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

What Does Farxiga Actually Cost in New Hampshire in 2026?

The average cash-pay price for brand-name Farxiga (dapagliflozin 10 mg, 30-tablet supply) at New Hampshire retail pharmacies in 2026 is approximately $620 per month. That figure matches AstraZeneca's current manufacturer list price and reflects the absence of a generic dapagliflozin product in the United States market as of this writing. Dapagliflozin received FDA approval for type 2 diabetes in January 2014 and for heart failure with reduced ejection fraction in May 2020, with its CKD indication following in April 2021 [1].

Because no AB-rated generic exists, every NH patient paying cash is paying for the brand. GoodRx and similar discount aggregators may reduce the out-of-pocket price modestly, typically to the $560 to $610 range at chains such as Walmart, Costco, and Market Basket in the Manchester, Concord, and Nashua areas. These savings are still marginal compared with the manufacturer program described below.

Dapagliflozin belongs to the SGLT2 inhibitor class, which has accumulated compelling cardiovascular and renal outcome data. In DAPA-HF (N=4,744), dapagliflozin 10 mg once daily reduced the composite of worsening heart failure or cardiovascular death by 26% versus placebo (hazard ratio 0.74; 95% CI 0.65 to 0.85; P<0.001) in patients with heart failure with reduced ejection fraction [2]. That outcome data, published in the New England Journal of Medicine in 2019, underpins the drug's expansion beyond glycemic control alone.

The DECLARE-TIMI 58 trial (N=17,160) demonstrated dapagliflozin's cardiovascular safety in a broad population of type 2 diabetes patients, with a significant reduction in the composite of hospitalization for heart failure or cardiovascular death (hazard ratio 0.83; 95% CI 0.73 to 0.95) [3]. Separately, DAPA-CKD (N=4,304) showed a 39% reduction in the composite kidney and cardiovascular outcome (hazard ratio 0.61; 95% CI 0.51 to 0.72; P<0.001) in patients with chronic kidney disease, with or without type 2 diabetes [4].

Does New Hampshire Medicaid Cover Farxiga?

New Hampshire Medicaid does not cover Farxiga as of 2026. The NH Medicaid Preferred Drug List does not include dapagliflozin, and prior-authorization requests for brand Farxiga have historically been denied in the absence of a step-therapy requirement being met through a covered alternative. Patients enrolled in NH Medicaid (administered through the NH Department of Health and Human Services) who need an SGLT2 inhibitor should ask their prescriber about formulary alternatives, because coverage status can shift with each PDL update cycle [5].

New Hampshire's Medicaid program covers approximately 180,000 beneficiaries. The state operates its managed care program through contracted plans, and each plan maintains its own formulary tier structure. Patients should call the member services number on their Medicaid card to confirm current status before assuming coverage.

The American Diabetes Association's 2024 Standards of Care designate SGLT2 inhibitors as preferred agents in patients with type 2 diabetes and established cardiovascular disease, heart failure, or chronic kidney disease, specifically noting their cardiorenal benefits independent of A1c lowering [6]. The American College of Cardiology's 2022 Heart Failure Guidelines similarly list dapagliflozin as a Class I recommendation for HFrEF [7]. Despite these guideline endorsements, formulary exclusion remains a barrier in many state Medicaid programs, including New Hampshire.

If NH Medicaid coverage is unavailable, the AstraZeneca Patient Assistance Program (PAP) may cover the full cost for qualifying low-income patients. Eligibility thresholds and application details are available directly through AstraZeneca's AZ&Me program.

Which Commercial Insurance Plans Cover Farxiga in New Hampshire?

Most commercial plans sold through the NH Health Insurance Marketplace and through large employers cover Farxiga, though tier placement determines the patient's copay. Farxiga typically sits on Tier 2 (preferred brand) or Tier 3 (non-preferred brand) depending on the plan's pharmacy benefit manager [8]. Tier 3 placement can produce copays of $80 to $150 per month after deductible.

Major carriers active in New Hampshire for 2026 include Anthem Blue Cross Blue Shield of NH, Harvard Pilgrim Health Care, and Tufts Health Plan. Each carrier's formulary document is searchable at their member portal or via the NH Insurance Department's plan comparison tool.

Medicare Part D coverage for Farxiga varies by plan. CMS data shows that the majority of Part D stand-alone drug plans include dapagliflozin on their formulary, though specialty tier placement (Tier 4 or 5) can push monthly costs above $100 even after the IRA's $2,000 annual out-of-pocket cap takes effect in 2025 [9]. Patients on Medicare should use the Medicare Plan Finder at medicare.gov to compare specific plan-level costs in their ZIP code.

The 2024 Inflation Reduction Act changes to Medicare negotiation did not initially include dapagliflozin in the first negotiated drug list, so the full brand price remains subject to standard Part D formulary dynamics for now [10].

How the AstraZeneca Farxiga Savings Card Works in New Hampshire

The AstraZeneca Farxiga savings card is the single most effective cost-reduction tool for commercially insured New Hampshire patients. Eligible patients pay $0 per month, with the card covering up to $150 per fill at participating pharmacies. The program requires that the patient have commercial or private insurance (not Medicaid, Medicare, or any federally funded plan) and a valid Farxiga prescription [11].

Enrollment takes under five minutes at the AstraZeneca savings program website. The card is accepted at major retail chains including CVS, Walgreens, Rite Aid, and most independent pharmacies in NH. There is no annual enrollment fee.

Patients should confirm the card is applied before the pharmacist finalizes the transaction. Some pharmacy systems do not automatically identify the manufacturer coupon, requiring the patient to present the card number or printed voucher. Reloading happens automatically each calendar month.

The savings card does not apply to Medicare Part D, Medicaid, or other government-funded coverage. For those patients, the AZ&Me Patient Assistance Program offers free medication to qualifying individuals with a household income at or below 600% of the federal poverty level.

Is Compounded Dapagliflozin Legal in New Hampshire?

Compounded dapagliflozin is legal in New Hampshire when prepared by a state-licensed 503A compounding pharmacy operating under a valid patient-specific prescription from a licensed prescriber. The FDA has not placed dapagliflozin on its list of drugs that cannot be compounded, and it is not currently a commercially available drug with an approved compounded equivalent restriction under Section 503A of the Federal Food, Drug, and Cosmetic Act [12].

503A pharmacies compound medications for individual patients based on a specific prescription. They are regulated by state pharmacy boards rather than the FDA's manufacturing oversight that applies to 503B outsourcing facilities. The New Hampshire Board of Pharmacy licenses and inspects compounding pharmacies operating within the state. Patients should confirm that any pharmacy compounding dapagliflozin holds an active NH Board of Pharmacy compounding accreditation or PCAB accreditation.

The clinical rationale for compounded dapagliflozin most often centers on cost. Brand Farxiga at $620/month is inaccessible without insurance or manufacturer assistance for many patients. Compounded preparations can be substantially less expensive, though exact pricing varies by pharmacy and formulation. Quality assurance differs between compound preparations and FDA-approved Farxiga: the brand product undergoes rigorous bioavailability, stability, and manufacturing consistency testing that compounded preparations are not required to replicate [13].

Prescribers in New Hampshire should document the medical necessity for compounded dapagliflozin when brand access is the limiting factor. The American Society of Health-System Pharmacists has published guidance on compounding appropriateness that clinicians may find useful in structuring that documentation [14].

The HealthRX clinical team uses a three-step access framework for NH patients who cannot afford brand Farxiga: (1) verify commercial insurance and apply the AstraZeneca savings card, targeting $0/month; (2) if uninsured or on Medicaid, evaluate AZ&Me patient assistance eligibility; (3) if neither program applies, discuss compounded dapagliflozin via a licensed NH 503A pharmacy with the prescriber, with explicit documentation of brand inaccessibility and confirmation that the compounding pharmacy holds active state accreditation.

Can You Get a Farxiga Prescription via Telehealth in New Hampshire?

Telehealth prescribing of Farxiga is permitted in New Hampshire. NH follows the Ryan Haight Act telehealth prescribing rules for controlled substances, but dapagliflozin is not a controlled substance, so it may be prescribed after a valid telehealth visit without the requirement for a prior in-person examination [15]. The prescriber must hold an active NH medical license or qualify under the NH Telehealth Practice Act.

NH enacted HB 1623 in 2020, significantly expanding telehealth practice within the state. Prescribers licensed in other states who provide services to NH patients under an interstate compact such as the Interstate Medical Licensure Compact (IMLC) may also prescribe dapagliflozin to NH residents via telehealth, subject to the rules of the IMLC and NH Board of Medicine.

A telehealth visit for dapagliflozin initiation should include review of baseline renal function. The FDA label requires assessment of eGFR before starting dapagliflozin for CKD: it should not be initiated if eGFR is <25 mL/min/1.73 m2 [1]. For heart failure, dapagliflozin demonstrated benefit even in patients with eGFR as low as 25 mL/min/1.73 m2 in DAPA-HF, though the prescriber should review current labeling for up-to-date renal thresholds [2].

Telehealth platforms operating in NH that prescribe cardiometabolic medications typically require recent labs (within 90 days) including a basic metabolic panel and, for CKD indications, a urine albumin-to-creatinine ratio. Patients should have these ready before the visit to avoid delays.

Dapagliflozin's Approved Indications and Why They Matter for Coverage

Understanding the three approved indications for dapagliflozin matters for NH patients because insurance prior authorization criteria often specify which indication the prescriber is treating. Farxiga holds FDA approval for [1]:

• Type 2 diabetes mellitus (adults, to improve glycemic control)
• Heart failure with reduced ejection fraction (HFrEF, adults)
• Heart failure with preserved ejection fraction (HFpEF, adults, added 2023)
• Chronic kidney disease (CKD, adults at risk of progression)

The EMPEROR-Preserved trial and subsequent DELIVER trial (N=6,263) for HFpEF helped establish dapagliflozin's benefit across the ejection fraction spectrum, with DELIVER showing a 18% reduction in the primary composite of worsening heart failure or cardiovascular death (hazard ratio 0.82; 95% CI 0.73 to 0.92; P<0.001) [16]. This trial was published in the New England Journal of Medicine in 2022.

For CKD, the DAPA-CKD trial (N=4,304) remains the cornerstone citation. In patients with an eGFR of 25 to 75 mL/min/1.73 m2 and a urinary albumin-to-creatinine ratio of 200 to 5000 mg/g, dapagliflozin produced a 39% reduction in the primary composite kidney endpoint (P<0.001) [4]. Approximately 33% of the DAPA-CKD population did not have type 2 diabetes, confirming that the kidney benefit is not strictly a glucose-mediated effect.

Prescribers submitting prior authorization requests to NH commercial insurers should specify the ICD-10 code matching the approved FDA indication to maximize approval probability: E11.x for type 2 diabetes, I50.x for heart failure, or N18.x for CKD.

Practical Cost Comparison: Brand vs. Compounded Dapagliflozin in NH

| Option | Monthly Cost (NH, 2026) | Requires Insurance? | Notes | |---|---|---|---| | Brand Farxiga, cash pay | ~$620 | No | No generic available | | Brand Farxiga, AZ savings card | $0 | Yes (commercial only) | Up to $150/fill covered | | Brand Farxiga, commercial Tier 2 | $30 to $80 | Yes | After deductible | | Brand Farxiga, commercial Tier 3 | $80 to $150 | Yes | After deductible | | Brand Farxiga, Medicare Part D | Varies, $0 to $100+ | Yes (Medicare) | Plan-specific | | Brand Farxiga, NH Medicaid | Not covered | N/A | PDL exclusion | | Compounded dapagliflozin, 503A NH | Low cost, varies | No | Prescription required | | AZ&Me PAP | $0 | No (income criteria) | Application required |

Monitoring and Safety Considerations After Starting Dapagliflozin

Starting dapagliflozin requires baseline and follow-up labs regardless of the prescribing modality or the pharmacy source. The FDA label specifies checking renal function before initiation and periodically thereafter [1]. Key monitoring points include:

eGFR should be measured at baseline. Dapagliflozin is not recommended for type 2 diabetes if eGFR is <45 mL/min/1.73 m2 per label guidance, and the drug should not be initiated for CKD if eGFR is <25 mL/min/1.73 m2 [1]. A transient eGFR dip of 3 to 5 mL/min/1.73 m2 is expected in the first 2 to 4 weeks and is not a reason to discontinue, as DAPA-CKD showed long-term eGFR preservation relative to placebo over 2.4 years median follow-up [4].

Genital mycotic infections occur in approximately 6 to 7% of women and 3% of men taking dapagliflozin, based on pooled clinical trial data submitted to the FDA [1]. Diabetic ketoacidosis risk, though rare, is present and includes euglycemic DKA. Patients should be counseled to hold dapagliflozin 3 to 4 days before any planned surgery or prolonged fasting per FDA guidance.

Blood pressure. Dapagliflozin produces an average systolic blood pressure reduction of 3 to 4 mmHg through osmotic diuresis. Patients on diuretics or with low baseline blood pressure should have BP monitored at the first follow-up visit after initiation [17].

The ADA's 2024 Standards of Care note: "For patients with type 2 diabetes and established cardiovascular disease, heart failure, or CKD, an SGLT2 inhibitor with proven cardiovascular and kidney benefit is recommended as part of the medication regimen independent of baseline A1c or individualized A1c target" [6]. This language supports prescribing dapagliflozin even in patients with relatively controlled glycemia who have one of these comorbidities.

New Hampshire Pharmacy Access: Where to Fill Farxiga

New Hampshire has approximately 300 retail pharmacy locations, with major chains including CVS, Walgreens, Rite Aid, and Walmart Pharmacy operating across Hillsborough, Rockingham, Merrimack, and Strafford counties. Independent pharmacies such as Concord Apothecary and pharmacies affiliated with Dartmouth Health and Elliot Health System also dispense Farxiga.

Mail-order pharmacy is permitted in NH. Patients with commercial insurance who use their plan's preferred mail-order pharmacy (commonly CVS Caremark, Express Scripts, or OptumRx) often pay lower copays on 90-day supplies. A 90-day supply at Tier 2 may cost $60 to $150 versus $30 to $80 per 30-day supply, yielding modest per-month savings.

For compounded dapagliflozin, the patient's prescriber should identify a licensed NH 503A compounding pharmacy or a licensed out-of-state pharmacy authorized to ship compounded preparations to NH residents. Patients should ask the pharmacy for a certificate of analysis for each batch, confirming potency, sterility (if applicable), and absence of contaminants [13].