Farxiga (dapagliflozin, AstraZeneca) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor approved for type 2 diabetes, heart failure, and chronic kidney disease. It was one of ten drugs selected for the first round of Medicare price negotiation under the Inflation Reduction Act, and in April 2026, the FDA approved the first generic dapagliflozin tablets from multiple ANDA holders. Both developments are reshaping formulary placement, step therapy policies, and patient out-of-pocket costs.
This guide is for access teams, prior authorization coordinators, and prescribers who need to navigate coverage for Farxiga across payer types.
Short answer
| Farxiga (dapagliflozin) | |
|---|---|
| Drug class | SGLT2 inhibitor |
| Manufacturer | AstraZeneca |
| FDA indications | Type 2 diabetes (adults and pediatric 10+), heart failure (all ejection fractions), chronic kidney disease at risk of progression |
| Administration | 5 mg or 10 mg oral tablet, once daily |
| List price (WAC) | ~$556/month (brand); IRA negotiated price $179/month for Medicare |
| Commercial copay | $0/month with Farxiga SavingsRx Card for commercially insured (max $175/fill) |
| Medicare Part D | ~$38.82/month average OOP; $179/month negotiated price under IRA |
| Medicaid | Varies by state; typically low copay |
| PA required | Not typically for T2D; common for HF and CKD without T2D |
| Step therapy | Some plans now require trial of generic dapagliflozin before brand Farxiga |
| Generic availability | First generics approved April 7, 2026 (multiple ANDA holders) |
FDA-approved indications and dosing
Type 2 diabetes (approved January 2014)
- Indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
- Pediatric indication: expanded to patients aged 10 years and older
- Dosing: 5 mg or 10 mg orally once daily
- Also approved to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors
- Pivotal trials: DECLARE-TIMI 58, dapagliflozin pediatric studies
Heart failure (approved November 2020 for HFrEF; expanded July 2023 for all EF types)
- Indicated to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure (all ejection fraction types)
- Dosing: 10 mg orally once daily
- Pivotal trials: DAPA-HF (reduced ejection fraction), DELIVER (preserved ejection fraction)
- Combined data from DAPA-HF and DELIVER demonstrated benefit across the full range of ejection fractions
Chronic kidney disease (approved April 2021)
- Indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease at risk of progression
- Dosing: 10 mg orally once daily
- Pivotal trial: DAPA-CKD
- Benefit demonstrated in both diabetic and non-diabetic kidney disease
Coverage by payer type
Commercial insurance
Farxiga is covered by most major commercial plans, typically as a Tier 2 or Tier 3 medication. Many plans are now placing generic dapagliflozin on a lower tier than brand Farxiga.
| Payer | Coverage status | Key requirements |
|---|---|---|
| Aetna (CVS Health) | Covered; Jardiance or Farxiga preferred for CKD and HF | PA common for HF and CKD without T2D; step therapy may apply |
| Blue Cross Blue Shield | Covered; varies by plan | PA for non-T2D indications; BCBS Michigan Medicare now lists dapagliflozin as preferred SGLT2 (replacing Jardiance) |
| Cigna | Covered; Tier 2–3 | PA for HF and CKD without T2D; generic dapagliflozin may be preferred |
| UnitedHealthcare | Covered; varies by plan | PA for non-T2D indications; quantity limits |
Typical PA criteria for heart failure:
- Confirmed diagnosis of heart failure (ICD-10: I50.x)
- Documentation of ejection fraction (HFrEF, HFpEF, or HFmrEF)
- Some plans require concomitant diagnosis of T2D
- Failure, contraindication, or intolerance to standard HF therapies (ACE inhibitors/ARBs/ARNIs, beta-blockers, MRAs)
Typical PA criteria for chronic kidney disease:
- Confirmed diagnosis of CKD (ICD-10: N18.x)
- Documentation of eGFR and albuminuria
- Some plans require concomitant diagnosis of T2D
- Failure, contraindication, or intolerance to standard CKD therapies
Medicare Part D
Approximately 90% of Medicare Part D plans cover Farxiga. Under the IRA negotiated price effective January 2026, the monthly cost is $179 (a 68% discount from the $556 list price).
Key 2026 Medicare details:
- $2,100 annual out-of-pocket cap for all Part D drugs
- IRA negotiated price: $179/month (68% discount from list)
- Low-Income Subsidy (LIS) patients: approximately $11/month
- Medicare Prescription Payment Plan (MPPP) allows monthly installment payments
Estimated monthly cost flow by coverage phase (Farxiga only; patients on multiple Part D drugs may reach the $2,100 cap sooner):
| Phase | Months | Estimated OOP/month |
|---|---|---|
| Deductible | Jan–Apr | $53–$179/month (clearing the $590 deductible) |
| Initial coverage | May–Dec | ~$44.75/month (25% coinsurance on $179) |
Note: A patient on Farxiga alone would spend approximately $980–$1,100/year out of pocket and would not reach the $2,100 catastrophic cap. The $2,100 cap applies to total Part D spending across all medications.
Medicaid
Farxiga is covered by state Medicaid programs. Cost varies by state, typically a low copay. Prior authorization criteria generally mirror commercial requirements, with possible additional state-specific documentation. Generic dapagliflozin may be preferred on some state formularies.
Prior authorization process
Required documentation
| Indication | Required documentation |
|---|---|
| Type 2 diabetes | Diagnosis of T2D (ICD-10: E11.x), HbA1c level, prior therapy records |
| Heart failure | Echocardiogram or other EF documentation, HF diagnosis (ICD-10: I50.x), NYHA class, prior/concurrent HF therapy records |
| Chronic kidney disease | eGFR and urine albumin-to-creatinine ratio, CKD diagnosis (ICD-10: N18.x), prior CKD therapy records |
Common ICD-10 codes
- N18.x: Chronic kidney disease
- I50.x: Heart failure
- E11.x: Type 2 diabetes mellitus
Common denial reasons and solutions
| Denial reason | Solution | Required documentation |
|---|---|---|
| Not medically necessary | Submit indication-specific documentation | EF results for HF; eGFR/UACR for CKD; HbA1c for T2D |
| Step therapy not met | Document prior therapy failure or trial | Records of prior SGLT2 inhibitor or other therapy trial |
| PA required for non-T2D use | Submit HF or CKD diagnosis documentation | Echocardiogram, eGFR results, specialist attestation |
| Non-formulary / generic preferred | Request formulary exception or switch to generic | Medical necessity letter if generic labeling does not cover indication |
| Quantity limits exceeded | Provide FDA dosing rationale | Prescriber attestation of appropriate 5 mg or 10 mg daily dosing |
Key consideration: generic labeling gaps
Generic dapagliflozin labeling approved in April 2026 may not include all branded indications. Heart failure without T2D and CKD without T2D may not appear on generic labeling. For these indications, prescribers may need to:
- Submit a PA specifically for brand Farxiga with medical necessity justification
- Document that the generic label does not cover the patient's specific indication
- Request a formulary exception when plans prefer the generic
Cost and patient assistance
Manufacturer savings programs
| Program | Eligibility | Benefit |
|---|---|---|
| Farxiga SavingsRx Card | Commercially insured patients | $0/month; max savings $175/fill |
| AZ&Me Patient Assistance Program | Uninsured or underinsured patients who cannot afford medication | Free medication for eligible patients |
| Cash patient assistance | Patients paying cash (no insurance) | AstraZeneca pays first $150 per fill |
Important: Manufacturer savings programs are not available for Medicare, Medicaid, or other government-insured patients.
Contact: 1-855-332-7944
Cost by insurance type
| Insurance type | Approximate out-of-pocket cost |
|---|---|
| Commercial + Farxiga SavingsRx Card | $0/month |
| Commercial without savings card | Varies by plan (copay or coinsurance) |
| Medicare Part D (IRA negotiated) | ~$38.82/month average; ~$44.75/month during initial coverage |
| Medicare Part D + LIS | ~$11/month |
| Medicaid | Varies by state (typically low copay) |
| Uninsured | Full WAC (~$556/month brand) or free via AZ&Me if eligible |
| Generic dapagliflozin | Potentially Tier 1–2 on many plans; lower OOP than brand |
Generic dapagliflozin considerations
With multiple ANDA holders now approved (Alembic, Ascend, Aurobindo, Cipla, Lupin, Macleods, Sandoz, and others), generic dapagliflozin is expected to offer significant cost savings. Many plans are placing the generic on Tier 1 or Tier 2 with lower patient cost-sharing. However, access teams should verify whether the generic label covers the patient's specific indication before switching.
What changed in 2026
- IRA negotiated price takes effect (January 2026): Farxiga's Medicare price dropped to $179/month, a 68% discount from the $556 list price. This was one of ten drugs in the first round of IRA negotiations.
- Generic dapagliflozin approved (April 7, 2026): The FDA approved the first generic dapagliflozin tablets from multiple ANDA applicants including Alembic, Ascend, Aurobindo, Cipla, Lupin, Macleods, and Sandoz. An authorized generic was already available before April 2026.
- Generic labeling excludes some branded indications: Generic dapagliflozin labeling may not include heart failure without T2D or CKD without T2D. Patients with these indications may need to remain on brand Farxiga with a formulary exception.
- Step therapy policies emerging: Some plans are implementing step therapy requiring a trial of generic dapagliflozin before authorizing brand Farxiga.
- $2,100 annual OOP cap (Medicare): Effective January 2026, Part D out-of-pocket costs are capped at $2,100 per year.
- BCBS Michigan Medicare formulary update: Dapagliflozin is now the preferred SGLT2 inhibitor, replacing Jardiance on the formulary.
What to monitor
- Generic dapagliflozin market uptake and tier placement: Watch how quickly plans shift generic dapagliflozin to Tier 1–2 and how brand Farxiga is re-tiered in response.
- Generic labeling expansion: Monitor whether generic manufacturers pursue labeling supplements to include HF and CKD indications without concomitant T2D.
- Payer step therapy policies: Track plans that require generic-first step therapy, particularly for patients with HF or CKD without T2D who may not be covered by the generic label.
- IRA future negotiation rounds: Monitor whether additional SGLT2 inhibitors are selected for Medicare price negotiation in subsequent rounds.
- Competition from other SGLT2 inhibitors: Watch for payer shifts between Farxiga, Jardiance (empagliflozin), and other SGLT2 inhibitors driven by generic availability, pricing, and formulary negotiations.
Sources
- FDA, generic dapagliflozin approval (April 2026): https://www.fda.gov/drugs/drug-alerts-and-statements/fda-approves-first-generic-dapagliflozin-tablets
- Drugs.com, generic Farxiga availability: https://www.drugs.com/availability/generic-farxiga.html
- Drugs.com, Farxiga FDA approval history: https://www.drugs.com/history/farxiga.html
- AstraZeneca, Farxiga HCP prescribing information: https://www.farxiga-hcp.com/
- CMS, IRA negotiated prices for initial price applicability year 2026: https://www.cms.gov/files/document/medicare-drug-price-negotiation-negotiated-prices-initial-price-applicability-year-2026.pdf
- AstraZeneca, Farxiga savings and support: https://www.farxiga.com/savings-support/cost
- BCBS Michigan, 2026 Medicare pharmacy updates: https://providerinfo.bcbsm.com/documents/alerts/2025/202511/alert-20251107-2026-medicare-pharmacy-updates.pdf
- Medicare Rights Center, IRA negotiated prices take effect for ten drugs in 2026: https://www.medicarerights.org/medicare-watch/2025/10/09/negotiated-prices-take-effect-for-ten-drugs-in-2026
- PrescriberPoint, Farxiga prior authorization resources: https://prescriberpoint.com/therapies/farxiga-72ad22a/prior-authorization-forms
- Aetna, antidiabetic agents PA policy: https://www.aetna.com/products/rxnonmedicare/data/2025%20commercial/Antidiabetic_Agents_ST,_Post_PA_Policy_676-D,_BOG_6332-D_UDR_05-2024.html
- LUGPA, negotiated drug prices under the Inflation Reduction Act: https://www.lugpa.org/negotiated-drug-prices-under-the-inflation-reduction-act
