Does Aetna cover Jardiance?

In this article:

• Does Aetna cover Jardiance?
• How much does Jardiance cost without insurance?
• How much does Jardiance cost with Aetna?
• How to check whether your Aetna plan covers Jardiance
• How to save on Jardiance

In this article

• Does Aetna cover Jardiance?
• How much does Jardiance cost without insurance?
• How much does Jardiance cost with Aetna?
• How to check whether your Aetna plan covers Jardiance
• How to save on Jardiance

Jardiance (empagliflozin) is a brand-name drug that’s approved by the Food and Drug Administration to lower blood sugar levels in people 10 years and older with Type 2 diabetes mellitus, to reduce the risk of dying of heart disease in adults diagnosed with heart failure or Type 2 diabetes, and to reduce certain health risks in people with chronic kidney disease. Jardiance is typically covered by insurance, but coverage varies from plan to plan. 

Does Aetna cover Jardiance?

Prescription drug coverage varies by plan, and some Aetna plans don’t offer drug coverage at all. However, when drug coverage is provided, Aetna typically covers Jardiance for Medicare, commercial, and marketplace plans. Medicaid coverage varies by state. 

James Lyons, a physician and medical consultant for Synergy Houses in West Chester, Pennsylvania, confirms that “in most cases, Aetna does cover Jardiance, mainly when it is prescribed for conditions like Type 2 diabetes with cardiovascular risk, heart failure, or chronic kidney disease. It is well-studied in these areas and has real benefits in terms of reducing hospitalization and protecting kidney function.” 

Here’s what you can usually expect from an Aetna health insurance plan:

• Commercial and marketplace insurance: Jardiance tends to be covered as a preferred brand (PB).
• Medicare Advantage or Part D: Aetna classifies Jardiance as a Tier 3 drug and limits the amount you can get to 30 tablets per 30 days. These Aetna plans allow Jardiance to be delivered via mail order. 

Jardiance typically requires prior authorization, which means Aetna will review your medical history before agreeing to cover the cost of this prescription. If Aetna refuses to cover Jardiance, your healthcare provider can appeal on your behalf. They typically need to submit a letter explaining why Jardiance is necessary for your treatment and why alternatives aren’t appropriate. 

“I have seen some hiccups with prior authorizations,” Dr. Lyons says. “It usually comes down to how the diagnosis is documented. For example, if the paperwork does not indicate that the patient meets the criteria, such as having established cardiovascular disease or reduced kidney function, the initial request may be denied. However, when we submit supporting records or lab results, we’re typically able to get it approved on appeal.”

Some Aetna plans require step therapy before the insurance company will approve a prescription for Jardiance. This means you must try a different (and typically more affordable) prescription first, and that Aetna will only approve your Jardiance prescription if the first medication didn’t work or caused unwanted side effects. 

According to Aetna’s coverage criteria, people with Type 2 diabetes must try metformin before Jardiance. Aetna doesn’t require Jardiance step therapy for people diagnosed with heart failure or chronic kidney disease. 

How much does Jardiance cost without insurance?

Without insurance, Jardiance costs an average of $870 for 30, 25 mg tablets. Jardiance is one of the most expensive sodium-glucose cotransporter 2 (SGLT2) inhibitors, but not by much. Most SGLT2 inhibitors cost over $800 for a 30-day supply without insurance. 

How much does Jardiance cost with Aetna?

Copays and coinsurance vary by plan, but many Aetna plans charge about $50 for a 30-day supply of a preferred brand drug like Jardiance. A 90-day supply has a copay of about $125. If your plan allows you to get Jardiance via mail-order, a 90-day supply is usually sent.

How to check whether your Aetna plan covers Jardiance 

There are several ways to check whether your specific Aetna plan covers Jardiance:

• Look at the formulary (also called the drug list). You may have received a printed version of this document. It should have an index to help you easily find the page with coverage details for Jardiance.
• Log in to your online Aetna account, if you have one. Here, you can view a digital copy of your plan’s formulary.
• Call the customer service number on the back of your Aetna health insurance card. A company representative can look up your plan and tell you whether Jardiance is covered.

How to save on Jardiance

If your Aetna plan doesn’t cover Jardiance, you aren’t stuck paying its full retail price. And even if you do have insurance coverage for Jardiance, there are ways to lower your out-of-pocket costs.

1. Sign up for a free SingleCare card

A SingleCare prescription discount card is absolutely free to use and could save you close to $350. Depending on your choice of pharmacy, you could pay about $528 for 30, 25 mg tablets of Jardiance with a SingleCare coupon if Aetna doesn’t cover it. Type Jardiance in the search bar, enter your ZIP code, and compare discounted prices at pharmacies near you. Select which pharmacy you want to go to and click “Get Coupon.” 

From here, you can save the coupon to your free SingleCare account, print it, or text or email it to yourself. Show the printed or digital coupon to your pharmacist when you pick up your Jardiance prescription. Don’t forget to tell your healthcare provider where to send the prescription if your usual pharmacy doesn’t have the lowest price. 

2. See if you’re eligible for the manufacturer’s savings program

Boehringer Ingelheim, the manufacturer of Jardiance, offers a savings program for people with commercial insurance (not Medicare or Medicaid, for example) who pay a copay or coinsurance fee for the medication. If you qualify, you could pay as little as $10 for a 30-day or 90-day supply of Jardiance. Eligibility guidelines disqualify a significant number of people.

3. Enroll in the Medicare Extra Help program

The Medicare Extra Help program reduces the out-of-pocket drug costs for Medicare recipients who meet certain income requirements. If you qualify for Extra Help, you could pay up to $12.15 for name-brand prescriptions like Jardiance.

4. Consider a 90-day supply

If your Aetna insurance plan doesn’t limit the quantity of Jardiance tablets you can receive at each refill, consider getting a 90-day supply rather than a 30-day supply. The 90-day copay may be less expensive than paying the 30-day copay three times.

5. Consider an alternative drug treatment

If your Aetna plan doesn’t cover Jardiance, or if your copay or coinsurance is too high, talk to your healthcare provider. They may be able to recommend more affordable Jardiance alternatives, such as drugs in other classes that work in different ways to treat your condition.