The cost of Farxiga on Medicare

Medical News Today

4 days ago

Farxiga can cost between $400 and $600 without insurance, depending on the pharmacy and whether a person buys the brand drug or the generic. Whether Medicare can pay a share of this cost depends on the person's specific plan.Farxiga (dapagliflozin) is a Food and Drug Administration (FDA)- approved medication that can help reduce blood sugar, lower the risk of hospitalization for heart failure, decrease the risk of death from cardiovascular issues, and slow the decline of kidney function in adults with type 2 diabetes, heart failure, or chronic kidney disease.Typically, Medicare drug coverage comes through a Medicare Part D or a Medicare Advantage prescription drug (MAPD) plan. However, whether a person can get coverage for Farxiga and how much it may cost after coverage depends on their specific plan.Glossary of Medicare termsOut-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.Premium: This is the amount of money someone pays each month for Medicare coverage. Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.What is the cost of a 30-day supply of Farxiga?Depending on the dispensing pharmacy, a month's supply of the branded drug Farxiga can cost more than $600 without insurance. Generic dapagliflozin costs less, though still quite pricy, with the lowest cost at around $400.Whether a Medicare drug plan may cover Farxiga or its generic version depends on the plan's specific formulary, which lists the drugs each plan includes. This is because private insurers manage Medicare Part D and MAPD plans and set their coverage lists.Medicare drug plans must typically include coverage for at least two medications from the most commonly prescribed categories. So, if the plans do not cover the drug, they might cover an alternative. If the plans cover the drug, a person's out-of-pocket cost may depend on the tier assigned to the drug within the formulary. Higher tiers typically mean higher costs. However, as of 2025, Medicare limits a person's total annual out-of-pocket drug expenses to $2,000.A person's deductible, premium, and copay with Medicare drug plans may vary by plan. In 2025, the national base beneficiary premium for Part D is $36.78, and according to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for Medicare Advantage plans is about $17.Is Farxiga covered under Medicare Part D?Either a Medicare Part D or MAPD plan may cover Farxiga based on the drug's tier classification in the plan's formulary. The drug's tier classification depends on the plan, though the generic may be in a lower tier than the brand drug. Lower tiers indicate more Medicare coverage and lower out-of-pocket drug costs.However, a Medicare drug plan might require prior authorization before coverage is provided. This could involve step therapy, in which a person must initially try a different, equally effective, but more affordable medication.Farxiga is among the 10 drugs whose prices Medicare and pharmaceutical companies renegotiated due to the Inflation Reduction Act of 2022. This lower price may take effect in 2026.»Learn more:Does Medicare cover prescriptions?How can I get Farxiga cheaper?Some ways a person can lower their costs for Farxiga include:ordering a 90-day supply of the drug to reduce pharmacy costsusing a mail-order pharmacy, which charges lesstaking advantage of the manufacturer's discount programusing the Medicine Assistance Tool and NeedyMeds for drug assistance programs and savings adviceA person cannot typically use a pharmaceutical discount program with their Medicare coverage, but in some cases, using the program may save a person more money than using their insurance.»Learn more:Farxiga (dapagliflozin) and costTakeawayFarxiga is a medication people take to help lower blood sugar and the risk of heart or kidney problems in people with type 2 diabetes, heart failure, or chronic kidney disease.The price of Farxiga ranges from $400 to $600 without insurance, varying based on the pharmacy and whether one opts for the brand-name drug or the generic version. Typically, a Medicare Part D or MAPD plan provides Medicare drug coverage. However, coverage for Farxiga and the final cost after insurance depend on the specific details of a person's plan.Many Medicare plans may cover this drug, and its price with coverage may be lower once Medicare's price negotiation starts in 2026.Medicare resourcesFor more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.