Jardiance (empagliflozin, Boehringer Ingelheim/Eli Lilly) and Farxiga (dapagliflozin, AstraZeneca) are sodium-glucose cotransporter-2 (SGLT2) inhibitors that have evolved beyond type 2 diabetes into cornerstone therapies for heart failure and chronic kidney disease. Both have landmark outcome trial data, both are now on formulary for most plans, and both are subject to the IRA's Medicare Drug Price Negotiation Program starting in 2026.
But they are not identical in label scope, pivotal evidence, or payer positioning. This comparison is for prescribers, access teams, and pharmacists who need to understand the practical differences that affect coverage, step therapy, and prescribing decisions.
Short answer
| Jardiance (empagliflozin) | Farxiga (dapagliflozin) | |
|---|---|---|
| Drug class | SGLT2 inhibitor | SGLT2 inhibitor |
| Manufacturer | Boehringer Ingelheim / Eli Lilly | AstraZeneca |
| FDA indications | T2D (age 10+), HF (HFrEF and HFpEF), CKD, CV death reduction in T2D + CVD | T2D (age 10+), HF (HFrEF and HFpEF), CKD, HF hospitalization in T2D + CV risk |
| Generic available | No | Yes (authorized generic dapagliflozin propanediol) |
| IRA negotiated price (2026) | $197/month (30-day supply) | $179/month (30-day supply) |
| Usual dosing | 10 mg once daily (HF/CKD/CV); 10 or 25 mg for T2D | 10 mg once daily (all indications) |
| Oral tablet | Yes | Yes |
| OTC | No | No |
| Prior authorization | Varies by plan; often required for CKD/HF without T2D | Varies by plan; often required for CKD/HF without T2D |
| Step therapy | Some plans require Farxiga/generic dapagliflozin before Jardiance | Some plans require Jardiance before Farxiga (depending on formulary) |
FDA-approved indications head-to-head
| Indication | Jardiance | Farxiga |
|---|---|---|
| Glycemic control in T2D (age 10+) | Yes | Yes |
| CV death reduction in T2D + established CVD | Yes (EMPA-REG OUTCOME) | Yes (DECLARE-TIMI 58) |
| Heart failure (reduced EF) | Yes (EMPEROR-Reduced) | Yes (DAPA-HF) |
| Heart failure (preserved EF) | Yes (EMPEROR-Preserved) | Yes (DELIVER) |
| CKD at risk of progression | Yes (EMPA-KIDNEY) | Yes (DAPA-CKD) |
| CKD without diabetes | Yes | Yes (first SGLT2i approved for CKD without diabetes) |
| HF hospitalization in T2D + CV risk | Yes (from EMPA-REG) | Yes (DECLARE-TIMI 58) |
Key label differences:
- Farxiga was the first SGLT2 inhibitor specifically FDA-approved for CKD in patients without diabetes (based on DAPA-CKD, approved April 2021). Jardiance later gained the CKD indication with EMPA-KIDNEY.
- Jardiance has a more established cardiovascular mortality signal (38% reduction in CV death in EMPA-REG OUTCOME), which was the primary driver of its cardiovascular indication.
- Both are now recognized by ADA, AHA, ACC, and KDIGO guidelines as first-line options for patients with T2D and heart failure or CKD.
Pivotal trial evidence
Jardiance landmark trials
| Trial | Population | Primary endpoint | Key result |
|---|---|---|---|
| EMPA-REG OUTCOME | 7,020 adults with T2D + established CVD | 3-point MACE (CV death, non-fatal MI, non-fatal stroke) | 14% relative risk reduction; 38% reduction in CV death |
| EMPEROR-Reduced | Adults with HFrEF (with or without T2D) | CV death or HF hospitalization | 25% relative risk reduction |
| EMPEROR-Preserved | Adults with HFpEF (with or without T2D) | CV death or HF hospitalization | 21% relative risk reduction |
| EMPA-KIDNEY | 6,609 adults with CKD at risk of progression | Kidney disease progression or CV death | 28% relative risk reduction |
Farxiga landmark trials
| Trial | Population | Primary endpoint | Key result |
|---|---|---|---|
| DECLARE-TIMI 58 | Adults with T2D + established CVD or CV risk | 2-point MACE; HF hospitalization/CV death | Non-significant MACE reduction; significant 17% reduction in HF hospitalization/CV death |
| DAPA-HF | Adults with HFrEF (with or without T2D) | CV death or worsening HF | 26% relative risk reduction |
| DELIVER | Adults with HFpEF (with or without T2D) | CV death or worsening HF | 18% relative risk reduction |
| DAPA-CKD | Adults with CKD (with or without T2D) | Sustained eGFR decline, ESKD, renal/CV death | 39% relative risk reduction in composite kidney endpoint |
The most notable difference: EMPA-REG OUTCOME demonstrated a stronger cardiovascular mortality signal for Jardiance (38% CV death reduction), while DAPA-CKD demonstrated a larger kidney-specific benefit for Farxiga (39% reduction in composite kidney endpoint in a broader CKD population including non-diabetic patients).
Dosing and administration
| Jardiance | Farxiga | |
|---|---|---|
| HF dose | 10 mg once daily | 10 mg once daily |
| CKD dose | 10 mg once daily | 10 mg once daily |
| T2D dose | 10 mg once daily; may increase to 25 mg | 5 mg or 10 mg once daily |
| T2D with CV disease dose | 10 mg once daily | 10 mg once daily |
| Renal impairment (T2D) | Not recommended when eGFR <30 mL/min/1.73 m² | Not recommended when eGFR <45 mL/min/1.73 m² |
| Renal impairment (HF/CKD) | No dose adjustment for eGFR ≥20 mL/min/1.73 m² | No dose adjustment for eGFR ≥25 mL/min/1.73 m² |
| With or without food | Either | Either |
| Available strengths | 10 mg, 25 mg tablets | 5 mg, 10 mg tablets |
Both drugs carry the same class-level warnings: risk of diabetic ketoacidosis (even without markedly elevated blood glucose), acute kidney injury, serious urinary tract infections, genital mycotic infections, hypoglycemia when combined with insulin or sulfonylureas, and rare necrotizing fasciitis of the perineum (Fournier's gangrene).
Formulary and payer coverage
Commercial insurance
Both drugs are widely covered on commercial formularies, but step therapy direction varies by plan and PBM.
| PBM/Payer | Jardiance | Farxiga | Notes |
|---|---|---|---|
| UnitedHealthcare commercial (2026 PDL) | Tier 4; step therapy, quantity limits | Step therapy; quantity limits (generic dapagliflozin preferred) | Generic dapagliflozin propanediol is listed at no cost-sharing as equivalent |
| OptumRx Premium Formulary (2026) | Tier 2 | Tier 2 (Farxiga); generic dapagliflozin available | Both preferred; generic dapagliflozin may have lower copay |
| Express Scripts National Preferred (2026) | Preferred | Preferred; generic dapagliflozin excluded from NPF | Both drugs preferred; counterintuitively, generic dapagliflozin is excluded from the NPF while brand Farxiga is preferred |
| CDPHP Medicare Part D (2026) | Step therapy: requires trial of brand Farxiga first | Preferred | SGLT2 step therapy group requires Farxiga trial before Jardiance |
| Kaiser Permanente (2026) | Covered | Covered | Check specific plan formulary |
Step therapy patterns in 2026:
- Some Medicare and commercial plans require a trial of Farxiga or generic dapagliflozin before approving Jardiance (e.g., CDPHP 2026 Medicare Part D step therapy list).
- Other plans treat both as equivalent Tier 2 agents without step therapy requirements.
- The availability of generic dapagliflozin is creating cost-based formulary preferences: where generic dapagliflozin is available at lower cost, plans may prefer it as the default SGLT2 inhibitor.
Medicare Part D (IRA-negotiated prices for 2026)
Both Jardiance and Farxiga were included in the first cycle of Medicare Drug Price Negotiation under the Inflation Reduction Act. The negotiated maximum fair prices (MFPs) became effective January 1, 2026:
| Drug | IRA-negotiated MFP (30-day supply) |
|---|---|
| Dapagliflozin (Farxiga) | $179 |
| Empagliflozin (Jardiance) | $197.00 |
These represent significant reductions from prior list prices, which exceeded $600/month for both. Actual patient out-of-pocket costs depend on the plan's benefit design, coverage phase, and whether the patient qualifies for the Low-Income Subsidy (LIS):
- Standard cost-sharing: 25% coinsurance during the initial coverage phase, up to the $2,100 annual out-of-pocket cap
- LIS patients: $12.65 or less per fill
- Medicare Prescription Payment Plan (MPPP): Monthly installments available instead of lump-sum cost-sharing
Generic dapagliflozin
Generic dapagliflozin propanediol (authorized generic of Farxiga) is now available. This is a significant development:
- Generic dapagliflozin is priced lower than brand Farxiga and Jardiance
- Some plans (e.g., UHC 2026 PDL) list generic dapagliflozin at no cost-sharing
- The generic approval currently covers T2D and HF risk reduction indications; for the CKD indication, brand Farxiga remains the reference product
- Jardiance does not yet have a generic equivalent
Medicaid
Both drugs are covered by state Medicaid programs, typically with minimal copay ($0–$8/month depending on state). Prior authorization may be required, particularly for non-T2D indications (HF without diabetes, CKD without diabetes).
Prior authorization considerations
When PA is typically required
- HF or CKD indication without concurrent T2D diagnosis
- Use in patients with eGFR below the label threshold
- Dose escalation beyond standard dosing
- Non-formulary or non-preferred SGLT2 inhibitor when step therapy applies
Required documentation
| Indication | Required documentation |
|---|---|
| T2D glycemic control | Diagnosis, current A1C, prior therapy records |
| Heart failure | Echocardiogram or other EF assessment, NYHA class, BNP/NT-proBNP |
| CKD | eGFR, urine albumin-to-creatinine ratio (uACR), CKD stage |
| CV risk reduction | Established CVD documentation or CV risk factors |
Switching between SGLT2 inhibitors
When formulary changes or access barriers require switching between Jardiance and Farxiga (or vice versa):
- No washout period is required when switching within the SGLT2 inhibitor class
- The patient can start the new drug at standard dosing immediately after stopping the previous one
- For HF or CKD patients where treatment continuity is critical, avoid gaps longer than 3–5 days; consider a bridge supply or early refill if the switch is due to a formulary change rather than clinical failure
- Document the reason for the switch (formulary mandate vs. clinical) in the PA submission, as payers may process formulary-driven switches more quickly
- When switching from Farxiga to Jardiance for CKD, verify that the patient meets the Jardiance CKD label criteria (the patient populations in DAPA-CKD and EMPA-KIDNEY differ slightly)
Cost comparison
| Cost metric | Jardiance | Farxiga | Generic dapagliflozin |
|---|---|---|---|
| Average monthly cash price (no insurance) | ~$819 (30 tablets) | ~$776 (30 tablets) | ~$860 (30 tablets retail) |
| With discount coupon (SingleCare) | ~$255 | ~$372 | ~$207 |
| IRA-negotiated Medicare price (2026) | $197/month | $179/month | Lower than brand |
| Commercial copay with savings card | As low as $0 | As low as $0 | N/A |
Manufacturer savings programs
| Drug | Program | Benefit |
|---|---|---|
| Jardiance | Jardiance Savings Card (commercially insured) | As low as $0 per fill; annual maximum applies |
| Farxiga | Farxiga Savings Card (commercially insured) | As low as $0 per fill |
| Jardiance | Medicare Resource Guide | Information on cost support options for Part D patients |
| Farxiga | AstraZeneca patient assistance | Support for qualifying uninsured or underinsured patients |
What changed in 2026
- IRA-negotiated Medicare prices in effect: Both Jardiance ($197/month) and Farxiga ($179/month) now have government-negotiated prices under the Inflation Reduction Act, reducing costs significantly for Medicare beneficiaries.
- Generic dapagliflozin availability: The authorized generic of Farxiga is now on market, creating a cost advantage for some plans and formularies.
- Step therapy divergence: Some Medicare Part D plans (e.g., CDPHP) require Farxiga trial before covering Jardiance, while others treat both as equivalent. The availability of generic dapagliflozin is driving formulary decisions.
- Updated clinical guidelines: ADA 2026 Standards of Care and KDIGO 2024 CKD guidelines both recommend SGLT2 inhibitors as first-line therapy for patients with T2D and heart failure or CKD, regardless of A1C level.
- EMPA-KIDNEY publication impact: Jardiance's CKD indication is now well-established, narrowing the previous gap where Farxiga had a clearer CKD label advantage.
What to monitor
- Generic dapagliflozin label expansion: Whether the FDA expands generic dapagliflozin labeling to include the CKD indication (currently only brand Farxiga carries the full CKD label).
- Formulary shifts driven by generic pricing: As generic dapagliflozin costs decrease, expect more plans to prefer it over both brand Farxiga and Jardiance.
- IRA negotiation cycle 2: Monitor whether either drug is re-negotiated or whether pricing changes in future years.
- Jardiance generic entry timeline: Monitor when empagliflozin exclusivity ends, which could equalize the cost landscape.
- New SGLT2 competitors: Monitor any new SGLT2 inhibitor approvals or label expansions (e.g., Inpefa/sotagliflozin) that could shift formulary positioning.
- CKD guideline updates: KDIGO and ADA may issue refined guidance on SGLT2 inhibitor selection based on patient-specific factors (eGFR range, albuminuria severity, heart failure type).
Sources
- FDA, Jardiance prescribing information (revised 2025): https://www.accessdata.fda.gov/drugsatfda_docs/label/2025/204629s063lbl.pdf
- FDA, Farxiga prescribing information (revised 2024): https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/202293s031lbl.pdf
- CMS, Medicare Drug Price Negotiation Program 2026 prices: https://www.cms.gov/newsroom/fact-sheets/2026-maximum-fair-prices-negotiated-drugs-first-cycle-medicare-drug-price-negotiation-program
- OptumRx, 2026 Premium Formulary: https://contenthub-aem.optumrx.com/content/dam/contenthub/onboarding/assets/wespath/Jan-01-2026-Premium-Formulary-Booklet.pdf
- UHC, 2026 Commercial Prescription Drug List: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/pharmacy/commercial-pdl-jan-2026.pdf
- CDPHP, 2026 Medicare Part D Step Therapy Drug List: https://www.cdphp.com/-/media/files/medicare/medicare2026/members/medicare-part-d-step-therapy-drug-list.pdf
- SingleCare, Farxiga vs Jardiance cost comparison: https://www.singlecare.com/blog/farxiga-vs-jardiance-cost/
- Heerspink HJL et al., DAPA-CKD trial: N Engl J Med. 2020;383(15):1436-1446. https://clinicaltrials.gov/study/NCT03036150
- HFSA, FDA Advisory Committee recommends Jardiance cardiovascular indication: https://hfsa.org/fda-advisory-committee-recommends-approval-jardiancer-empagliflozin-cardiovascular-indication
- Boehringer Ingelheim, Jardiance HCP CKD guidelines: https://pro.boehringer-ingelheim.com/us/products/jardiance/ckd/guidelines
- AstraZeneca, Farxiga HCP CKD data: https://www.farxiga-hcp.com/chronic-kidney-disease
