Key Takeaways

Farxiga costs with Medicare become much more manageable when you understand your coverage options and the savings available in 2026.

• Medicare coverage is widespread: About 90% of Medicare Part D plans include Farxiga on their formularies, with most plans requiring no prior authorization.
• 2026 pricing offers substantial relief: The negotiated Medicare price falls to $178.50 monthly, representing a 68% reduction from previous pricing.
• Annual spending protection kicks in: Once you reach the $2,000 yearly cap, you pay nothing for covered medications for the rest of that year.
• Additional savings options exist: 90-day supplies, mail-order pharmacies, and patient assistance programs can reduce your expenses further.
• Your specific plan details matter: Coverage terms and copayments vary between Medicare Part D plans, so checking your plan’s formulary is essential.

Medicare’s negotiated pricing combined with the annual spending limit creates meaningful financial protection for beneficiaries managing diabetes, heart failure, or chronic kidney disease.

Without insurance, Farxiga can cost up to $600 per month, putting this essential medication beyond reach for many people with Type 2 diabetes, heart failure, or chronic kidney disease. Medicare coverage changes this reality significantly for eligible beneficiaries. Medicare Part D beneficiaries paid an average of $260 out-of-pocket for Farxiga in 2022, and upcoming changes promise even greater affordability.

This guide addresses your main questions about Medicare coverage for Farxiga: whether Medicare covers the medication, what you’ll actually pay in 2026, and how Part D plans handle coverage. You’ll also learn about patient assistance options and how the new $2,000 annual cap protects you from high prescription costs.

What is Farxiga and Why Medicare Covers It

What Farxiga treats

Farxiga (dapagliflozin) treats several serious health conditions that frequently affect Medicare beneficiaries. The medication reduces the risk of kidney disease progression, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease. Currently in the US, 37 million people have CKD.

For adults whose hearts cannot pump enough blood effectively, Farxiga reduces the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits. The medication also helps adults with Type 2 diabetes and known cardiovascular disease or multiple cardiovascular risk factors by reducing their risk of hospitalization for heart failure.

Farxiga improves blood sugar control when combined with diet and exercise in adults and children who are 10 years of age and older with Type 2 diabetes. This ability to manage blood sugar while protecting vital organs explains why Medicare Part D plans regularly include Farxiga in their formularies.

How SGLT2 inhibitors work

Farxiga belongs to a class of medications called sodium-glucose cotransporter 2 (SGLT2) inhibitors. These drugs work in the proximal renal tubule of your kidneys by blocking the reabsorption of filtered glucose. When SGLT2 is inhibited, your body removes excess glucose and sodium through urination instead of reabsorbing these substances back into your bloodstream.

This mechanism creates multiple therapeutic effects. For people with Type 2 diabetes, increased glucose excretion helps lower blood sugar levels. For those with chronic kidney disease, reducing intraglomerular pressure helps keep kidney filters relaxed and healthy over the long term. Farxiga also reduces the elevated activity of the sympathetic nervous system that contributes to heart failure progression.

The DAPA-CKD trial demonstrated that Farxiga reduced the relative risk of worsening renal function, onset of end-stage kidney disease, or cardiovascular or renal death by 39% compared to placebo. The medication also significantly reduced the relative risk of death from any cause by 31%.

Who needs this medication

Medicare beneficiaries with chronic kidney disease at risk of progression need Farxiga regardless of diabetes status. The medication works for patients with CKD Stages 2-4 and elevated urinary albumin excretion. Adults with heart failure where the heart is weak and cannot pump adequately also benefit from this treatment.

People with Type 2 diabetes who have cardiovascular disease or multiple risk factors need this medication to prevent heart failure hospitalization. The medication is not for use in people with Type 1 diabetes to improve blood sugar control. Farxiga is also not recommended for patients with polycystic kidney disease or those requiring immunosuppressive therapy for kidney disease.

Does Medicare Cover Farxiga

Medicare Part D coverage for Farxiga

Ninety percent of Medicare drug plans cover Farxiga. According to AstraZeneca, most Medicare Part D plans cover the medication without prior authorization for most beneficiaries. You can access coverage through either a standalone Medicare Part D plan or a Medicare Advantage Prescription Drug (MAPD) plan.

Federal regulations require Part D plans to cover most FDA-approved medications, but private insurers have flexibility in structuring coverage. While Farxiga is likely covered, the extent of coverage and associated costs differ from one plan to another. Individual plans vary in which medications are covered and how much of the cost is covered.

Part D plans must cover at least two drugs within commonly prescribed drug categories. Even if brand-name Farxiga is not on your plan’s formulary, generic dapagliflozin or other SGLT2 inhibitors are likely available.

Checking your plan’s formulary

Every Medicare Part D and MAPD plan maintains a formulary, the official list of medications the plan covers. The only way to know if Farxiga is covered under your specific plan is by checking this formulary.

You can review formulary information through Medicare.gov/plan-compare or by calling the plan directly. Formularies may change at any time, and your Medicare plan will notify you if necessary.

What to do if your plan doesn’t cover it

If your plan doesn’t include Farxiga, you have several options. First, discuss alternative medications with your doctor. For instance, Jardiance is covered by every Medicare prescription drug plan.

You can submit a formulary exception request to add Farxiga to your plan’s covered drugs. Your doctor must provide written support stating the medication is medically necessary. For standard requests, your plan must decide within 72 hours. If waiting endangers your health, request an expedited review for a decision within 24 hours.

If denied, you can file a redetermination request, the first of five appeal levels. You can also switch plans during the Annual Enrollment Period from October 15 to December 7.

Farxiga Cost with Medicare in 2026

Average out-of-pocket costs

Medicare Part D beneficiaries currently pay an average of $38.82 per month for Farxiga. Your actual costs depend on your specific plan’s formulary tier placement, deductible requirements, and coinsurance structure.

Cost without insurance

Without insurance coverage, Farxiga ranges from $400 to over $600 per month. The list price stands at $377.82 for a 30-day supply as of January 1, 2026.

How the 2026 price negotiation affects you

Starting January 1, 2026, the negotiated price for Farxiga drops to $178.50 for a 30-day supply, a 68% discount from the 2023 list price of $556. This negotiated price affects how quickly you reach your out-of-pocket maximum, since your True Out-of-Pocket spending calculations use this lower price rather than the original list price.

Monthly premiums and deductibles

For 2026, the Part D national base premium reaches $38.99. The maximum Part D deductible increases to $615, up from $590 in 2025. Some plans offer lower deductibles or waive them entirely.

Copay expectations by plan tier

Your copay depends on which tier your plan places Farxiga. Plans typically require 25% coinsurance during the initial coverage phase. With the negotiated price of $178.50, a 25% coinsurance equals approximately $44.63 per month.

Ways to Lower Your Farxiga Costs

You have several options to reduce your Farxiga expenses beyond the negotiated Medicare prices.

Ordering a 90-day supply

A 90-day supply reduces your pharmacy trips and lowers overall costs. Your insurance company must approve this option, but it streamlines medication management while cutting expenses.

Using mail-order pharmacies

Mail-order pharmacies charge less than retail locations. AstraZeneca offers a mail-order program that may save you money on your Farxiga prescription.

AstraZeneca patient assistance program

The AZ&Me program provides medications at no cost to eligible patients who cannot afford them. You may qualify if you’re covered under Medicare but still face affordability challenges. Once enrolled, you receive up to a 90-day supply shipped directly to your home at no cost. Enrollment lasts one year, and you can reapply after that period.

When to use a Farxiga coupon for Medicare

You cannot use the Farxiga savings card with Medicare. Patients enrolled in state or federally funded prescription insurance programs are not eligible. However, using a discount program instead of your Medicare coverage may save more money in some cases.

Generic dapagliflozin as an alternative

Generic dapagliflozin costs around $400, still expensive but less than brand-name pricing.

The $2,000 annual cap on drug costs

The maximum out-of-pocket cost for 2026 Part D prescription drugs reaches $2,100. Once you hit this limit, your plan covers 100% of covered medication costs for the rest of the year.

Conclusion

Medicare coverage makes Farxiga significantly more affordable than the $600 monthly price without insurance. The 2026 negotiated price of $178.50 per month represents real savings, especially when combined with the new $2,000 annual out-of-pocket cap. We recommend checking your specific plan’s formulary to confirm coverage details. If you still face affordability challenges, patient assistance programs and mail-order options can help reduce costs even further.

FAQs

Q1. Does Medicare Part D cover Farxiga? Yes, approximately 90% of Medicare Part D plans cover Farxiga. Coverage is available through standalone Medicare Part D plans or Medicare Advantage Prescription Drug (MAPD) plans. Most plans cover the medication without requiring prior authorization, though specific coverage details and costs vary by plan.

Q2. What will I pay for Farxiga with Medicare in 2026? Medicare beneficiaries currently pay an average of $38.82 per month for Farxiga. Starting January 1, 2026, the negotiated price drops to $178.50 for a 30-day supply. Your actual cost depends on your plan’s tier placement, deductible, and coinsurance structure, with typical coinsurance around 25% during the initial coverage phase.

Q3. Can I use a Farxiga coupon or savings card with Medicare? No, you cannot use the Farxiga savings card if you’re enrolled in Medicare or other state or federally funded prescription insurance programs. However, in some situations, using a discount program instead of your Medicare coverage might result in lower costs.

Q4. What conditions does Farxiga treat? Farxiga treats multiple conditions including Type 2 diabetes, chronic kidney disease (CKD stages 2-4), and heart failure. It reduces the risk of kidney disease progression, cardiovascular death, and hospitalization for heart failure. The medication also improves blood sugar control in adults and children 10 years and older with Type 2 diabetes.

Q5. What should I do if my Medicare plan doesn’t cover Farxiga? If your plan doesn’t cover Farxiga, you can request a formulary exception with written support from your doctor stating medical necessity. Your plan must decide within 72 hours for standard requests or 24 hours for expedited reviews. You can also discuss alternative SGLT2 inhibitors with your doctor or switch plans during the Annual Enrollment Period (October 15 to December 7).