Jardiance (empagliflozin, Boehringer Ingelheim / Eli Lilly) is a sodium-glucose co-transporter 2 (SGLT2) inhibitor approved for type 2 diabetes, cardiovascular risk reduction, heart failure, and chronic kidney disease. It was the first SGLT2 inhibitor to demonstrate cardiovascular outcome benefit and has since expanded well beyond its original diabetes indication. Coverage varies significantly by diagnosis: type 2 diabetes generally faces fewer barriers, while heart failure and CKD often trigger prior authorization.
This guide is for access teams, prior authorization coordinators, and prescribers who need to navigate coverage for Jardiance across payer types.
Short answer
| Jardiance (empagliflozin) | |
|---|---|
| Drug class | SGLT2 inhibitor |
| Manufacturer | Boehringer Ingelheim / Eli Lilly |
| FDA indications | Type 2 diabetes (adults and pediatric 10+), cardiovascular risk reduction in T2D with established CVD, heart failure (all ejection fraction types), chronic kidney disease at risk of progression |
| Administration | Oral tablet; 10 mg or 25 mg once daily |
| List price (WAC) | ~$573/month |
| IRA negotiated price (2026) | $197/month (66% discount) |
| Commercial copay | $0/month with Jardiance Savings Card (30- or 90-day supply) |
| Medicare Part D | Covered by ~90% of plans; $0–$2,100/year depending on coverage phase |
| Medicaid | Varies by state; nominal copay |
| PA required | Common for HF and CKD indications; less common for T2D |
| Step therapy | May apply for T2D (metformin failure); less common for HF/CKD |
| Generic available | No (generic dapagliflozin approved April 2026 is a competitor, not a generic for empagliflozin) |
FDA-approved indications and dosing
Type 2 diabetes (approved August 2014)
- Indicated as an adjunct to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus
- Dosing: 10 mg once daily; may increase to 25 mg once daily for additional glycemic control
- Pivotal trials: EMPA-REG OUTCOME (cardiovascular outcomes), phase 3 glycemic control studies
Cardiovascular risk reduction in T2D with established CVD (approved December 2016)
- Indicated to reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease
- Dosing: 10 mg once daily
- Pivotal trial: EMPA-REG OUTCOME demonstrated 38% relative risk reduction in CV death
Heart failure (approved February 2021, broadened February 2022)
- Indicated to reduce the risk of cardiovascular death plus hospitalization for heart failure in adults with heart failure
- HFrEF (reduced ejection fraction) approval: February 2021
- HFpEF (preserved ejection fraction) broadened label: February 2022 — making Jardiance the first SGLT2 inhibitor approved for all heart failure regardless of ejection fraction
- Dosing: 10 mg once daily
- Pivotal trials: EMPEROR-Reduced (HFrEF), EMPEROR-Preserved (HFpEF)
Chronic kidney disease (approved September 2023)
- Indicated to reduce the risk of sustained eGFR decline, end-stage kidney disease, cardiovascular death, and hospitalization in adults with chronic kidney disease at risk of progression
- Dosing: 10 mg once daily
- Pivotal trial: EMPA-KIDNEY
Coverage by payer type
Commercial insurance
Jardiance is covered by most major commercial plans as a preferred brand (Tier 2 or 3). Prior authorization is common for non-T2D indications.
| Payer | Coverage status | Key requirements |
|---|---|---|
| Aetna (CVS Health) | Covered; PA required | Jardiance or Farxiga preferred for CKD and HF; step therapy may apply for T2D; PA required |
| Blue Cross Blue Shield | Covered; varies by plan | PA required for HF and CKD; some plans (e.g., BCBS Michigan 2026 Medicare) shifting to dapagliflozin as preferred SGLT2 |
| Cigna | Covered; preferred brand | PA may be required; Tier 2–3 placement |
| UnitedHealthcare | Covered; preferred brand | PA required for non-T2D indications; quantity limits |
| OptumRx formulary | Tier 2–3 (preferred brand) | PA required for HF/CKD |
Typical PA criteria for heart failure:
- Confirmed diagnosis of heart failure (HFrEF or HFpEF)
- Documentation of ejection fraction measurement
- Some plans require concurrent use of guideline-directed medical therapy (ACEi/ARB/ARNI, beta-blocker, MRA)
- Trial and failure, contraindication, or intolerance of alternative therapies may be required
Typical PA criteria for chronic kidney disease:
- Confirmed diagnosis of CKD at risk of progression
- Documentation of eGFR and urine albumin-to-creatinine ratio
- Jardiance or Farxiga typically preferred over other SGLT2 inhibitors for this indication
- Some plans require documentation that patient is not a candidate for or has failed standard-of-care therapies
Medicare Part D
Jardiance is covered by approximately 90% of Medicare Part D plans. The IRA out-of-pocket cap is $2,100 for 2026.
Key 2026 Medicare changes:
- IRA negotiated price: $197/month (66% discount from $573 list price), effective January 2026
- $2,100 annual out-of-pocket cap for all Part D drugs
- Medicare Prescription Payment Plan (MPPP) allows monthly installment payments instead of lump-sum cost-sharing
- Low-Income Subsidy (LIS) patients: approximately $11–$12/month for brand
Medicaid
Jardiance is covered by state Medicaid programs. PA requirements vary by state but generally mirror commercial criteria for non-T2D indications. Cost-sharing is nominal. Some states may require step therapy through metformin before approving an SGLT2 inhibitor for T2D.
Prior authorization process
Required documentation
| Indication | Required documentation |
|---|---|
| Type 2 diabetes | HbA1c level, prior diabetes therapy records (metformin trial/failure if step therapy applies), renal function (eGFR) |
| Cardiovascular risk reduction | Diagnosis of T2D with established CVD, documentation of cardiovascular condition, current medication list |
| Heart failure | Echocardiogram or other EF measurement, NYHA class documentation, current heart failure medication regimen, eGFR |
| Chronic kidney disease | eGFR and urine albumin-to-creatinine ratio, CKD staging, prior nephrology workup if applicable, current medication list |
Reauthorization requirements
- T2D: Documentation of maintained glycemic control (HbA1c response) or continued clinical benefit
- HF: Documentation of maintained or improved clinical status; continued need for SGLT2 inhibitor therapy
- CKD: Documentation of stable or improved renal function (eGFR trend); continued benefit assessment
- Authorization duration: Typically 6–12 months depending on payer and indication
Common denial reasons and solutions
| Denial reason | Solution | Required documentation |
|---|---|---|
| Step therapy not met (T2D) | Document prior metformin failure or contraindication | Detailed records of prior diabetes therapies, HbA1c trends |
| Not medically necessary (HF/CKD) | Submit indication-specific documentation | EF measurement for HF; eGFR and UACR for CKD |
| PA not submitted for non-T2D indication | Submit PA with diagnosis code and clinical rationale | Chart notes confirming HF or CKD diagnosis and severity |
| Non-formulary drug | Request formulary exception | Medical necessity letter; documentation of alternatives tried or contraindicated |
| Quantity limits exceeded | Provide FDA dosing rationale | Prescriber attestation of appropriate dosing per label |
Cost and patient assistance
Manufacturer savings programs
| Program | Eligibility | Benefit |
|---|---|---|
| Jardiance Savings Card | Commercially insured patients | $0/month for 30- or 90-day supply |
| BI Cares Patient Assistance Program (PAP) | Uninsured or underinsured; income at or below 250% FPL; Medicare patients eligible | Free medication |
| BI Cares PAP — online application | Same as above; must be completed by HCP | Online portal for streamlined application |
BI Cares PAP contact information:
- Phone: 1-800-556-8317
- Fax: 1-866-851-2827
- Online application portal now available; must be completed by a healthcare provider
BI Cares PAP reapplication:
- Medicare patients: reapply each calendar year
- Uninsured patients: reapply every 12 months
Cost by insurance type
| Insurance type | Approximate out-of-pocket cost |
|---|---|
| Commercial + Jardiance Savings Card | $0/month |
| Commercial without savings card | Varies by plan (Tier 2–3 copay or coinsurance) |
| Medicare Part D | $0–$2,100/year depending on coverage phase |
| Medicare Part D + LIS | ~$11–$12/month |
| Medicaid | Nominal copay (varies by state) |
| Uninsured | Full WAC (~$573/month) or free via BI Cares PAP if eligible |
What changed in 2026
- IRA negotiated price takes effect: $197/month, a 66% discount from the $573 list price, effective January 2026. This applies to Medicare Part D and sets a new benchmark for SGLT2 inhibitor pricing.
- Generic dapagliflozin approved (April 2026): While not a generic for empagliflozin, the approval of generic dapagliflozin (a competing SGLT2 inhibitor) has triggered formulary shifts. Some plans now prefer generic dapagliflozin over branded Jardiance.
- BCBS Michigan Medicare formulary shift: Dapagliflozin is now the preferred SGLT2 inhibitor on BCBS Michigan 2026 Medicare plans. Patients currently on Jardiance must switch to dapagliflozin or pay higher cost-sharing.
- Medicare Part D $2,100 out-of-pocket cap: Effective January 2026 under the IRA, capping annual Part D out-of-pocket costs for all beneficiaries.
- Medicare Prescription Payment Plan (MPPP): Allows patients to spread out-of-pocket costs across monthly payments rather than paying lump sums at the pharmacy.
- BI Cares PAP online portal: Boehringer Ingelheim launched an online application portal for the Patient Assistance Program, streamlining the enrollment process (application must still be completed by an HCP).
What to monitor
- Generic empagliflozin entry timeline: Monitor patent expiry and potential ANDA filings for a true generic of empagliflozin, which would significantly alter the SGLT2 market.
- Payer formulary shifts toward dapagliflozin generic: With generic dapagliflozin now approved, expect additional payers to follow BCBS Michigan's lead in designating it as preferred SGLT2, particularly in Medicare Part D.
- IRA future negotiation rounds: Monitor whether empagliflozin or other SGLT2 inhibitors are selected for future Medicare price negotiation rounds beyond 2026.
- New SGLT2 competitors or label expansions: Watch for any new SGLT2 inhibitor approvals or label expansions that could shift formulary positioning and prior authorization requirements.
Sources
- FDA, Jardiance prescribing information: https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/204629s063lbl.pdf
- Drugs.com, Jardiance FDA approval history: https://www.drugs.com/history/jardiance.html
- Eli Lilly, Jardiance CKD approval: https://investor.lilly.com/news-releases/news-release-details/us-fda-approves-jardiancer-treatment-adults-chronic-kidney
- 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
- Boehringer Ingelheim, Patient Assistance Program: https://boehringer-ingelheim.com/us/our-responsibility/patient-assistance-program
- Jardiance savings card: https://patient.boehringer-ingelheim.com/us/products/jardiance/savings
- BCBS Michigan, 2026 Medicare pharmacy updates: https://providerinfo.bcbsm.com/documents/alerts/2025/202511/alert-20251107-2026-medicare-pharmacy-updates.pdf
- 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
- Maryland PDAB, Jardiance cost review study report: https://pdab.maryland.gov/Documents/meetings/2026/March%2023%202026/2026.03.16.DRAFT.Jardiance%20Cost%20Review%20Study%20Report.v.1.0.Final.pdf
- MCT2D, 2026 Patient Assistance Program guide: https://assets.ctfassets.net/1p0t6jhbvwk9/2f4rJneGOZ658h0fQhPVlz/a5cc7ca5e04b7bb11c409404eb769b7d/MCT2D_2026_Patient_Assistance_Program_Guide_updated_2-3-26_NK.pdf
