Today I fell into the Medicare Donut hole with Jardiance, widely advertised for Type II diabetes.
Anyone have a solution to this problem? If you buy the drugs without insurance, who has best prices? Some say Costco. GoodRx. Any experience out there? What do you recommend?
For Medicare, the key numbers are $4430 (increasing to $4660 next year) to $7050.
I have AARP United Healthcare HMO. For Jardiance their numbers are $607.66 list for a 30 day supply of Jardiance. Below the $4430 annual total, cost is 7.7% or $47/mo. Above $4430, the cost moves to 25% or $151.92/mo. Above $7050, the cost is 3 to 5%, or $18-$30.
The $4430 is the sum of all the list figures for the year. I was given a quote of $490.93 for a 3 month supply from OptumRx, the United mail order pharmacy.
At $607.66, you get almost 8 months at $50/mo (or $400) and then 4 months at abt $150 (or $600) for a total of $1000/yr.
The donut hole is a strong incentive to use generics when you can. But when you can’t, ouch!!
I don’t have a need for Jardiance, but I do order my prescriptions via mail order or using GoodRx. I competitively shop using Blink Health, CVS, Walgreens, and Good Rx. I’ve also read that Amazon is getting into the pharmacy biz and may also have attractive pricing.
Please let us know what you end up trying!
'38Packard - Best of Luck
I do not have a personal experience with this specific drug, however, every prescription I have ever needed I have found is the cheapest at Medicine Shoppe. And the last time I was there I overheard the person that was in line in front of me speaking of this specific drug and they found it was cheapest there as well.(edited)
In the context of this thread and your post on LBYM and saving on drug costs and mention of the low carb board, is it worth mentioning aggressive therapeutic lifestyle interventions WRT your question.
Certainly discussed this plenty on the H&N board and I have an idea it might pertain to your situation. Apologies if you are doing everything feasible in that regard. I know it can get a bit irksome when well meaning but ill informed folks offer simple solutions to complex problems.
I do the low carb diet and am losing some weight. Also maintaining active lifestyle with exercise appropriate for my age. Blood sugars and A1Cs being monitored and good. Not doing insulin. Metformin works for me but causes problems. Hence, Jardiance. Would be nice to get off the meds but I’m happy to have it under control and not getting worse.
Ditto high blood pressure and chronic kidney disease. I’m at 70+% kidney function. Normal abt 80% for my age group. Nephrologist says I one of her star patients as most gradually get worse. I’m up from 41% kidney function being aggressive about controlling high blood pressure. Treating blood sugar also helped.
We were with friends for brunch yesterday and I saw something interesting first hand…use of a continuous-read glucose monitor in a non-diabetic…or rather not yet diabetic.
Our pal is 70 and, although his fasting glucose, A1c and even his circulating insulin are ok (but trending higher…especially insulin) his father developed T2D as he got older in spite of not being overweight. Hoping to use technology to detect a slide downhill before the standard blood work was affected, he decided on a CGM.
I don’t know if Medicare actually covered it as I’ve always associated the use with insulin dependent diabetes but the cost is coming down as the manufacturers are marketing aggressively to the non diabetic community. Anyways, it seems the newer, more “granular” approach is something called time in range…the actual real time measurement on a daily basis that avoids the highs and lows associated with early disease that the 3 month average (A1c) and fasting glucose don’t capture. Or rather, avoids those highs and lows if you don something about it.
Our pal is an anesthesiologist and said that he got it after more than a few patients whose most recent A1c and fasting glucose were “good” (for someone with diabetes, I guess) but whose reading that day per their CGM was well over 200. Not exactly good glycemic control. Apparently, he felt it was quite an eye opener for him, even though most endocrinologists he spoke to were lukewarm in the “not enough evidence” sort of way.
Don’t know what age appropriate exercise is, mind…let me not strive for age appropriate in that respect.
Age appropriate exercise means gardening, shoveling snow, and laps around the big box stores. Not running or climbing ladders. Climbing stairs can be a challenge.
So, had cause to think about you this morning during my Z2/coronary atherosclerosis mitigation training as I listened to my Peter Attia podcast. A deep dive into CGM usage and all sorts of other blood glucose control strategies.
My health related expenses have jumped big time over the past couple of years…mostly unrelated to drs’ visits or meds (although the Repatha would make my eyes water if I hadn’t decided on our part D plan) … but rather the background things I pay for. Peloton and iFit (treadmill) subscriptions plus Peter Attia etc. Money well spent as it was stuff I realised I didn’t know enough about on Attia’s podcast that made me suggest a circulating insulin test to my PCP (covered by Medicare) and ask about a Coronary Artery Calcium scan (not covered by Medicare)
Today’s podcast was the one mentioned in the hyperlink here (AMA#26)…
I realise that I could’ve edited my post to include this snippet. I didn’t forget it, BTW but added it to a second post because a few months back there was a flurry of posts getting removed from the LBYM board…allegedly “off topic”…and I wasn’t sure if it was someone acting as a self appointed OT enforcer, FAing posts that were then deleted or if the link somehow triggered and automatic removal. Seems to be a bit less of those shenanigans these days but we shall see
Dr today advises that Medicare insurance companies use very high list prices. That can run up your donut hole quickly. I’ve been doing Jardiance since July. At $600/mo, my drug cost toward $4450 donut hole should be about $3600. That implies I’ve spent maybe $800 toward the donut hole on my generics (with no charge to me).
Dr suggests using GoodRx for generics and pay cash to preserve insurance money below the donut hole for most expensive meds. He says most patients gradually move into the donut hole as they require more medications or come up with side effects that cause them to need more expensive meds. Its a common problem. He hopes negotiated prices for Medicare will force insurance companies to use more competitive prices. Its a racket of the drug and insurance companies increasingly hard to avoid.
I read on line that side effects of metformin are best avoided by taking med with a meal with protein. Dinner is best time. Dr says taking two Metformin XL with dinner is my best shot at overcoming side effects. Plan to give it a try and avoid need for Jardiance. Jardiance gave good A1C number. So does two metformin per day. But side effects are a problem.
It’s great that your doctor has tips like this up his sleeve…I hadn’t thought about the donut hole since I’m such a n00b to repeat medications and only recently (since September) started the $600 a month habit with Repatha.
The thing that really irks me is that there’s nothing I can do…or could’ve done…to prevent the CVD that’s made these meds part of my life. A bit like type 1 diabetes, familial hypercholesterolemia isn’t readily preventable except by not being born in the first place. It’s lifestyle…diet and exercise…that’s kept me healthy and symptomfree this far. At least, if I’d been complicit in my ASCVD by eating and sitting my way there, I’d have tools at my disposal to keep my drug costs in line.
Today I filled my metformin er prescription, 180 tablets, at Walmart with GoodRx for $6.
The irony is that I had switched to metformin regular earlier because OptumRx does not have ER on their tier 1 generic list. It would have been expensive. But in the donut hole I didn’t even check. I would not be surprised at $100 copay, at least $25.
My doctors advice was right on target. Walmart is much better. Less than the insurance copay and much less than the charge toward the donut hole.
This is my alternative to Jardiance. We know that two metformins per day will give me good A1c’s. One metformin is not enough. Instructions have always been to take with food. I have been doing one at 9 am and one at midnight with a snack. The big experiment is will two ers at dinner time resolve the upset stomach problem. Wish me luck.
Literature says take with food and best results are with protein at dinnertime. But its surprising how little research is reported on this problem. 70% of metformin users report upset stomach.
Jardiance is much better in the upset stomach department, and does deliver good A1c, but the price is outrageous.
Ditto Jardiance. $47/mo. At $600/mo expect to hit donut hole at 7 months. Then $70/mo from the drug company (but 4 to 6 weeks to set up). Best I can do so far. But still trying ideas with metformin.