Farxiga Medicare Part D Coverage: Cost, Copays, and How to Pay Less in 2026

What the Medicare-Negotiated Price Means for Farxiga in 2026

Farxiga was one of the first ten drugs selected for direct price negotiation between Medicare and manufacturers under the Inflation Reduction Act (IRA). The Centers for Medicare & Medicaid Services (CMS) announced the Maximum Fair Price (MFP) for dapagliflozin in August 2024, and that price took effect on January 1, 2026 1. The negotiated price represents a reduction of roughly 76% compared to the pre-negotiation list price.

Before this change, many Part D enrollees were paying $300 to $500 or more out of pocket per year for Farxiga alone, depending on their plan's formulary tier and cost-sharing structure. The new MFP applies at the pharmacy counter for all Part D-covered prescriptions of Farxiga. This is not a rebate that flows to insurers behind the scenes. It is a lower price you actually see. CMS estimated that approximately 800,000 Medicare beneficiaries used Farxiga in 2022, and the agency projected average per-beneficiary savings of over $2,300 annually once negotiated prices began 2.

The distinction matters. Even if your plan places Farxiga on a higher cost-sharing tier, the coinsurance percentage now applies to a much lower base price. A beneficiary paying 33% coinsurance on a $620 monthly price faced roughly $205 per fill. That same 33% applied to $178 drops the monthly cost to about $59.

How Medicare Part D Plans Cover Farxiga on Their Formularies

Most Part D plans include Farxiga on their formularies, though the specific tier placement varies by plan and region. Farxiga typically lands on Tier 3 (preferred brand) or Tier 4 (non-preferred brand) 3. Plans that list the competing SGLT2 inhibitor Jardiance (empagliflozin) as their preferred agent may place Farxiga on a higher tier, and vice versa.

Tier placement directly affects your copay or coinsurance. Tier 3 copays on many Part D plans range from $35 to $50 per fill. Tier 4 coinsurance typically runs 25% to 40% of the drug cost. With the negotiated price now in effect, even a Tier 4 placement at 40% coinsurance means roughly $71 per month rather than the $248 it would have been at list price.

Some plans require step therapy. This means your prescriber must document that you tried metformin (for diabetes) or an ACE inhibitor/ARB (for CKD or heart failure) before the plan will approve Farxiga. The American Diabetes Association's 2024 Standards of Care recommend SGLT2 inhibitors as a first-line add-on to metformin for patients with established cardiovascular disease or high cardiovascular risk, which can support prior authorization appeals 4.

To check your specific plan's formulary and tier placement, use the Medicare Plan Finder at medicare.gov or call the number on the back of your Part D card.

The $2,000 Annual Out-of-Pocket Cap and What It Changes

The IRA introduced a hard $2,000 annual cap on out-of-pocket Part D spending, effective January 1, 2025 5. Before this cap existed, Medicare Part D had a coverage gap (the "donut hole") and a catastrophic phase where beneficiaries still owed 5% coinsurance with no upper limit. For patients on multiple brand-name drugs, annual costs could exceed $10,000.

That structure is gone. Once your true out-of-pocket spending (copays plus coinsurance) reaches $2,000 in a calendar year, you pay nothing for covered Part D drugs for the remainder of that year. This cap applies across all your Part D prescriptions, not just Farxiga.

Here is a practical example. A Medicare beneficiary takes Farxiga for CKD and also fills prescriptions for lisinopril and atorvastatin. The generics cost perhaps $15 per month total. Farxiga, at the negotiated price with Tier 3 copays of $47 per month, adds $564 per year. Total annual Part D out-of-pocket spending: roughly $744. That patient never hits the cap. But a patient who also takes Eliquis, Entresto, and an insulin (all brand-name) could reach $2,000 by mid-year, after which Farxiga and every other covered drug becomes free for the rest of the year.

CMS also introduced the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket costs into predictable monthly installments rather than paying large amounts at the pharmacy in January and February. You can enroll through your Part D plan 5.

Prior Authorization: Why Plans Require It and How to Get Approved

Many Part D plans require prior authorization (PA) for Farxiga, particularly when prescribed for heart failure or chronic kidney disease rather than type 2 diabetes. The PA process exists because plans want clinical documentation that the prescription matches an FDA-approved indication and that the patient has tried lower-cost alternatives where appropriate.

For type 2 diabetes, the typical PA criteria include: a documented diagnosis of type 2 diabetes, current or prior use of metformin (or documented intolerance/contraindication), and an HbA1c above a plan-specific threshold (often 7.0% or higher). For heart failure, plans may require documentation of NYHA Class II-IV symptoms and a left ventricular ejection fraction measurement. The DAPA-HF trial enrolled patients with ejection fraction of 40% or below and demonstrated a 26% reduction in the composite of cardiovascular death or worsening heart failure events (HR 0.74, 95% CI 0.65 to 0.85) 6. For CKD, plans typically require an eGFR between 25 and 75 mL/min/1.73 m² and a urine albumin-to-creatinine ratio of 200 mg/g or higher, mirroring the DAPA-CKD trial's enrollment criteria, which showed a 39% reduction in the composite kidney endpoint (HR 0.61, 95% CI 0.51 to 0.72) 7.

If your PA is denied, you have appeal rights. Your prescriber can submit a coverage determination request, and if denied again, a formal appeal to an independent review entity. The 2024 ADA Standards of Care state: "For patients with type 2 diabetes and established atherosclerotic cardiovascular disease, heart failure, or diabetic kidney disease, an SGLT2 inhibitor with proven benefit is recommended regardless of HbA1c" 4. Citing this guideline in an appeal letter often accelerates approval.

A PA approval is typically valid for 12 months. Mark your calendar. If your refill is denied near the renewal date, contact your prescriber's office promptly to resubmit.

Extra Help (Low-Income Subsidy) and How It Slashes Farxiga Costs

Medicare's Extra Help program, also called the Low-Income Subsidy (LIS), provides substantial additional savings for beneficiaries with limited income and resources. In 2026, full Extra Help eliminates the Part D premium and reduces copays to $0 for drugs below the generic threshold and $4.50 to $11.20 for brand-name drugs like Farxiga 8.

Eligibility thresholds for 2026: individual annual income below approximately $22,590 and resources (excluding your home and car) below $17,220. Married couples filing jointly face thresholds of roughly $30,660 in income and $34,360 in resources. These figures adjust annually. Partial Extra Help, which still reduces premiums and copays meaningfully, has slightly higher income limits.

You apply through the Social Security Administration, either online at ssa.gov, by phone, or at a local SSA office. State Medicaid offices can also enroll eligible individuals. Many beneficiaries who qualify do not apply. The Medicare Payment Advisory Commission (MedPAC) estimated in its March 2023 report to Congress that roughly 2 to 3 million eligible beneficiaries were not receiving LIS benefits 9.

If you qualify for full Extra Help, your Farxiga copay drops to $11.20 or less per fill. That is roughly $134 per year, compared to the $620-per-month cash price that uninsured patients face.

AstraZeneca's Patient Assistance Programs

AstraZeneca operates two programs relevant to Farxiga affordability. The first is the Farxiga Savings Card, which offers commercially insured patients a copay as low as $0 per month. Federal law prohibits the use of manufacturer copay cards with Medicare, Medicaid, or other federal healthcare programs. Medicare beneficiaries cannot use this card.

The second is AZ&Me, AstraZeneca's patient assistance program for uninsured or underinsured patients who meet income criteria (generally at or below 400% of the federal poverty level) 10. Medicare beneficiaries who do not qualify for Extra Help and face high out-of-pocket costs can sometimes qualify, though acceptance varies by year and program capacity. AZ&Me provides Farxiga at no cost to approved patients, shipped directly to the patient or prescriber's office. The application requires prescriber involvement and proof of income.

A third pathway exists through state pharmaceutical assistance programs (SPAPs). Roughly 20 states operate SPAPs that supplement Part D coverage. These programs have their own eligibility criteria and may provide additional copay assistance for high-cost drugs. The Medicare Rights Center maintains a database of SPAPs searchable by state 11.

Dr. Julianne Holt-Lunstad, a health policy researcher, noted in a 2023 American Heart Association policy statement: "Medication nonadherence driven by cost remains one of the largest modifiable contributors to poor cardiovascular outcomes in the Medicare population" 12. The layered savings available in 2026 (negotiated price, OOP cap, LIS, SPAPs) represent the most substantial cost reduction for Farxiga since the drug's 2014 approval.

Farxiga vs. Jardiance: How Medicare Coverage Compares

Jardiance (empagliflozin) is the other widely prescribed SGLT2 inhibitor and was also among the first ten drugs selected for Medicare price negotiation. Both drugs now carry negotiated Maximum Fair Prices under Part D, making the cost difference between them smaller than it has ever been 1.

From a clinical standpoint, both drugs are FDA-approved for type 2 diabetes and heart failure. Farxiga holds an additional FDA approval for chronic kidney disease based on the DAPA-CKD trial, which enrolled patients with and without diabetes. The EMPA-KIDNEY trial, published in the New England Journal of Medicine in January 2023 (N=6,609), showed empagliflozin reduced the risk of kidney disease progression or cardiovascular death by 28% (HR 0.72, 95% CI 0.64 to 0.82) 13. The FDA subsequently expanded Jardiance's label to include CKD in June 2025.

The Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guideline update states: "SGLT2 inhibitors are recommended for patients with CKD who have an eGFR ≥20 mL/min/1.73 m², with or without diabetes" 14. This class-level recommendation means your prescriber can use either drug, and formulary preference on your specific plan should guide the choice when clinical factors are equivalent.

If your plan's formulary places Jardiance on a lower tier, switching from Farxiga to Jardiance (or the reverse) can save you $10 to $30 per month without sacrificing clinical benefit. Ask your prescriber whether a switch is appropriate given your specific indications.

When a Generic Dapagliflozin Might Arrive

No generic version of dapagliflozin is available in the United States as of May 2026. AstraZeneca holds patents on Farxiga that, according to FDA Orange Book listings, extend into 2031 for certain formulation and use patents 15. Patent litigation settlements and paragraph IV challenges from generic manufacturers could accelerate this timeline, but no abbreviated new drug application (ANDA) for dapagliflozin has received tentative FDA approval to date.

When a generic does arrive, the price drop is typically steep. SGLT2 inhibitors are small-molecule drugs (not biologics), and historical precedent suggests generic entry reduces prices by 80% to 90% within two years of launch. For context, the generic for canagliflozin (Invokana) is not yet available either, as the SGLT2 inhibitor class is still relatively young.

Until then, the negotiated MFP of approximately $178 per month is the lowest price Medicare will pay for Farxiga. This negotiated rate is scheduled to remain in effect through at least 2027, at which point CMS will renegotiate or extend 1.

Strategies to Minimize Your Farxiga Costs Under Part D

Start with the Medicare Plan Finder at medicare.gov during Open Enrollment (October 15 through December 7 each year). Enter Farxiga and all your other medications, select your preferred pharmacy, and compare total estimated annual costs across available plans. A plan with a $45 Farxiga copay might have a higher monthly premium than one with a $70 copay, but the lower copay plan could still save you money overall if you fill prescriptions every month.

Next, confirm your plan allows 90-day mail-order fills. Many Part D plans charge two copays for a 90-day supply rather than three, saving you one copay per quarter. Over 12 months, that is four fills instead of 12, and the savings compound.

Ask your prescriber to document all applicable diagnoses when submitting the prior authorization. Farxiga's strongest formulary coverage often applies when heart failure and CKD are listed alongside diabetes, because the clinical evidence base is broader and plans have fewer grounds for denial.

If your income has changed, recheck your Extra Help eligibility annually. Job loss, a spouse's death, or retirement can shift your income below the LIS threshold. The application takes about 15 minutes online and can save thousands.

Finally, do not overlook the Medicare Prescription Payment Plan. Spreading your annual drug costs across 12 monthly payments does not reduce the total amount, but it prevents the cash flow shock of January and February when deductibles reset. For patients on fixed incomes, predictability has real value. Contact your Part D plan directly to enroll 5.

The FDA's MedWatch safety reporting system lists dapagliflozin's most common adverse effects as genital mycotic infections (occurring in 4% to 8% of trial participants) and urinary tract infections, both manageable with standard treatment 16. If side effects cause you to consider discontinuing, discuss alternatives with your prescriber before stopping, especially if you take Farxiga for heart failure or CKD, where abrupt discontinuation could worsen outcomes.