Farxiga Cost in Maine 2026: Cash Price, Insurance, Medicaid, and Compounded Options

What Is the Farxiga List Price in Maine in 2026?

AstraZeneca's wholesale acquisition cost for Farxiga is approximately $620 per month for a 30-tablet supply of the 10 mg dose in 2026. That figure applies at retail pharmacies across Maine when no insurance or discount program is used. Without assistance, the annual cash-pay burden reaches roughly $7,440.

The 5 mg tablet carries a nearly identical list price because AstraZeneca prices both strengths at parity. For most adult patients with type 2 diabetes, heart failure, or chronic kidney disease (CKD), the clinically studied and FDA-approved dose is 10 mg once daily, as reflected in the Farxiga prescribing information on file with the FDA [1].

Retail prices fluctuate by pharmacy. A 30-day supply of brand-name dapagliflozin 10 mg at major Maine chains (Hannaford Pharmacy, Walgreens, CVS) generally tracks within 5 percent of the $620 WAC figure because no generic dapagliflozin tablet was FDA-approved as of mid-2025. Generic entry would substantially reduce that figure, but AstraZeneca's exclusivity period continues to protect the brand [2].

GoodRx and similar discount platforms sometimes list negotiated cash prices in the $480 to $560 range at select Maine zip codes. Those prices require presenting the coupon at dispensing and cannot be combined with Medicare Part D or Medicaid.

MaineCare (Medicaid) Coverage for Farxiga

MaineCare covers Farxiga for qualifying Maine residents, but a prior authorization (PA) is required. The PA criteria align with FDA-approved indications: type 2 diabetes (typically when first-line metformin is contraindicated or insufficient), heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), and CKD with albuminuria [3].

Prescribers submit the PA through the Maine Department of Health and Human Services (DHHS) pharmacy portal. Supporting documentation should include the confirmed diagnosis, relevant lab values (eGFR, UACR for CKD; echocardiography or clinical notes for heart failure), and a brief clinical rationale. Approvals are typically valid for 12 months before renewal.

The clinical case for coverage is well-supported. In DAPA-HF (N=4,744), dapagliflozin 10 mg reduced the composite of worsening heart failure or cardiovascular death by 26 percent versus placebo (hazard ratio 0.74; 95% CI 0.65 to 0.85; P<0.001) in patients with HFrEF, regardless of diabetes status [4]. The 2022 AHA/ACC Heart Failure Guideline assigns SGLT2 inhibitors a Class I, Level A recommendation for symptomatic HFrEF [5]. Citing both the trial data and the guideline language in a PA letter substantially improves approval odds.

MaineCare beneficiaries who qualify pay $0 to $3.65 per fill depending on their specific benefit tier. That makes MaineCare the lowest-cost pathway for eligible low-income Maine residents.

Commercial Insurance and Farxiga Coverage in Maine

Maine's commercial insurers, including Anthem BCBS Maine, Harvard Pilgrim, and Tufts Health Plan, generally place Farxiga on Tier 3 or Tier 4 of their formularies. Tier placement determines out-of-pocket cost.

For a Tier 3 drug, typical Maine plan cost-sharing in 2026 runs $50 to $90 per 30-day fill after the deductible is met. Tier 4 specialty placement can push that to $100 to $150 per month. Many plans require step therapy, meaning a prescriber must document a trial of metformin and possibly one other agent before Farxiga is approved [6].

Patients on Medicare Part D face a different structure. The 2025 Inflation Reduction Act cap of $2,000 on annual out-of-pocket Part D spending applies in 2026, which benefits patients who require Farxiga long-term. Before reaching the cap, cost-sharing depends on the specific Part D plan's formulary; some plans cover dapagliflozin at preferred brand tier with $47 co-pays, while others place it on non-preferred specialty tier with 25 to 33 percent coinsurance.

The American Diabetes Association's 2024 Standards of Care state that "for patients with type 2 diabetes and established cardiovascular disease, heart failure, or CKD, an SGLT2 inhibitor with proven cardiovascular or kidney benefit is recommended independent of HbA1c" [7]. Insurers operating in Maine are subject to this guideline language in coverage-dispute appeals.

AstraZeneca Savings Programs for Maine Patients

AstraZeneca offers two distinct assistance programs that Maine residents can access.

Farxiga Savings Card. Commercially insured patients who are not enrolled in a government program (Medicare, Medicaid, TRICARE) may pay as little as $0 per 30-day fill through AstraZeneca's co-pay card program. Eligibility requires a valid commercial insurance card and a prescription from a licensed provider. The card is activated at AstraZenecaAccessProgram.com and submitted at the pharmacy counter [8].

AZ&Me Prescription Savings Program. Uninsured or underinsured Maine patients who meet income thresholds (generally at or below 600 percent of the federal poverty level) may receive Farxiga at no cost through the AZ&Me program. Applications are submitted online or by phone; AstraZeneca ships the medication directly or routes it through a participating pharmacy. In 2024, AstraZeneca reported that the AZ&Me program provided medicines to more than 450 to 000 U.S. patients annually [9].

Patients should apply before their first fill, because savings cards cannot be retroactively applied to previous co-pays.

Compounded Dapagliflozin in Maine: Legality and Practicalities

Compounded dapagliflozin is legally available in Maine through 503A state-licensed compounding pharmacies. 503A pharmacies operate under state board oversight and compound medications for individual patients with a valid prescription, as authorized under Section 503A of the Federal Food, Drug, and Cosmetic Act [10].

Dapagliflozin is not on the FDA's 503A bulk drug substances list as a prohibited compound, and no federal shortage or outsourcing restriction applies to it as of mid-2025 [11]. A licensed Maine prescriber may write a prescription for compounded dapagliflozin at a 503A pharmacy that carries the active pharmaceutical ingredient (API).

Cost varies by pharmacy. Several Maine-affiliated telehealth and compounding pharmacy partnerships price compounded dapagliflozin in the range of $60 to $120 per month, representing an 80 to 90 percent reduction from the brand list price. Some programs offer it at no cost to patients who qualify under specific telehealth subscription plans.

Two practical cautions apply. First, compounded products are not FDA-approved; bioequivalence testing is not required for 503A compounds. Second, the compounded product cannot be substituted for the FDA-approved Farxiga on a claim basis; it is dispensed only under a prescription explicitly calling for the compound. Patients using compounded dapagliflozin for cardiovascular or kidney indications should have documented clinical monitoring in place, because the outcome trial data cited above (DAPA-HF, DECLARE-TIMI 58) were generated with the branded, FDA-approved formulation [4] [12].

The Maine Board of Pharmacy (207-624-8603) maintains the current list of licensed 503A pharmacies operating in the state. Prescribers and patients can verify a pharmacy's license status at the Maine DHHS professional licensing portal before dispensing.

Telehealth Prescribing of Farxiga in Maine

Farxiga is legally prescribable via telehealth in Maine. The Maine Legislature's telehealth parity laws require commercial insurers to cover telehealth visits on par with in-person visits, and Maine has no state-law restriction on prescribing Schedule-uncontrolled medications (dapagliflozin is non-scheduled) via synchronous video or asynchronous messaging platforms [13].

A licensed Maine prescriber must conduct an appropriate clinical evaluation before issuing a new prescription. For dapagliflozin, that evaluation typically includes review of renal function (serum creatinine, eGFR), confirmation of the primary diagnosis, screening for contraindications (eGFR <25 mL/min/1.73 m² is a contraindication for the type 2 diabetes indication per the Farxiga label), and documentation of urogenital infection risk [1].

HealthRX providers licensed in Maine can initiate, manage, and refill dapagliflozin prescriptions via telehealth visits. Lab orders can be placed at any Quest or LabCorp draw site in Maine; results route back to the prescribing provider before the first fill is authorized for new patients.

Clinical Indications That Drive Prescribing in Maine

Understanding which diagnoses qualify for coverage also clarifies which patients benefit most. The FDA has approved dapagliflozin for three distinct indications [1].

Type 2 diabetes mellitus. Dapagliflozin 10 mg once daily lowers HbA1c by approximately 0.8 to 0.9 percentage points as monotherapy and adds to metformin or insulin regimens. In DECLARE-TIMI 58 (N=17,160), dapagliflozin reduced the composite of hospitalization for heart failure or cardiovascular death by 17 percent (HR 0.83; 95% CI 0.73 to 0.95; P<0.001 for non-inferiority, P=0.005 for superiority on HHF/CV death composite) in a broad type 2 diabetes population [12].

Heart failure. The DAPA-HF trial demonstrated a 26 percent reduction in worsening heart failure events or cardiovascular death in HFrEF patients treated with dapagliflozin 10 mg (HR 0.74; 95% CI 0.65 to 0.85; P<0.001) [4]. The DELIVER trial (N=6,263) extended these findings to HFpEF, showing an 18 percent reduction in the primary composite endpoint (HR 0.82; 95% CI 0.73 to 0.92; P<0.001) [14]. Both results held across diabetic and non-diabetic subgroups.

Chronic kidney disease. In DAPA-CKD (N=4,304), dapagliflozin reduced the composite of sustained eGFR decline, ESKD, cardiovascular death, or renal death by 39 percent versus placebo (HR 0.61; 95% CI 0.51 to 0.72; P<0.001) [15]. The KDIGO 2024 CKD guideline gives SGLT2 inhibitors a Grade 1A recommendation for adults with CKD and eGFR 20 to 45 mL/min/1.73 m², or eGFR 45 or higher with UACR at or above 200 mg/g [16].

These three indications also represent the three PA pathways available under MaineCare, making the clinical documentation relatively straightforward for a prescriber familiar with each trial's inclusion criteria.

Side Effects and Monitoring Requirements Relevant to Maine Patients

Patients and prescribers in Maine need a clear monitoring plan regardless of which cost pathway they use.

Urinary tract infections (UTIs) and genital mycotic infections are the most common adverse effects. The Farxiga prescribing label reports genital mycotic infections in approximately 6.9 percent of women and 2.7 percent of men versus 1.5 percent and 0.5 percent on placebo, respectively [1]. Patients with recurrent UTIs or genital infections may need additional counseling or may not be good candidates for the drug.

Diabetic ketoacidosis (DKA) can occur with SGLT2 inhibitors, including in patients with type 2 diabetes, particularly during surgical fasting, severe illness, or significant carbohydrate restriction. The FDA issued a safety communication on this risk in 2015, and the label carries a specific warning [17]. Maine prescribers should instruct patients to hold dapagliflozin at least 3 days before elective surgery.

Acute kidney injury has been reported, primarily in volume-depleted patients. Baseline renal function should be checked before prescribing, and periodic monitoring every 6 to 12 months is standard practice per the ADA Standards of Care [7].

Fournier's gangrene (necrotizing fasciitis of the perineum), though rare, prompted an FDA safety communication in 2018 [18]. Patients should seek immediate care for signs of perineal pain, swelling, or fever.

How to Choose the Right Cost Pathway in Maine

The table below maps patient situation to the most cost-effective access route for dapagliflozin in Maine.

| Patient Situation | Recommended Pathway | Estimated Monthly Cost | |---|---|---| | MaineCare beneficiary | PA approval, then MaineCare formulary | $0 to $3.65 | | Commercially insured, Tier 3/4 | AstraZeneca savings card | $0 | | Uninsured, income <600% FPL | AZ&Me program | $0 | | Uninsured, income above threshold | 503A compounded dapagliflozin | $60 to $120 | | Medicare Part D | Part D plan (check formulary tier) | $0 to $2,000/year cap | | Commercially insured, savings card ineligible | GoodRx discount at retail | ~$480 to $560 |

Patients should check eligibility for the AstraZeneca savings card first, because it eliminates co-pays entirely for commercially insured individuals and requires minimal paperwork. MaineCare PA should be pursued simultaneously if the patient is income-eligible, as approval takes 5 to 15 business days and provides a durable long-term solution [6].

Prior Authorization Tips for Maine Prescribers

A PA denial is not final. Maine law (22 M.R.S. Section 2699-B) requires insurers to complete standard PA decisions within 72 hours and urgent PAs within 24 hours. Prescribers have the right to an expedited peer-to-peer review and a formal internal appeal within 30 days of a denial [19].

In an appeal letter, cite the specific NEJM trial supporting the indication (DAPA-HF for heart failure, DAPA-CKD for CKD, DECLARE-TIMI 58 for type 2 diabetes with CV risk), the guideline-level recommendation (ADA 2024, AHA/ACC 2022, KDIGO 2024), and the patient's specific clinical parameters. Short, data-dense appeal letters resolve faster than long narrative ones.

The American Heart Association notes: "SGLT2 inhibitors have demonstrated consistent benefits on heart failure hospitalization and cardiovascular death across a wide spectrum of ejection fraction, making them foundational therapy in chronic heart failure management" [5]. That statement directly addresses common payer objections about indication scope.

Dapagliflozin vs. Other SGLT2 Inhibitors Available in Maine

Empagliflozin (Jardiance, Eli Lilly/Boehringer Ingelheim) and canagliflozin (Invokana, Janssen) are the two other commercially available SGLT2 inhibitors in Maine pharmacies. Both carry broadly similar list prices in 2026.

Empagliflozin has FDA approval for type 2 diabetes, HFrEF, HFpEF, and CKD, with comparable cardiovascular outcomes data from EMPEROR-Reduced and EMPEROR-Preserved. Canagliflozin holds approval for type 2 diabetes and CKD (CREDENCE trial, N=4,401 [20]). Neither has a distinct clinical advantage over dapagliflozin across the full approved indication set; the choice depends on formulary tier, prior PA experience, and patient-specific factors like eGFR.

For MaineCare patients, the formulary tier placement matters most. Prescribers should verify which SGLT2 inhibitor sits on the lower tier for a given patient's MaineCare managed care plan before submitting a PA, because switching the target drug to an already-preferred agent can eliminate the PA requirement altogether.

Farxiga Dosing and Administration for Maine Patients

Dapagliflozin is taken orally once daily, with or without food. The starting and maintenance dose for type 2 diabetes is 5 mg once daily, which may be increased to 10 mg for additional glycemic control [1]. For heart failure and CKD, the approved dose is 10 mg once daily regardless of diabetes status.

Renal dose adjustments: the drug should not be initiated in patients with eGFR <25 mL/min/1.73 m² for the diabetes indication. For heart failure and CKD, initiation is supported down to eGFR 25 mL/min/1.73 m² based on DAPA-CKD and DAPA-HF enrollment criteria, although the FDA label notes limited data below that threshold [1] [4] [15].

Patients starting dapagliflozin for the first time should receive explicit counseling on genital hygiene, hydration, and sick-day rules (hold the drug if unable to maintain fluid intake, per standard SGLT2 inhibitor sick-day guidance) [7].