Does Medicaid cover Jardiance?

In this article:

• How much does Jardiance cost?
• Does Medicaid cover Jardiance?
• Factors influencing Medicaid coverage for Jardiance
• How to get Jardiance with Medicaid
• Cost of Jardiance with Medicaid
• Ways to get discounts on Jardiance without Medicaid

In this article

• How much does Jardiance cost?
• Does Medicaid cover Jardiance?
• Factors influencing Medicaid coverage for Jardiance
• How to get Jardiance with Medicaid
• Cost of Jardiance with Medicaid
• Ways to get discounts on Jardiance without Medicaid

Jardiance (empagliflozin) is a brand-name prescription that helps adults with Type 2 diabetes manage their blood sugar levels. It can also lower the risk of death from heart disease and hospitalization for heart failure in adults whose hearts cannot pump enough blood to the rest of their body. Additionally, Jardiance can reduce the risk of worsening kidney disease, end-stage kidney disease (ESKD), death due to cardiovascular disease, and hospitalization in adults with chronic kidney disease. It belongs to a family of antidiabetic medications called sodium-glucose cotransporter 2 (SGLT2) inhibitors.

Medicaid is a government program that helps pay for healthcare costs for people with low income. It is funded by both the federal government and the states, and administered on the state-level, so the rules and coverage can be different depending on where you live. Medicaid can cover many medical services, including doctor visits, hospital stays, and prescription drugs like Jardiance.

The cost of Jardiance can depend on several factors, like if you have insurance, why you need it, and where you buy it. So, does Medicaid cover Jardiance? The answer isn’t simple—it depends on your state and why you need the medication.

How much does Jardiance cost?

The average retail price of Jardiance without insurance or discounts is $855 for 30, 25 mg tablets, which is typically a one-month supply for some people.” The price can change based on the dosage and which pharmacy you go to. Different pharmacies might have different prices, so it’s good to compare them to find the best deal.

For example, taking the 10 milligram (mg) dose once a day might cost less than taking a higher dose. Some online pharmacies offer slightly lower prices, but be cautious and ensure they are reputable. Your local pharmacist should be able to help you compare prices and check for any discount programs.

Does Medicaid cover Jardiance?

Medicaid coverage for Jardiance varies by state. Some states might cover Jardiance, while others might not. Even if it is covered, there might be rules about who can get it. For example, some states might only cover it for people with Type 2 diabetes who meet specific criteria.

To determine if your state covers Jardiance, check your state’s Medicaid website or managed Medicaid plan’s formulary, or call your local Medicaid office. They can tell you if Jardiance may becovered and what you need to do to get it.

Here are a few examples:

• Texas Medicaid: It may cover Jardiance if it’s prescribed for Type 2 diabetes and other treatments have not been effective.
• California Medicaid (Medi-Cal): This could require prior authorization and proof that other medications were tried first.
• New York Medicaid: Coverage may be available but with specific requirements based on medical necessity.

Some states administer their Medicaid programs through private insurance plans, each of which may have a different formulary, or list of covered medications and potential restrictions like prior approval or step therapy.

Factors influencing Medicaid coverage for Jardiance

If your state’s Medicaid program covers Jardiance, there might be specific rules you need to follow. These rules can include:

• You may need to have a diagnosis of Type 2 diabetes.
• You may need to show that other diabetes medications didn’t work for you. This is called step therapy.
• Your healthcare provider may need to confirm that Jardiance is necessary for you. This is called prior authorization. 

Other factors that influence Medicaid drug coverage include age (people with both Medicare and Medicaid may receive their medications through a Medicare Part D plan instead of Medicaid), overall health condition, and any other medications you are taking. Some states also examine your income level and how much you can afford to pay out-of-pocket.

How to get Jardiance with Medicaid

Here are the steps you might need to follow to get Jardiance with Medicaid:

• Visit your healthcare provider: Make an appointment with your healthcare provider to discuss your condition and why Jardiance might be the proper medication. If they agree that Jardiance is suitable, they will write you a prescription.
• Wait for prior authorization: Your healthcare provider might need to submit a form or additional information to your state’s Medicaid program for approval.
• Take or have your healthcare provider send the approved prescription to your pharmacy. Your pharmacist might contact your healthcare provider or Medicaid office for clarification if there’s any issue.

Cost of Jardiance with Medicaid

The amount you’ll pay for Jardiance with Medicaid can vary by state. Medicaid can significantly lower costs, but you might still have to pay a copayment or coinsurance. Checking the costs in your state’s drug formulary can help you understand what you’ll pay. For example, you may have to pay any or all of the following:

• Copayments: Some states require you to pay a small fee each time you fill your prescription. According to the drug’s manufacturer, Boehringer Ingelheim, Medicaid beneficiaries have copay costs that average $0–$8 a month.
• Coinsurance: You might need to pay a percentage of the medication cost, such as 10%.
• Monthly premiums: Depending on your income and the rules of your state Medicaid program, you might also have to pay a monthly fee to participate in Medicaid.

Ways to get discounts on Jardiance without Medicaid

If you don’t have Medicaid or your state doesn’t cover Jardiance, you can save on the cost. One way is to use a SingleCare prescription discount card. This card provides immediate access to digital coupons you can use for Jardiance at many pharmacies, making it more affordable. For example, with a SingleCare coupon for Jardiance, you could pay $482 instead of $855 for 30, 25 mg tablets.  

Other discount options include:

• Manufacturer coupons: Sometimes, drug manufacturers offer coupons or discount programs for eligible patients. Boehringer Ingelheim offers a Jardiance Savings Card that allows eligible individuals to pay as little as $10 for a one- or three-month prescription for up to 12 months. The program isn’t available to those with Medicaid.

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• Patient assistance programs: These programs are offered by drug companies and run by nonprofit organizations. They can help you get your medication at a lower cost or even for free if you qualify. The Boehringer Ingelheim Cares Foundation offers a Patient Assistance Program that provides free medication, including Jardiance, to eligible patients. You and your healthcare provider will have to complete and submit the application to determine eligibility and start getting free Jardiance.
• Generic alternatives: While Jardiance itself doesn’t have a generic version yet, your healthcare provider might know of other similar medications that are more affordable.

RELATED: Jardiance alternatives

• Medicare and Medicare Extra Help: If you have both Medicare and Medicaid, you are considered dually eligible, meaning you can use Medicaid to pay for certain things that Medicare won’t. Although Medicare Part D plans may cover a variety of anti-diabetes drugs, they may require prior authorization for Jardiance or may not cover it at all. But, starting in 2026, Medicare will be able to negotiate directly with manufacturers for the price of certain Medicare Part B and Part D drugs that don’t have competition, including Jardiance. Until then, if you struggle to afford Jardiance with Medicare Part D, you can apply for the Part D Low-Income Subsidy (LIS) program, also known as Extra Help. If eligible, you’ll pay no more than $12.15 for each Jardiance prescription. If you have both Medicare and Medicaid, you will be enrolled in Extra Help automatically.

RELATED: Jardiance cost with Medicare

By following this guide, you can better understand how to manage the cost of Jardiance, whether you have Medicaid or are looking for other ways to save.