Does Medicare Cover Jardiance?

Is Jardiance covered under Part B or Part D?

Jardiance is covered under Medicare Part D (prescription drug coverage), not under Original Medicare Part A or Part B. The reason is simple: Jardiance is a tablet you swallow yourself at home. Part B generally pays only for drugs that you cannot administer on your own, such as medications a doctor or nurse injects or infuses for you in a clinical setting.

Because Original Medicare (Parts A and B) does not include routine self-administered prescription drugs, Parts A and B alone will not pay for Jardiance. To get it covered, you need either a standalone Part D drug plan added to Original Medicare, or a Medicare Advantage plan that includes drug coverage (often written as MA-PD).

If you have Original Medicare with no drug plan, you would pay the full retail price for Jardiance out of pocket. That is why enrolling in some form of drug coverage matters if you take this medication.

How to confirm your plan covers Jardiance

Drug coverage is decided plan by plan. Each Part D and Medicare Advantage drug plan publishes a formulary, which is its list of covered drugs. To confirm Jardiance is covered and see what tier it is on, check your plan's formulary directly or use the official Medicare Plan Compare tool, which lets you enter your drugs and compare plans side by side.

Even when Jardiance is on the formulary, your plan may apply utilization-management rules before it pays:

• Prior authorization: your prescriber must get the plan's approval before the drug is covered.
• Step therapy: you may have to try a lower-cost alternative first and show it did not work for you.
• Quantity limits: the plan caps how much it will cover over a set period.
• If a rule blocks your access, your prescriber can request a formulary or coverage exception with a supporting statement explaining why you need Jardiance.

What does Jardiance cost with Medicare in 2026?

Drugs sit on formulary tiers, commonly three to five of them, and your share of the cost rises as the tier number goes up. Because Jardiance is a brand-name drug with no generic equivalent, it typically sits on a higher (non-preferred or specialty) tier, which means higher copays or coinsurance. If you believe it belongs on a lower-cost tier, your prescriber can request a tiering exception.

Your actual out-of-pocket cost depends on your plan and on the coverage phase you are in. Many plans charge a deductible before coverage begins; your Jardiance copay or coinsurance applies after any deductible is met and varies with the plan's tier placement.

There is important protection in 2026: Part D out-of-pocket spending on covered drugs is capped at $2,100 for the year. Once your spending on covered drugs (including Jardiance) reaches that cap, those covered drugs cost you $0 for the rest of the calendar year.

• 2026 Part D out-of-pocket cap: $2,100 per year, after which covered drugs cost $0.
• 2026 Part D national base beneficiary premium: $38.99/month (you pay your own plan's premium, which may differ).
• Higher-income beneficiaries pay a Part D income-related surcharge (IRMAA) of $14.50 to $91.00/month on top of the plan premium, triggered above 2024 MAGI of $109,000 single / $218,000 joint.

Extra Help, late penalties, and lowering your cost

If you have limited income and resources, the Extra Help program (also called the Part D Low-Income Subsidy) can dramatically lower what you pay. Extra Help can cover your Part D premium, eliminate your deductible, and cap your copays.

For 2026, the Extra Help income limits are $23,475 per year for an individual and $31,725 for a married couple living together. The 2026 resource (asset) limits are $18,090 for an individual and $36,100 for a married couple living together; those resource figures already include a $1,500-per-person burial allowance. You apply through the Social Security Administration.

• Late-enrollment penalty: if you go without creditable drug coverage and enroll later, you pay 1% of $38.99 for each full month you were uncovered, rounded to the nearest $0.10, added to your premium for life.
• This is why enrolling in drug coverage when first eligible matters, even before you need a drug like Jardiance.
• Extra Help is the single biggest cost reducer for those who qualify; check your eligibility with Social Security.

What if your plan denies Jardiance?

If your plan refuses to cover Jardiance or applies a restriction you disagree with, you have the right to push back. You or your prescriber can file a coverage determination request asking the plan to cover the drug, make an exception to a rule, or place it on a lower tier.

If the plan denies that request, you can move through Medicare's multi-level appeals process. Each level gives an independent look at your case. A supporting statement from your prescriber explaining the medical need is often the deciding factor.

Heart failure, kidney disease, and whether a generic exists

Jardiance is prescribed for more than type 2 diabetes; doctors also prescribe it for certain heart and kidney conditions. From a Medicare standpoint, coverage follows the same path regardless of why it is prescribed: it is covered under Part D when it is on your plan's formulary and any plan rules are met. Coverage is not tied to a single diagnosis, but plan rules such as prior authorization may ask your prescriber to document the condition being treated.

As of this writing, Jardiance is a brand-name drug with no generic equivalent on the market, which is a key reason it tends to sit on a higher cost tier. Because there is no cheaper generic version to switch to, the best ways to lower your cost are comparing plans on Plan Compare for the lowest Jardiance cost-sharing, requesting a tiering exception, and applying for Extra Help if you qualify.