How Does Medicare Cover Jardiance in 2026?

Jardiance (empagliflozin) is an oral SGLT2 inhibitor developed by Boehringer Ingelheim and Eli Lilly. Medicare covers Jardiance under Part D for three FDA-approved indications as of 2026: glycemic control in adults and children aged 10 and older with type 2 diabetes; reduction of cardiovascular death and hospitalization in adults with heart failure (both reduced and preserved ejection fraction); and slowing the progression of chronic kidney disease. Medicare patients prescribed Jardiance solely for heart failure or chronic kidney disease, even without a type 2 diabetes diagnosis, are equally covered under Part D and equally entitled to the 2026 Maximum Fair Price.

Jardiance was among the first 10 drugs selected for Medicare price negotiation under the Inflation Reduction Act (Public Law 117-169, signed August 16, 2022). The negotiated Maximum Fair Price of $197 per 30-day supply took effect January 1, 2026, representing a 66 percent reduction from the pre-negotiation list price of $573. Because Jardiance is an oral self-administered tablet dispensed at retail pharmacies, it falls entirely under Medicare Part D. There is no HCPCS J-code for Jardiance and it is not billed under Medicare Part B. The drug flows through Part D formularies and the 2026 annual out-of-pocket cap of $2,100 applies. Compare the parallel IRA negotiation for Farxiga (dapagliflozin), another SGLT2 inhibitor with a 2026 Maximum Fair Price of approximately $179 per month, available at Farxiga Medicare coverage.

Before January 2026, Medicare beneficiaries on Jardiance faced annual drug costs of $5,000 or more in the pre-IRA benefit structure. The 2026 Part D redesign also added the Medicare Prescription Payment Plan, which lets patients spread their out-of-pocket costs monthly rather than paying a large lump sum early in the benefit year. Patients with Medicare Part D who also qualify for Extra Help (Low-Income Subsidy) through Social Security pay roughly $11 per Jardiance fill. If you are not yet on Medicare and want to check whether you qualify, the Medicare eligibility page covers all criteria. Patients with incomes near or below the Medicaid threshold should also check Medicaid income limits to see if Medicaid coverage, which carries a $1 to $4 copay, might apply.

What Jardiance Medicare Costs by Point of Pay (2026)

The price you pay depends almost entirely on WHERE you pay. The same jardiance medicare can cost many times more at a hospital than at your local pharmacy:

Why Hospitals Charge So Much

Jardiance is an oral self-administered tablet, so inpatient hospital billing is far less common than with injectable drugs. When a Medicare patient is admitted to the hospital and is already taking Jardiance at home, the hospital typically bundles the drug into the DRG (Diagnosis-Related Group) payment under Medicare Part A. In those bundled cases, Jardiance does not appear as a separate patient-facing line item. CMS guidelines recommend stopping SGLT2 inhibitors like Jardiance before surgery or fasting procedures due to the risk of euglycemic diabetic ketoacidosis. Patients should verify they are not billed for Jardiance during a hospital stay where the medication was clinically discontinued.

When Jardiance appears as a separate hospital line item, it typically signals a billing classification issue rather than a legitimate facility charge. The most common scenario is an outpatient observation admission coded such that the drug is billed outside Part D coverage as a hospital outpatient drug charge. Under Medicare Part B outpatient rules, Jardiance is not a Part B drug and has no HCPCS J-code, so any attempt to bill it under Part B or as a standalone facility charge should be challenged. Patients who see Jardiance listed on a hospital bill at $900 to $1,800 for a stay should request an itemized bill, confirm their admission status (inpatient Part A vs. outpatient observation), and if the drug was billed outside Part D, dispute the charge through CMS Hospital Price Transparency procedures.

Patient Assistance Programs

Boehringer Ingelheim operates the BI Cares Patient Assistance Program for Medicare patients who cannot afford the $197 Maximum Fair Price and for uninsured patients who do not yet have Medicare. Federal anti-kickback statute (42 U.S.C. Section 1320a-7b) blocks the manufacturer copay savings card for any patient whose prescription is covered by Medicare, Medicaid, TRICARE, or VA. Medicare patients must therefore use the income-based BI Cares PAP rather than the savings card. The contrast with retail pricing is stark: without insurance, Jardiance retails at $550 to $831 per month; qualifying Medicare patients who cannot afford $197 and apply to BI Cares can receive the drug at no cost.

Medicare Part D

Jardiance is a covered Medicare Part D drug under all three of its approved indications in 2026. The formulary tier varies by plan, but most Part D plans place Jardiance on Tier 3 (preferred brand) or Tier 4 (non-preferred brand). Prior authorization is a standard Part D plan requirement for Jardiance, meaning your prescriber must document a qualifying diagnosis and, in some cases, show that formulary alternatives were considered. The IRA-negotiated Maximum Fair Price of $197 per 30-day supply applies regardless of formulary tier placement: all Part D plans are federally required to honor the $197 Maximum Fair Price as the patient-facing ceiling, whether Jardiance is on Tier 3 or Tier 5. The 2026 Part D deductible can be up to $615, meaning some enrollees pay deductible-phase costs before reaching the $197 MFP-level coverage. After paying $2,100 in annual out-of-pocket Part D spending, all covered drugs including Jardiance cost $0 for the rest of the calendar year.

Medicare patients who also qualify for the Part D Extra Help program (also called the Low-Income Subsidy, or LIS) pay a dramatically reduced copay for Jardiance. ASPE data from prior benefit years shows that Extra Help-eligible beneficiaries paid approximately $1.67 per month on average for Jardiance. In 2026, with the IRA-negotiated $197 Maximum Fair Price as the ceiling and Extra Help reducing that further, eligible patients pay roughly $11 per fill. Extra Help eligibility requires income at or below 150 percent of the federal poverty level and limited assets. Apply through Social Security at ssa.gov or call 1-800-772-1213. The Medicare Prescription Payment Plan, also available starting 2025, lets any Part D enrollee spread out annual cost-sharing into monthly installments, which can help with Jardiance costs before the $2,100 annual cap is reached.

Common Jardiance Medicare Billing Errors

Jardiance is an oral tablet with no HCPCS J-code. If your Medicare plan is charging more than $197 per 30-day fill in 2026, or if Jardiance appears on a hospital inpatient bill as a separate line item, check for these common billing errors:

• Part D plan charged more than $197 per 30-day fill in 2026: the Maximum Fair Price is federally mandated for all Part D plans. Call your plan's member services to request application of the MFP. If the plan declines, file a coverage determination request or contact 1-800-MEDICARE.
• Wrong formulary tier applied: Jardiance coded to a Tier 5 specialty tier with a cost-sharing rate that exceeds the $197 MFP. The MFP overrides tier-based cost-sharing for Medicare patients in 2026.
• Prior authorization not completed before dispensing: if PA was not submitted or was denied without appeal, you may have been charged the full cash price. Your prescriber's office can retroactively submit PA documentation and request a pharmacy reversal within the plan's claims adjustment window.
• Manufacturer savings card applied to a Medicare prescription: if a pharmacist mistakenly ran the Jardiance savings card alongside a Medicare Part D claim, both the patient and pharmacist may have violated the anti-kickback statute. The correct billing pathway for Medicare is through the Part D plan at the $197 MFP.
• Inpatient hospital bill includes Jardiance as a separate charge when it should be bundled in the DRG: if you were an inpatient under Medicare Part A, Jardiance should generally be bundled into the DRG payment, not billed separately to you.

Frequently Asked Questions