Jardiance vs Tresiba: Cost and Access Head-to-Head

Why Comparing Cost Between These Two Drugs Is Complicated

Jardiance and Tresiba belong to different drug classes, treat different aspects of glucose dysregulation, and move through insurance formularies on separate tracks. A sticker-price comparison tells you almost nothing about what a given patient will pay. The real cost picture depends on plan design, tier placement, prior authorization hurdles, and available manufacturer support.

Drug Class Shapes Formulary Strategy

Jardiance is an SGLT2 inhibitor. It lowers blood glucose by blocking glucose reabsorption in the proximal tubule of the kidney, causing excess glucose to be excreted in urine 1. Because SGLT2 inhibitors now carry FDA-approved indications for heart failure and chronic kidney disease on top of type 2 diabetes, many pharmacy benefit managers have moved them to preferred formulary tiers. That shift has improved access for a broad patient population.

Tresiba is insulin degludec, an ultra-long-acting basal insulin with a half-life exceeding 25 hours. It demonstrated non-inferiority to insulin glargine U-100 on major adverse cardiovascular events (MACE) in the DEVOTE trial (N=7,637) while producing a 53% lower rate of severe nocturnal hypoglycemia 2. Basal insulins compete in a crowded market against glargine U-100 biosimilars, glargine U-300, and insulin detemir. That competition means Tresiba often sits on Tier 3 or behind a step-therapy wall requiring prior failure on a less expensive basal insulin.

The WAC Number vs. The Real-World Number

Wholesale acquisition cost is a benchmark, not a price tag. Jardiance's WAC near $620/month and Tresiba's WAC of $530 to $590/month do not account for rebates negotiated between manufacturers and pharmacy benefit managers. After rebates, the net cost to insurers for both drugs drops substantially. A 2023 analysis published in Diabetes Care estimated that average net prices for branded diabetes medications can run 40% to 60% below list price after accounting for rebate flow 3.

For patients, out-of-pocket cost depends on their plan's cost-sharing structure. A commercially insured patient on a plan that places Jardiance at Tier 2 may pay a $35 copay, while the same patient on a different plan with Jardiance at Tier 3 could face a $75 to $150 copay or coinsurance of 25% to 40%.

Jardiance: Cost Breakdown and Access Pathways

Jardiance (empagliflozin) is manufactured by Boehringer Ingelheim and marketed in partnership with Eli Lilly. It is available in 10 mg and 25 mg tablets, taken once daily. The 25 mg dose is the most commonly prescribed for type 2 diabetes after a brief titration period.

Commercial Insurance Coverage

Most large commercial insurers cover Jardiance. The drug appears on the preferred brand tier of Express Scripts, CVS Caremark, and OptumRx national formularies as of 2026. Some plans require prior authorization documenting metformin intolerance or inadequate glycemic control on metformin before approving Jardiance. The 2022 ADA/EASD consensus report recommends SGLT2 inhibitors as preferred second-line therapy in patients with established atherosclerotic cardiovascular disease (ASCVD), heart failure, or chronic kidney disease, regardless of A1c 4.

That guideline endorsement has made prior authorization approvals more straightforward. When a prescriber documents ASCVD, heart failure with reduced ejection fraction, or CKD with eGFR 20 to 45 mL/min/1.73 m², most plans approve without appeal.

Medicare Part D

Jardiance is covered under Medicare Part D. Patients in the coverage gap (the "donut hole") previously faced 25% coinsurance on brand-name drugs. Under the Inflation Reduction Act provisions that took effect in 2025, annual out-of-pocket spending on Part D drugs is capped at $2,000, which may reduce the financial burden for Medicare beneficiaries taking Jardiance alongside other branded medications 5.

Manufacturer Savings and Patient Assistance

Boehringer Ingelheim offers a copay savings card for commercially insured patients. Eligible patients may pay as little as $10 per month, with a maximum annual benefit. Patients without insurance or those on government plans (Medicare, Medicaid, Tricare) are not eligible for the copay card but may qualify for the Boehringer Ingelheim Cares Foundation patient assistance program, which provides Jardiance at no cost to qualifying low-income patients.

Tresiba: Cost Breakdown and Access Pathways

Tresiba (insulin degludec) is manufactured by Novo Nordisk. It is available as FlexTouch U-100 (100 units/mL) and FlexTouch U-200 (200 units/mL) prefilled pens. Dosing is highly individualized. A patient on 40 units daily will consume roughly one U-100 pen every 7.5 days, translating to about four pens per month.

Commercial Insurance Coverage

Tresiba faces stiffer formulary competition than Jardiance. Many pharmacy benefit managers prefer insulin glargine biosimilars (Semglee, Rezvoglar) as first-line basal insulins because their net cost after rebates is lower. On plans that exclude Tresiba or place it on a non-preferred tier, patients face two options: pay the higher cost-sharing or request a formulary exception.

Formulary exception requests for Tresiba succeed more often when the prescriber documents one of several clinical scenarios: recurrent nocturnal hypoglycemia on glargine, need for dosing flexibility (Tresiba's ultra-long half-life allows a wider dosing window of up to 8 hours), or persistent glycemic variability despite optimized glargine dosing. The DEVOTE trial's finding of 53% lower severe nocturnal hypoglycemia compared to glargine U-100 provides a strong clinical rationale for these appeals 2.

Medicare Part D

Tresiba is covered under Medicare Part D, and the $35/month insulin copay cap introduced by the Inflation Reduction Act applies. This is a significant access advantage. Regardless of which phase of the Part D benefit a patient is in, their insulin copay will not exceed $35 per month per insulin product 5. For Tresiba specifically, this means the out-of-pocket cost for Medicare beneficiaries dropped substantially from the pre-2023 field, where some patients paid $300 or more per month during the coverage gap.

Novo Nordisk Patient Access Programs

Novo Nordisk offers several programs. The My$99Insulin program caps the cost of a 30-day supply of any Novo Nordisk insulin at $99 for uninsured patients paying cash. The Novo Nordisk Patient Assistance Program (PAP) provides free insulin to patients with household income at or below 400% of the federal poverty level. Commercially insured patients may also access copay savings through the Tresiba savings card.

Head-to-Head Clinical Value: What You Get for the Money

Comparing cost without comparing clinical value is incomplete. These two drugs serve different roles in diabetes management, and their landmark trials measured different endpoints in different populations.

Jardiance: The EMPA-REG OUTCOME Data

EMPA-REG OUTCOME enrolled 7,020 patients with type 2 diabetes and established cardiovascular disease. Patients received empagliflozin 10 mg, empagliflozin 25 mg, or placebo on top of standard care. At a median follow-up of 3.1 years, the empagliflozin group showed a 38% relative risk reduction in cardiovascular death (3.7% vs. 5.9%, HR 0.62, 95% CI 0.49 to 0.77, P<0.001) and a 35% relative risk reduction in hospitalization for heart failure 1.

These results changed treatment guidelines. The ADA Standards of Care now recommend SGLT2 inhibitors for patients with T2D and ASCVD, HFrEF, or CKD as a first-line add-on to metformin, or even as initial therapy in certain cases 4.

Tresiba: The DEVOTE Data

DEVOTE enrolled 7,637 patients with type 2 diabetes at high cardiovascular risk. The trial compared insulin degludec to insulin glargine U-100. On the primary composite MACE endpoint, degludec was non-inferior to glargine (HR 0.91, 95% CI 0.78 to 1.06). The pre-specified secondary endpoint of severe hypoglycemia showed a statistically significant 40% lower rate with degludec overall (HR 0.60, 95% CI 0.48 to 0.76, P<0.001) and a 53% lower rate of nocturnal severe hypoglycemia 2.

Clinical Value Per Dollar

These drugs are not interchangeable. A patient with type 2 diabetes, established ASCVD, and an A1c of 7.8% on metformin alone gets more clinical value per dollar from Jardiance than from Tresiba, because Jardiance addresses the leading cause of mortality in that population (cardiovascular death) while providing glycemic improvement. A patient with type 2 diabetes, an A1c of 9.5%, and recurrent nocturnal hypoglycemia on glargine gets more clinical value from switching to Tresiba, because the immediate clinical problem is hypoglycemia risk and insulin requirement.

Many patients end up on both. The 2022 ADA/EASD consensus algorithm positions SGLT2 inhibitors and basal insulin as complementary, not competitive, therapies 4.

Insurance Navigation: Practical Steps

Getting either drug approved and affordable requires a systematic approach. The steps differ by drug and by plan type.

For Jardiance

1. Check your plan's formulary online or call the number on your insurance card. Confirm tier placement and whether prior authorization is required.
2. If prior authorization is needed, ask your prescriber to document your cardiovascular or renal comorbidities. Plans rarely deny Jardiance when ASCVD, HF, or CKD is present.
3. Enroll in the Boehringer Ingelheim copay card if commercially insured. The card is available at the Jardiance website and can be activated before your first fill.
4. If uninsured, apply for the Boehringer Ingelheim Cares Foundation PAP. Processing takes 4 to 6 weeks.

For Tresiba

1. Confirm formulary status. If Tresiba is excluded or non-preferred, ask your prescriber to submit a formulary exception with documentation of hypoglycemia on glargine or need for dosing flexibility.
2. If on Medicare Part D, confirm the $35/month insulin cap applies to your plan. Most Part D plans implemented this as of January 2025.
3. If commercially insured, activate the Tresiba savings card through the Novo Nordisk website.
4. If uninsured, use the My$99Insulin program for immediate access at $99/month, and apply for the Novo Nordisk PAP for longer-term free coverage.

State-Level Variability in Access

Access to both drugs varies by state due to differences in Medicaid formulary design, state-level insulin pricing laws, and pharmacy benefit manager contracts. As of 2026, at least 25 states have enacted insulin copay cap laws for state-regulated commercial plans, typically limiting copays to $25 to $50 per 30-day supply 6. These caps apply to Tresiba but not to Jardiance, since the laws target insulin products specifically.

Medicaid coverage varies as well. Jardiance is covered by Medicaid in all 50 states, but some state Medicaid programs require step therapy through metformin and a sulfonylurea before approving an SGLT2 inhibitor. Tresiba is covered by most state Medicaid programs, though several prefer glargine biosimilars and require prior authorization for degludec.

Patients in states with both an insulin copay cap and generous Medicaid SGLT2 coverage (California, Colorado, New York) may find combined therapy more affordable than patients in states with restrictive formularies and no state-level pricing protections.

Generic and Biosimilar Outlook

No generic version of empagliflozin is available in the United States as of May 2026. Boehringer Ingelheim's composition-of-matter patent extends into 2025, but additional formulation and method-of-use patents could delay generic entry until 2027 or 2028, depending on litigation outcomes 7.

For Tresiba, no interchangeable biosimilar of insulin degludec has been approved by the FDA as of this writing. Novo Nordisk's patent protections for degludec have been the subject of ongoing litigation. The insulin biosimilar market has expanded rapidly for glargine, but degludec biosimilar development is earlier-stage. Patients should not expect a lower-cost degludec biosimilar before 2028 at the earliest.

The absence of generics and biosimilars for both drugs means that manufacturer savings programs and insurance negotiation remain the primary levers for reducing out-of-pocket cost in the near term.

When Cost Should Not Drive the Decision

Cost matters. But for patients with type 2 diabetes and established cardiovascular disease, the EMPA-REG OUTCOME data showing a 38% reduction in cardiovascular death with empagliflozin represents a mortality benefit that no basal insulin has demonstrated 1. Choosing Tresiba over Jardiance purely on price in that population could be a clinically consequential mistake. The ADA Standards of Care are explicit: SGLT2 inhibitors should be prioritized in patients with ASCVD, HF, or CKD regardless of A1c or cost considerations 4.

Conversely, a patient who needs basal insulin for glycemic control should not avoid Tresiba in favor of Jardiance to save money if their A1c is above target and they require exogenous insulin. The right drug is the one that addresses the patient's primary clinical need. Cost optimization should happen around that decision, not instead of it.

For patients who need both an SGLT2 inhibitor and basal insulin, stacking manufacturer copay programs can bring the combined monthly out-of-pocket cost to under $50 on many commercial plans.