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

What Is the Cash Price for Farxiga in Maryland in 2026?

AstraZeneca's manufacturer list price for Farxiga in 2026 is approximately $620 per month for a 30-tablet supply of 10 mg tablets. At Maryland retail pharmacies, the cash-pay price tracks closely to that figure, typically ranging from $595 to $640 depending on the chain. No FDA-approved generic dapagliflozin exists in the United States as of mid-2025, which keeps brand prices high [1].

That $620 sticker price is what an uninsured Maryland resident pays without any coupon or assistance program. The difference between insured and uninsured costs is substantial. A commercially insured patient using AstraZeneca's savings card may pay as little as $0 per month, while a Medicare Part D enrollee faces variable costs depending on their specific plan formulary and coverage phase [2].

Dapagliflozin was first approved by the FDA in January 2014 for type 2 diabetes [1]. Its label was later expanded to include heart failure with reduced ejection fraction (HFrEF) in May 2020, heart failure with preserved ejection fraction (HFpEF) in August 2022, and chronic kidney disease (CKD) in May 2021 [1]. Each additional indication has broadened the pool of patients who can pursue insurance coverage with a strong clinical rationale, which matters when navigating prior authorization in Maryland.

The DAPA-HF trial (N=4,744) published in the New England Journal of Medicine demonstrated that dapagliflozin 10 mg reduced the composite of worsening heart failure or cardiovascular death by 26% compared with placebo (hazard ratio 0.74 to 95% CI 0.65, 0.85, P<0.001) in patients with HFrEF [3]. That level of cardiovascular outcome data strengthens medical necessity arguments with Maryland insurance plans and Medicaid [3].

Does Maryland Medicaid Cover Farxiga?

Maryland Medicaid covers Farxiga, but prior authorization (PA) is required. The PA criteria generally require documentation of a qualifying diagnosis (type 2 diabetes, heart failure, or CKD), evidence that the patient meets clinical thresholds, and a prescriber attestation that Farxiga is medically necessary [4].

For type 2 diabetes, Maryland Medicaid typically requires a documented HbA1c at or above a threshold value and evidence that at least one first-line agent (usually metformin) was tried or is contraindicated. For heart failure indications, the PA submission should include echocardiographic data confirming the diagnosis and ejection fraction, along with the relevant ICD-10 code. For CKD, the eGFR and urine albumin-to-creatinine ratio (UACR) are key data points the plan reviewer checks against FDA label criteria [4].

The American Diabetes Association's 2024 Standards of Care classify SGLT2 inhibitors, including dapagliflozin, as preferred agents in patients with type 2 diabetes and established cardiovascular disease, heart failure, or CKD, regardless of HbA1c level [5]. Citing that guideline recommendation in a PA letter meaningfully improves approval odds.

Maryland HealthChoice managed care organizations (MCOs) such as Aetna Better Health of Maryland, CareFirst Community Health Plan, and United Healthcare Community Plan administer Medicaid benefits and each maintains its own formulary. Dapagliflozin's placement and PA criteria can differ between MCOs even within the same state program. Patients should obtain the specific PA form from their assigned MCO before their prescriber submits documentation [4].

If an initial PA is denied, Maryland law gives enrollees the right to an expedited internal appeal within 72 hours for urgent situations and a standard appeal within 30 days [4]. An external review by the Maryland Insurance Administration is available if the internal appeal fails.

Which Commercial Insurance Plans in Maryland Cover Farxiga?

Most major commercial plans operating in Maryland, including CareFirst BlueCross BlueShield, Cigna, Aetna, UnitedHealthcare, and Kaiser Permanente Mid-Atlantic, cover Farxiga on their formularies, usually on Tier 3 or Tier 4 [6]. Tier placement determines the copay, which can range from roughly $45 to $150 per month after deductible, depending on the plan design.

Prior authorization is common on commercial plans for the heart failure and CKD indications. For type 2 diabetes, some plans cover Farxiga without PA at Tier 3 when the prescriber selects the diabetes indication specifically [6]. Step therapy requirements, which mandate trying a less expensive SGLT2 inhibitor or another drug class first, appear on some Maryland commercial formularies. Empagliflozin (Jardiance) is occasionally listed as the preferred SGLT2 inhibitor, requiring a PA or exception for dapagliflozin.

The AstraZeneca Farxiga savings card program is only valid for commercially insured patients. Medicare and Medicaid patients are explicitly excluded by federal anti-kickback rules [2].

For Medicare Part D enrollees in Maryland, the 2024 Inflation Reduction Act changes to the Medicare drug benefit cap out-of-pocket costs at $2,000 annually beginning in 2025 [7]. That cap meaningfully reduces exposure for patients on expensive drugs like Farxiga who previously faced high costs during the coverage gap phase.

How Does the AstraZeneca Savings Card Work in Maryland?

The AstraZeneca Patient Savings Card for Farxiga is available to commercially insured Maryland residents who meet eligibility criteria. Eligible patients may pay as little as $0 per month for a 30-day or 90-day supply, depending on plan copay structure and the card's benefit maximum [2].

To enroll, patients visit the AstraZeneca Farxiga savings card portal, enter their insurance information, and receive a card or digital code to present at the pharmacy. The card covers the difference between the insurance copay and the program's maximum benefit. AstraZeneca sets an annual benefit cap (the specific 2026 figure should be confirmed at the time of enrollment) [2].

Patients who lose commercial insurance coverage during the year must notify AstraZeneca or the card becomes void for that fill. Maryland residents transitioning from commercial insurance to Maryland Medicaid should switch to the Medicaid PA pathway rather than attempting to use the savings card, which would violate federal program rules [2].

AstraZeneca also operates an AZ&Me prescription savings program for uninsured or underinsured patients who meet income thresholds, potentially providing Farxiga at no cost. Income eligibility and documentation requirements apply [2].

Is Compounded Dapagliflozin Legal in Maryland?

Compounded dapagliflozin from a state-licensed 503A pharmacy is legal in Maryland. Section 503A of the Federal Food, Drug, and Cosmetic Act governs traditional pharmacy compounding, and Maryland Board of Pharmacy rules allow licensed compounding pharmacies to prepare dapagliflozin preparations when a valid patient-specific prescription is presented [8].

503A pharmacies compound for individual patients on a prescription-by-prescription basis. They cannot mass-produce compounded dapagliflozin for general sale. The physician or licensed prescriber must have an established patient relationship and a legitimate medical need documented in the record [8].

Cost is the primary reason patients ask about compounded dapagliflozin. A compounded preparation can cost significantly less than the $620 brand list price, and some Maryland telehealth clinics that work with 503A compounding pharmacies offer it to patients who do not have insurance coverage or whose insurance does not cover the brand [9].

The FDA has not approved any compounded version of dapagliflozin for safety and efficacy. Patients considering this route should confirm the pharmacy holds a current Maryland 503A license and that the prescribing provider has reviewed their full medication list for interactions, particularly with diuretics, insulin, or other hypoglycemic agents [8].

The HealthRX Clinical Team uses a three-step framework when helping Maryland patients decide between brand Farxiga, insurance-covered Farxiga, and compounded dapagliflozin. Step 1: confirm the patient's active insurance and run a real-time benefits check. Step 2: if insurance covers Farxiga (with or without PA), pursue that route first with an AstraZeneca savings card stacked on top if the plan permits. Step 3: if no insurance coverage exists or is denied after appeal, evaluate compounded dapagliflozin from a licensed Maryland 503A pharmacy as a cost-access measure while continuing to work on insurance coverage for the brand drug.

Can I Get Farxiga via Telehealth in Maryland?

Telehealth prescribing of Farxiga is permitted in Maryland. Maryland's telehealth law does not restrict prescribing of non-controlled medications via audio-video encounters, and dapagliflozin is not a controlled substance [10].

A licensed Maryland prescriber (MD, DO, NP, or PA with prescriptive authority) can evaluate a patient via a synchronous video visit, confirm the clinical indication, and transmit a Farxiga or dapagliflozin prescription to a Maryland pharmacy or a mail-order pharmacy licensed to dispense in Maryland [10].

For patients with type 2 diabetes, a telehealth provider will typically review recent HbA1c, fasting glucose, eGFR, and urine albumin data before initiating dapagliflozin. The FDA label requires confirming eGFR is adequate before starting: dapagliflozin is not recommended when eGFR falls below 25 mL/min per 1.73 m² for diabetes and should be used cautiously in the eGFR 25, 45 range [1]. A telehealth encounter that includes lab review satisfies the standard-of-care requirement for this check.

Maryland's 2021 telehealth parity law requires that commercial insurers reimburse telehealth visits at the same rate as in-person visits for equivalent services [10]. That parity applies to the prescribing consultation, though it does not extend to drug coverage itself.

What Are the Cheapest Ways to Get Farxiga in Maryland?

For a commercially insured Maryland patient, the AstraZeneca savings card stacked on the insurance copay often brings the effective cost to $0 per month [2]. That is the lowest cost route for patients who qualify.

For uninsured patients, the AZ&Me program may supply Farxiga at no cost based on income documentation [2]. GoodRx and similar discount platforms list dapagliflozin prices at Maryland pharmacies and sometimes offer coupons that reduce the cash price below $620, though the discount varies by pharmacy and month [11].

Mail-order pharmacies under a 90-day supply often provide a modest per-tablet discount versus 30-day retail fills. CVS Caremark, Express Scripts, and OptumRx each serve Maryland patients with 90-day mail fills that may reduce per-month cost by 10 to 15% when insurance covers mail-order at a preferred tier [6].

Compounded dapagliflozin from a licensed Maryland 503A pharmacy represents the lowest cash-pay option for patients without coverage. Confirm current pricing directly with the compounding pharmacy, as it varies by formulation and supply contract [9].

NeedyMeds and the Partnership for Prescription Assistance maintain databases of patient assistance programs applicable in Maryland. Both are free to search and list AstraZeneca assistance options alongside independent nonprofit programs [12].

Clinical Context: Why Farxiga's Cost Matters for Maryland Patient Outcomes

Maryland has a cardiovascular disease burden above the national average in several ZIP codes, particularly in Baltimore City and Prince George's County [13]. Dapagliflozin carries FDA-approved indications for three conditions that disproportionately affect those populations: type 2 diabetes, heart failure, and CKD.

The DECLARE-TIMI 58 trial (N=17,160) showed dapagliflozin reduced the composite of cardiovascular death or hospitalization for heart failure by 17% versus placebo in adults with type 2 diabetes and established cardiovascular disease or multiple risk factors (hazard ratio 0.83 to 95% CI 0.73, 0.95, P<0.001) [14]. These outcomes data matter for Maryland prescribers navigating PA requirements because they provide the strongest class of evidence for medical necessity.

In CKD specifically, the DAPA-CKD trial (N=4,304) demonstrated a 39% reduction in the composite of sustained 50% decline in eGFR, end-stage kidney disease, cardiovascular death, or renal death with dapagliflozin versus placebo (hazard ratio 0.61 to 95% CI 0.51, 0.72, P<0.001) [15]. The Kidney Disease: Improving Global Outcomes (KDIGO) 2022 guidelines now include SGLT2 inhibitors as a recommended therapy for CKD patients with eGFR 20 mL/min per 1.73 m² or higher and urine albumin-to-creatinine ratio at or above 200 mg/g [16].

The 2022 American Heart Association/American College of Cardiology heart failure guideline gives dapagliflozin a Class I, Level A recommendation for HFrEF regardless of diabetes status, stating: "In patients with HFrEF, SGLT2 inhibitors are recommended to reduce HF hospitalizations and cardiovascular mortality" [17]. That Class I designation is directly useful when writing PA letters to Maryland insurance plans or MCOs.

Cost barriers that prevent Maryland patients from accessing dapagliflozin carry real clinical consequences given those outcome data. A 2023 analysis in JAMA Internal Medicine found that cost-related non-adherence to cardiovascular medications occurred in 14.3% of US adults with heart failure, with lower-income patients and Black patients disproportionately affected [18]. Maryland's diverse patient population makes cost-access support programs not merely convenient but clinically necessary.

Prescribers in Maryland writing for dapagliflozin should document the specific FDA-approved indication and reference the applicable guideline recommendation in the chart note. That documentation accelerates PA and provides a clear trail if an appeal becomes necessary.

The standard starting dose for type 2 diabetes is 5 mg orally once daily in the morning, with or without food, and may be increased to 10 mg once daily for additional glycemic control or when the heart failure or CKD indication is the primary reason for prescribing [1]. Patients should be counseled on genital mycotic infection risk (approximately 6 to 8% in trials), urinary tract infection risk, and rare but serious risks including diabetic ketoacidosis and Fournier's gangrene [1].

Maryland clinicians initiating dapagliflozin should check baseline eGFR and urine albumin before the first prescription and recheck eGFR at 2 to 3 months after initiation to confirm stability, consistent with KDIGO 2022 monitoring recommendations [16].