicare drug coverage, most patients can expect to pay about $37 a month for Farxiga.

How Medicare covers prescription drugs

Medicare drug coverage options can seem a bit complicated. The first thing to know is that different parts of Medicare cover various aspects of health care:

  • Part A: Hospital insurance that helps cover inpatient care; part of original Medicare
  • Part B: Health insurance that helps cover outpatient care, durable medical equipment, and preventive services; part of original Medicare)
  • Part C (Medicare Advantage: Privately administered alternative to original Medicare that bundles Parts A and B, and typically Part D
  • Part D is an optional add-on to original Medicare that helps cover the cost of prescription drugs and some recommended vaccines

Even if a person has Medicare drug coverage, it’s essential to understand that each plan has its own formulary—the official list of medications the plan covers. The good news is that all Medicare Part D drug plans offer coverage for at least two drugs within commonly prescribed drug categories. Even if Farxiga is not covered by a patient’s Part D plan, other anti-diabetic drugs are likely to be.

Does Medicare cover Farxiga?

Farxiga is covered by most Medicare Part D plans, according to AstraZeneca, the drug’s manufacturer. But coverage is not guaranteed. 

While Medicare does cover SGLT2 inhibitors, Farxiga is one of several medications in this drug class. The only way a Medicare beneficiary can know if Farxiga is covered is by checking their specific Part D plan’s formulary. 

“Ultimately, it is important for patients to understand that individual plans vary in which medications are covered and how much of the cost is covered,” said Blair Gingerich, Pharm.D., an ambulatory care pharmacist in northern Indiana. Even when Farxiga is covered, Medicare enrollees may have a copay. For instance, the average out-of-pocket expenses for Medicare Part D beneficiaries taking Farxiga in 2022 was $260, according to Department of Health and Human Services (HHS) data.

What is the cost of Farxiga on Medicare?

According to the HHS, about 639,000 Part D beneficiaries used Farxiga in 2022. Those who were not eligible for the low-income subsidy (LIS), also known as Extra Help, paid an average of $448 over the course of the year. That means they paid about $37 per month for Farxiga. With Extra Help assistance, beneficiaries paid less—about $18 annually or $1.50 monthly. 

Not everyone qualifies for Extra Help. First, a patient must live in the United States and either be enrolled in Medicare Part D or be willing to enroll in Medicare Part D. Beyond that, eligibility depends on an enrollee’s resource and income limits. Specific requirements and application instructions can be found on the Social Security Administration website. 

Average out-of-pocket costs of Farxiga on Medicare Part D
Without Extra Help assistance With Extra Help assistance
Annually $448 $18
Monthly $37 $1.50

 

Ultimately, the cost of Farxiga on Medicare depends on a patient’s plan and eligibility for Extra Help. The cost of Farxiga may also change depending on which stage of Part D coverage they’re in, their plan’s formulary, their pharmacy, and other factors.

How the prescription drug law affects Farxiga

In 2022, a new prescription drug law was introduced as part of the Inflation Reduction Act. This law enables Medicare to negotiate directly with pharmaceutical companies, which should ultimately result in lower prescription drug costs for consumers. Farxiga was selected as one of the first 10 drugs for negotiated prices and should be available at lower prices starting in 2026. Under the new law, there will also be a Part D out-of-pocket price cap of $2,000 starting in 2025. 

Medicare’s ability to broker lower drug prices is considered a significant step toward affordable healthcare in the United States. Of course, the negotiation process is not finished yet, so no one knows exactly how low prices will go. 

How to save on Farxiga

Farxiga is a brand-name drug with a high list price, but it is also a necessary treatment for many people with Type 2 diabetes, heart failure, cardiovascular disease, or chronic kidney disease. That’s why most insurance and Medicare Part D plans cover Farxiga.

Beyond enrolling in Medicare Part D coverage, there are other ways to save on Farxiga. 

SingleCare Prescription Discount Card

A SingleCare prescription discount card provides access to coupons for generic and brand-name drugs at more than 35,000 pharmacies nationwide. With a SingleCare coupon for Farxiga, you can pay $502 for 30, 10 mg tablets versus paying the average retail price of $800. Be sure to ask your pharmacist to compare the cost of Farxiga with a coupon versus the cost with Medicare to ensure you’re getting the best price. The catch is that Medicare and coupons cannot be used together—you need to pick one or the other.

RELATED: How much is Farxiga without insurance?

Ask for a 90-day supply

“If you have Medicare Part D coverage and want to save some money, you can consider choosing a 90-day supply instead of a 30-day one,” Ginn-Meadow suggested. In many cases, 90-day prescriptions break down to a lower cost per pill than 30-day prescriptions. However, this is not always the case, so it’s best to ask your healthcare provider or pharmacist to help you compare costs. 

Farxiga patient assistance program 

If you have Medicare Part D but still can’t afford Farxiga, you can apply for the AstraZeneca patient assistance program, AZ&Me. You must meet eligibility requirements to enroll, but there’s no cost to sign up, and you could get free Farxiga for up to a year, after which you can re-enroll. 

RELATED: Farxiga patient assistance: Eligibility, savings & more

Farxiga alternatives

A generic version of Farxiga, dapagliflozin, was made available in early 2024, however, it isn’t much cheaper than brand-name Farxiga. The normal counter price of generic Farxiga was $782 for 30, 10 mg tablets in May of 2024, compared to $800.29 for brand-name Farxiga. However, a SingleCare coupon could reduce the cost to $366.85. 

There are other brand-name and generic Farxiga alternatives that may be more affordable. Although the price you pay will ultimately depend on the condition you’re treating and the details of your Medicare Part D plan, options include metformin, glipizide, Jardiance, Januvia, and Rybelsus, among others. Jardiance and Farxiga are both SGLT2 inhibitors, meaning they have similar chemical structures and mechanisms of action (the way they work) in the body. But that doesn’t mean they’re exact replicas of one another. For example, some SGLT2 inhibitors are better than others at preventing cardiovascular disease or kidney disease progression, according to Dr. Gingerich. 

Ultimately, only a healthcare provider can recommend the best Farxiga alternative for each patient. “It is best for an individual to discuss which SGLT2 inhibitor is right for them with their provider,” Dr. Gingerich said.

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