Farxiga is a common medication prescribed to treat conditions like diabetes, heart failure, and chronic kidney disease. Its wide use means the drug affects a considerable portion of Medicare beneficiaries.
Understanding the cost of Farxiga on Medicare can be complex. This article clarifies the factors influencing its cost and coverage under Medicare to help you navigate your healthcare expenses more effectively.
What is Farxiga?
Farxiga, known generically as dapagliflozin, belongs to a class of medications called SGLT2 inhibitors. It’s primarily used to treat type 2 diabetes, but it also has approved use for conditions such as heart failure and chronic kidney disease.
Farxiga partially blocks sugar and sodium reabsorption in the kidneys, which can help manage blood glucose levels and provide other health benefits.
The widespread use of the medication is understandable, given that approximately 28% of Medicare beneficiaries have diabetes, 15% have been diagnosed with heart failure, and about 1 in 4 have chronic kidney disease.
Does Medicare cover Farxiga?
According to its manufacturer, Medicare Part D (Prescription Drugs) plans cover Farxiga without prior authorization for most beneficiaries.
Coverage can, however, vary between different Medicare Part D plans.
The only way to know if your plan covers Farxiga is by checking your Part D plan formulary (the list of covered drugs under a particular plan).
Federal regulations require Part D plans to cover most FDA-approved medications, but Medicare has some flexibility in structuring the coverage.
That means that while Farxiga is likely to be covered, the extent of coverage and associated costs can differ from one plan to another.
It’s also important to note that Farxiga was selected as one of the first ten drugs for Medicare drug price negotiations under the Inflation Reduction Act (IRA).
This negotiation process began in 2023 and will see prices taking effect in 2026. It aims to increase the accessibility and affordability of prescription drugs for Medicare beneficiaries.
Need help to find the best prescription coverage, including Farxiga?
Visit CoverRight to compare plans and get expert guidance tailored to your needs.
How much does Farxiga cost on Medicare?
The cost of Farxiga on Medicare can vary significantly based on several factors, including the specific Medicare plan, the pharmacy used, and whether the beneficiary qualifies for additional assistance programs.
From 2018 through 2022, the average annual out-of-pocket spending on Farxiga per enrollee increased by 26%, from $206 to $260 – an average monthly cost of about $22.
The cost may also depend on the dosage prescribed.
Farxiga is available in 5 and 10 mg tablets, and the price may vary slightly between these dosages. The quantity of medication purchased, such as a 30-day or 90-day supply, can also affect its overall cost.
It’s worth reiterating that Farxiga is a brand-name medication for the generic drug dapagliflozin. While generic drugs typically cost less than brand-name medications, this is not the case in this particular case.
FAQ
Do all Medicare plans cover Farxiga?
Not all Medicare plans guarantee Farxiga coverage.
Medicare Advantage and Medicare Part D plans have different copay options for brand-name drugs like Farxiga. Review your plan details or contact your insurance provider directly to understand your coverage and potential out-of-pocket costs.
Are there alternatives to Farxiga that Medicare covers?
Yes, there are alternatives to Farxiga that Medicare may cover. A notable alternative is Jardiance, another SGLT2 inhibitor. Jardiance and Farxiga have similar chemical structures and mechanisms of action in the body but are not identical.
The coverage and costs of these alternatives can vary under different Medicare plans, just as they do for Farxiga.
If you’re considering an alternative medication, check your plan formulary and discuss potential options with your healthcare provider.
They can help determine the most appropriate medication for your health needs and financial situation.
Where can I get help with the cost of Farxiga?
If you’re struggling with the cost of Farxiga, there are several options available:
- Extra Help: This low-income subsidy program significantly reduces out-of-pocket costs for eligible beneficiaries. In 2022, those receiving Extra Help paid only $18 annually for Farxiga. You can find specific requirements and application instructions on the Social Security Administration website.
- AstraZeneca Patient Assistance Program (AZ&Me): You can apply for this program if you have Medicare Part D but still can’t afford Farxiga. Signing up is free; if you meet the eligibility requirements, you receive Farxiga for up to a year. You can re-enroll after this period if you still need assistance.
