How Much Does Farxiga (Dapagliflozin) Cost in North Carolina in 2026?

Farxiga Retail Price in North Carolina

The average cash price for a 30-day supply of brand-name Farxiga 10 mg in North Carolina is $620 in 2026. That figure holds relatively steady across CVS, Walgreens, Walmart, and independent pharmacies statewide. AstraZeneca sets the wholesale acquisition cost (WAC), and without insurance or a discount program, NC patients pay the full amount.

Prices vary by less than $15 between metro areas like Charlotte, Raleigh-Durham, and Greensboro and smaller markets like Asheville or Fayetteville. The lack of geographic variation reflects the fact that Farxiga has no approved generic competitor. AstraZeneca holds patent protection, and the FDA has not approved an abbreviated new drug application (ANDA) for dapagliflozin as of May 2026.

Dapagliflozin belongs to the sodium-glucose cotransporter 2 (SGLT2) inhibitor class. The FDA approved Farxiga in January 2014 for type 2 diabetes and subsequently expanded its labeling to include heart failure with reduced ejection fraction in 2020 and chronic kidney disease in 2021. Those expanded indications came on the strength of large outcomes trials, including DAPA-HF, which enrolled 4,744 patients across 20 countries and demonstrated a 26% relative risk reduction in the composite of worsening heart failure or cardiovascular death (HR 0.74; 95% CI 0.65 to 0.85; P<0.001) [1]. That trial changed prescribing patterns nationwide and drove demand for the drug among cardiologists and nephrologists, not just endocrinologists.

For NC patients paying cash, the $620 monthly figure translates to $7,440 per year. That number places Farxiga in line with other branded SGLT2 inhibitors like empagliflozin (Jardiance), which carries a similar list price.

North Carolina Medicaid Coverage for Farxiga

NC Medicaid covers Farxiga for heart failure and chronic kidney disease indications but does not cover it when prescribed for type 2 diabetes alone. This is a meaningful distinction for low-income patients who may carry a diabetes diagnosis without a concurrent HF or CKD diagnosis.

North Carolina completed its Medicaid expansion under the Affordable Care Act in December 2023, adding roughly 600,000 newly eligible adults. The NC Division of Health Benefits maintains a preferred drug list (PDL) that determines which medications are covered without prior authorization. As of early 2026, Farxiga requires prior authorization for most Medicaid beneficiaries, and claims are approved only when the prescribing indication is heart failure or CKD.

For patients with type 2 diabetes who also have stage 3 or higher CKD (eGFR <60 mL/min/1.73 m²), the CKD indication can serve as the basis for coverage. The DAPA-CKD trial (N=4,304) showed that dapagliflozin reduced the composite risk of sustained decline in eGFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes by 39% (HR 0.61; 95% CI 0.51 to 0.72; P<0.001) compared with placebo [2]. Prescribers in NC can cite this trial data in prior authorization appeals.

"SGLT2 inhibitors are now a cornerstone of guideline-directed medical therapy for heart failure with reduced ejection fraction, independent of diabetes status," according to the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure [3]. NC Medicaid's coverage policy reflects this clinical consensus by covering the HF indication regardless of whether the patient has diabetes.

Patients denied Medicaid coverage for the T2D-only indication have three options: appeal with supporting clinical documentation, switch to a covered alternative like metformin or a sulfonylurea, or pursue the AstraZeneca patient assistance program.

Insurance Coverage and Copays Across NC Plans

Most major commercial insurance plans in North Carolina cover Farxiga, though tier placement and copay amounts vary significantly. Blue Cross Blue Shield of North Carolina, the state's largest insurer, lists Farxiga on its preferred brand formulary tier for most plans, with copays typically ranging from $35 to $75 per month before applying the manufacturer savings card.

Aetna, Cigna, and UnitedHealthcare plans sold on the NC ACA marketplace or through employer groups also cover Farxiga, generally as a Tier 3 (non-preferred brand) medication. Tier 3 placement often means copays of $50 to $100 or coinsurance of 25% to 40% before any discount programs are applied.

Medicare Part D plans present a different picture. Farxiga coverage under Part D depends on the specific plan formulary. Under the Inflation Reduction Act's $2,000 annual out-of-pocket cap that took effect January 1, 2025, Medicare beneficiaries now have a hard ceiling on their total Part D drug spending [4]. For patients taking Farxiga and other branded medications, the $2,000 cap means that total annual costs are predictable even if the drug sits on a high copay tier.

NC has approximately 2.1 million Medicare beneficiaries, and SGLT2 inhibitors rank among the top 20 branded drugs by Part D spending in the state. Patients who hit the $2,000 cap early in the year (often by March or April if they take multiple branded drugs) pay $0 for the remainder of the calendar year.

AstraZeneca Savings Card and Patient Assistance

The AstraZeneca savings card is the single most effective tool for reducing out-of-pocket Farxiga costs in North Carolina. Eligible commercially insured patients pay as little as $0 per month, with the card covering up to $300 per 30-day fill.

Eligibility requirements are straightforward. The patient must have commercial insurance (not Medicare, Medicaid, or any other government-funded plan), be a resident of the United States or Puerto Rico, and have a valid prescription for Farxiga. There is no income requirement. The card can be activated online, by phone, or at the pharmacy counter. It applies automatically at participating pharmacies across NC, including all major chains.

For uninsured patients, AstraZeneca offers the AZ&Me prescription savings program. This separate program provides Farxiga at no cost to patients who meet income criteria (generally household income at or below 400% of the federal poverty level). A single adult earning $62,400 or less in 2026 would qualify. The application requires proof of income and a prescription from a licensed provider.

The AstraZeneca savings card does not apply to patients enrolled in Medicare Part D. This is a federal anti-kickback statute limitation, not an AstraZeneca policy. Medicare Part D beneficiaries should explore the Medicare Extra Help (Low-Income Subsidy) program, which can reduce Part D copays to $0 to $11.20 per prescription depending on income level [5].

Compounded Dapagliflozin in North Carolina

Compounded dapagliflozin is legal in North Carolina through licensed 503A compounding pharmacies. This pathway allows pharmacists to compound patient-specific preparations of dapagliflozin when a valid prescription exists and a prescriber-patient relationship has been established.

Section 503A of the Federal Food, Drug, and Cosmetic Act permits state-licensed pharmacies to compound medications for individual patients based on a prescription. North Carolina's Board of Pharmacy regulates these pharmacies and requires adherence to USP compounding standards.

The cost of compounded dapagliflozin varies by pharmacy but is often significantly lower than the branded product. Some NC 503A pharmacies advertise compounded SGLT2 inhibitors at prices ranging from $30 to $90 per month, though availability fluctuates based on active pharmaceutical ingredient (API) sourcing.

There are clinical considerations worth noting. Compounded medications do not undergo FDA bioequivalence testing, so absorption characteristics may differ from the branded tablet. The FDA's guidance on compounding emphasizes that compounded drugs are not FDA-approved and do not carry the same safety and efficacy guarantees as commercially manufactured products [6]. Patients and prescribers should weigh cost savings against the lack of bioequivalence data.

503B outsourcing facilities, which can produce compounded medications in larger batches without patient-specific prescriptions, represent a different regulatory pathway. Several 503B facilities ship compounded dapagliflozin to NC, though their pricing and availability change frequently as the FDA increases its oversight of these facilities.

Telehealth Prescribing of Farxiga in NC

North Carolina permits telehealth prescribing of Farxiga. Licensed prescribers can evaluate patients via synchronous audio-video visits and issue new or refill prescriptions for dapagliflozin without requiring an in-person visit first.

NC's telehealth parity law (N.C. Gen. Stat. § 58-3-247) requires commercial insurers to cover telehealth services at the same rate as in-person visits. This means the prescribing visit itself is covered by insurance, and the resulting Farxiga prescription can be filled at any NC pharmacy.

Telehealth platforms operating in NC must use prescribers licensed by the North Carolina Medical Board. The Ryan Haight Act requires a valid prescriber-patient relationship before controlled substances can be prescribed via telehealth, but dapagliflozin is not a controlled substance, so this federal restriction does not apply.

For patients in rural NC counties (roughly 80 of the state's 100 counties are classified as rural by the NC Office of Rural Health), telehealth removes a significant access barrier. Patients in counties like Robeson, Columbus, or Tyrrell may live 45 minutes or more from the nearest endocrinologist or cardiologist. A telehealth visit allows them to receive a Farxiga prescription and have it filled at their local pharmacy or delivered by mail.

Monitoring requirements should not be overlooked. SGLT2 inhibitors require baseline and periodic assessment of renal function and potassium levels. The ADA Standards of Care (2026) recommend checking eGFR and serum potassium before initiation and at least annually thereafter [7]. Telehealth prescribers must ensure patients have access to laboratory services, which are widely available at LabCorp and Quest Diagnostics locations across NC.

How Farxiga Compares to Other SGLT2 Inhibitors on Cost in NC

Farxiga is one of three major branded SGLT2 inhibitors available in North Carolina, alongside empagliflozin (Jardiance) and canagliflozin (Invokana). Pricing across the class is remarkably similar.

Jardiance (empagliflozin) carries a retail cash price of approximately $620 to $640 per month in NC. The EMPA-REG OUTCOME trial (N=7,020) showed a 38% relative risk reduction in cardiovascular death with empagliflozin versus placebo in patients with type 2 diabetes and established cardiovascular disease [8]. That trial predated DAPA-HF by several years and established the cardiovascular benefit of the SGLT2 class.

Invokana (canagliflozin) is priced similarly at approximately $580 to $620 per month. The CREDENCE trial (N=4,401) demonstrated a 30% reduction in the primary composite renal endpoint with canagliflozin in patients with type 2 diabetes and CKD [9].

From a coverage standpoint, most NC insurance formularies favor one SGLT2 inhibitor over others. BCBSNC has historically placed Jardiance on a preferred tier, while some Cigna plans prefer Farxiga. Checking the specific formulary before prescribing can save patients $20 to $50 per month in copay differences.

"Given the consistent class effect demonstrated across DAPA-HF, EMPEROR-Reduced, EMPA-REG OUTCOME, and CREDENCE, the choice of SGLT2 inhibitor often comes down to formulary placement and patient cost," notes the 2024 KDIGO Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease [10].

Tips for Reducing Your Farxiga Cost in North Carolina

The gap between $620 per month and $0 per month is bridgeable for most NC patients. The strategy depends on insurance status.

For commercially insured patients: activate the AstraZeneca savings card before your first fill. This single step reduces cost to $0 for the vast majority of commercially insured patients in NC. Your pharmacist can process the card at any participating pharmacy.

For Medicare Part D beneficiaries: check whether your plan covers Farxiga and at what tier. Apply for Extra Help if your income qualifies. Remember that the $2,000 annual out-of-pocket cap limits your total Part D drug spending regardless of tier placement.

For NC Medicaid enrollees: if your primary diagnosis is type 2 diabetes, work with your prescriber to document any concurrent heart failure or CKD diagnosis. Prior authorization requests citing the DAPA-HF or DAPA-CKD trial data and the relevant FDA-approved indication have higher approval rates.

For uninsured patients: apply for the AZ&Me program through AstraZeneca. If you don't qualify or prefer an alternative, ask your prescriber about compounded dapagliflozin from a licensed NC 503A pharmacy. Confirm that the pharmacy holds a current NC Board of Pharmacy license and follows USP <795> compounding standards.

Patients should also check GoodRx, RxSaver, and similar discount platforms, which occasionally offer coupons bringing the cash price below $600 at specific NC pharmacies. These coupons cannot be combined with insurance or the AstraZeneca savings card.