Tuesday , October 24 2017
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Prescription Coverage for SGLT2 inhibitors

Here’s out most recent list of insurance covereage. The cash price for 1 month of Invokana is $315.72. Current actual coverage is:

  • RXE United and other discount cards are approximately $268.
  • PSN Commercial calls it non-formulary and charges a $100 co-pay.
  • AARP-United Health will allow the first fill with a $95 co-pay then a prior authorization is needed.
  • Paid/Medco calls it non-formulary and charges an $85 co-pay.
  • Humana Part D requires prior authorization before the first fill and no partial fill is available until the prior authorization is approved.

Just follow link for the complete list.

  • WIN, or WHP Health Initiative (can include WellCare) requires prior authorization before the first fill and no partial fill is available until the prior authorization is approved.
  • Catalyst Commercial calls it non-formulary and charges a $131.00 co-pay.
  • Blue Cross Medicare calls it non-formulary and will not pay at all for it. They advise the pharmacist to call the physician to change drugs.
  • NMH Optimum Health Care Part D calls it non-formulary and will not pay at all for it.
  • Express Scripts for Tri Care or the Department of Defense has it for a $17 co-pay with no prior authorization required.
  • ESI/Medco (Commercial & Part D) now has various copays depending on the plan the member is on.
  • Envision Rx (Commercial & Part D) Can be Tier 2 for commercial and is tier 3 for Part D with prior auth
  • HealthPartners Commercial plan is tier 2 may require step edit
  • AvMed Commercial covers at tier 2
  • Emblem Health (Managed Medicaid) will pay for it with a prior authorization
  • Sharp Healthcare (IDN) requires prior authorization
  • Sanford Health Plan requires prior authorization
  • Wyoming Medicaid will pay with prior authorization and proof of step therapy

In addition, many of our patients are being seen by Accountable Care Organization (ACO) practices and each of these have their own formularies and for the most part are not currently covering this class of drugs.

Co-pay relief for your patients can be found directly on Janssen’s website
With this savings card and your patients’ private insurance, patients pay no more than $5 per month for their medication out-of-pocket costs. The card is valid for 12 uses, $1200 maximum benefit, or 12 months from when they activate it. Must be redeemed with a valid prescription.

See more SGLT-2 Resources