Does Medicare Cover Farxiga?

Which part of Medicare covers Farxiga?

Farxiga (the brand name for dapagliflozin) is a once-daily pill you take yourself at home. Self-administered prescription drugs like this are paid for through Medicare's drug coverage, called Part D — not through Parts A or B.

You can get Part D coverage two ways: a stand-alone Part D plan that you add to Original Medicare, or a Medicare Advantage plan that includes drug coverage (sometimes called an MAPD plan). Either route can cover Farxiga if the drug is on that plan's list of covered drugs.

• Part A (hospital) and Part B (medical): generally do NOT cover outpatient pills you take at home, including Farxiga.
• Part D (drug plan): this is where Farxiga is covered, if it is on the plan's formulary.
• Medicare Advantage with drug coverage (MAPD): covers Farxiga the same way a stand-alone Part D plan does, subject to the plan's formulary.

Is Farxiga on my plan's formulary?

Each Part D and MAPD plan publishes a formulary — its own list of covered drugs. Plans decide which drugs to include, but Medicare requires every plan to cover at least two drugs in each commonly prescribed category. That means whether Farxiga specifically is covered, and at what cost, can differ from one plan to the next.

The most reliable way to check is to look up your exact plan's formulary on Medicare.gov or in your plan's documents. Farxiga is FDA-approved and prescribed for type 2 diabetes, certain types of heart failure, and chronic kidney disease; Part D coverage follows the plan's formulary rules rather than the specific condition you are treating.

• Plans must cover at least 2 drugs in each commonly prescribed class, but not every plan covers Farxiga by name.
• Coverage can come with rules such as prior authorization or step therapy — check your plan's details.
• Use the plan finder on Medicare.gov to confirm Farxiga is on your specific plan before you assume it is covered.

How much does Farxiga cost with Medicare in 2026?

Farxiga was one of the first 10 drugs chosen for the Medicare Drug Price Negotiation Program created by the Inflation Reduction Act. Medicare negotiated a price of $178.50 for a 30-day supply, effective January 1, 2026 — a 68% discount from the previous $556 list price.

That negotiated price is what counts for Medicare beneficiaries, but it is not necessarily your copay. What you actually pay at the pharmacy depends on your plan's cost-sharing (a flat copay or a percentage coinsurance) and which phase of the benefit you are in. If your plan has a deductible, you may pay more until you meet it.

There is also a yearly safety net. In 2026, Medicare Part D caps your out-of-pocket spending at $2,100. Once your out-of-pocket drug costs reach that cap, you pay $0 for your covered Part D drugs — including Farxiga — for the rest of the calendar year.

• 2026 negotiated price: $178.50 for a 30-day supply (68% below the $556 list price), effective January 1, 2026.
• Your share = your plan's copay or coinsurance for the tier Farxiga sits on; a plan deductible may apply first.
• 2026 Part D out-of-pocket cap: $2,100 — after that, covered drugs cost you $0 for the rest of the year.

Help paying for Farxiga and avoiding penalties

If your income and savings are limited, you may qualify for Extra Help (also called the Low-Income Subsidy), which lowers or eliminates Part D premiums, deductibles, and copays. For 2026, your resources must be at or below $18,090 for an individual or $36,100 for a married couple living together; your home, vehicles, and certain other items do not count toward that limit.

Keep in mind that enrolling in Part D when you are first eligible matters. If you go without creditable drug coverage and join later, you can owe a late-enrollment penalty. The penalty is 1% of the 2026 national base beneficiary premium of $38.99 per month, multiplied by the number of full months you went without coverage, rounded to the nearest $0.10, and it is added to your premium for as long as you have Part D.

Higher earners pay more. If your income is above certain thresholds, you pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part D premium. IRMAA applies above a modified adjusted gross income of $109,000 for a single filer or $218,000 for a joint return (based on 2024 income), with a Part D surcharge ranging from $14.50 to $91.00 per month in 2026.

• Extra Help (LIS) 2026 resource limit: $18,090 (individual) / $36,100 (married couple living together), excluding home and vehicles.
• Part D late penalty: 1% of $38.99 x full uncovered months, rounded to the nearest $0.10, added to your premium for life.
• Part D IRMAA surcharge: $14.50-$91.00/month in 2026 above $109,000 single / $218,000 joint MAGI (2024 income).

What if your plan doesn't cover Farxiga?

If your Part D or MAPD plan does not cover Farxiga, you are not out of options. You or your prescriber can ask the plan for a formulary exception, which is a formal request for the plan to cover a drug that is not on its list (or to lower your cost-sharing). Your doctor will usually need to explain why Farxiga is medically necessary for you.

There may also be covered alternatives already on your formulary. A generic version of dapagliflozin or another SGLT2 inhibitor in the same drug class could be covered and could lower your cost. Talk with your doctor and pharmacist about whether a formulary alternative would work for your condition.

• Request a formulary exception through your plan if Farxiga is not covered.
• Ask about generic dapagliflozin, which a plan may cover at a lower cost.
• Another SGLT2 inhibitor on your formulary may be a covered alternative — discuss with your prescriber.