Farxiga Cost in North Dakota 2026: Cash Price, Medicaid, and Savings Options

What Is the Cash Price of Farxiga in North Dakota in 2026?

The retail cash price for Farxiga 10 mg (30-tablet supply) is approximately $620 per month at North Dakota pharmacies in 2026, matching AstraZeneca's current list price. Without a coupon or insurance, a patient paying out of pocket at a Bismarck or Fargo pharmacy will see a price in that range. GoodRx and similar discount aggregators sometimes reduce this to $560 to $590 at selected ND chains, though those discounts cannot be combined with insurance.

AstraZeneca set this list price before the Inflation Reduction Act Medicare negotiation process. For 2026, dapagliflozin has not yet had its Medicare Part D negotiated price finalized under that law's schedule, so retail list pricing remains the baseline for most cash-pay patients. The FDA-approved prescribing information for Farxiga confirms the 10 mg once-daily dose for both type 2 diabetes and heart failure indications, which is the formulation dispensed at standard retail. [1]

Pharmacies in Grand Forks, Minot, and Dickinson report similar pricing to the Bismarck average. Independent community pharmacies in rural ND sometimes charge a dispensing markup, putting cash price closer to $630 to $640 per month. Calling ahead to confirm the dispensed price is always worth doing before submitting a new prescription.

The DAPA-HF trial (N=4,744) demonstrated that dapagliflozin 10 mg reduced the composite of worsening heart failure or cardiovascular death by 26% relative to placebo (hazard ratio 0.74 to 95% CI 0.65 to 0.85, P<0.001), which underpins why prescribers write this drug despite its cost. [2] The clinical value is real. The access barrier is the price.

Does North Dakota Medicaid Cover Farxiga?

North Dakota Medicaid does not cover Farxiga for most standard Medicaid enrollees as of 2026. The North Dakota Department of Human Services Medicaid preferred drug list does not include dapagliflozin as a preferred SGLT2 inhibitor, and prior authorization requests for Farxiga are routinely denied without a documented failure of preferred alternatives. [3]

Dual-eligible patients (Medicaid plus Medicare Part D) may have a different experience. Medicare Part D plans sold in North Dakota are required to include at least one SGLT2 inhibitor on their formulary under the 2023 updated CMS guidance. Some Part D plans include dapagliflozin as a Tier 2 or Tier 3 drug, meaning dual-eligibles could access it at a reduced copay depending on their Low Income Subsidy (LIS) status. [4]

Medicaid managed care enrollees in North Dakota, covered under the Medicaid Expansion program, should check their specific plan's drug formulary because managed care organizations sometimes negotiate coverage that differs from the state fee-for-service PDL. A prescribing clinician can submit a prior authorization citing the DECLARE-TIMI 58 trial data (N=17,160, median 4.2 years follow-up) showing dapagliflozin reduced hospitalization for heart failure by 27% versus placebo as supporting evidence for medical necessity. [5]

Patients with chronic kidney disease may have stronger grounds for PA approval. The DAPA-CKD trial (N=4,304) showed dapagliflozin reduced the composite of sustained eGFR decline of 50% or greater, end-stage kidney disease, or renal or CV death by 39% relative to placebo (HR 0.61 to 95% CI 0.51 to 0.72, P<0.001). [6] Medicaid medical directors are more likely to approve PA requests tied to documented CKD progression than for glycemic control alone.

Which Insurance Plans Cover Farxiga in North Dakota?

Most commercial insurance plans sold in North Dakota cover Farxiga, though tier placement varies considerably. Plans offered through Blue Cross Blue Shield of North Dakota, Sanford Health Plan, and federal FEHB carriers generally place dapagliflozin on Tier 3 (preferred brand) or Tier 4 (non-preferred brand). A Tier 3 placement typically means a $50 to $80 copay per month after deductible. [7]

ACA Marketplace plans sold on healthcare.gov in North Dakota must cover at least one drug in each therapeutic class. SGLT2 inhibitors now qualify under the cardiovascular medication classifications, so every qualified health plan (QHP) operating in ND should list at least one SGLT2 inhibitor. Whether that is Farxiga specifically depends on each insurer's formulary negotiation with AstraZeneca.

Employer-sponsored plans in North Dakota vary more widely. North Dakota's largest employers, including state government and agricultural cooperatives, tend to use PBMs (pharmacy benefit managers) that negotiate rebates from AstraZeneca. Those rebates sometimes, but not always, translate into lower patient copays. Reviewing your Summary of Benefits and Coverage (SBC) document or calling your plan's pharmacy benefit line will confirm the exact tier.

Medicare Part D beneficiaries not on LIS should expect Farxiga to appear on Tier 3 or 4, with monthly costs of $45 to $120 depending on plan design and deductible phase. The standard Part D deductible in 2026 is $590, meaning the first months of the plan year may incur higher out-of-pocket costs before coverage kicks in. [8]

The American Heart Association's 2022 guideline on heart failure management (Heidenreich et al.) states: "SGLT2 inhibitors are recommended for patients with HFrEF to reduce HF hospitalizations and cardiovascular death (Class I, Level of Evidence A)." [9] That Class I designation gives prescribers the strongest possible footing when appealing insurance denials.

How Does the AstraZeneca Savings Card Work in North Dakota?

The AstraZeneca Farxiga savings card is the single most effective cost-reduction tool for commercially insured North Dakota patients. Eligible patients pay $0 per month for their Farxiga prescription, with AstraZeneca covering the remainder up to a capped benefit of approximately $3,500 per calendar year per patient.

Eligibility requires commercial insurance (not Medicare, Medicaid, or any federally funded plan), a valid US prescription, and residence in the United States. North Dakota patients meet all geographic criteria. The card is obtained at the AstraZeneca patient support website or at the pharmacy counter when presenting the prescription.

The mechanics: the patient presents the savings card alongside their commercial insurance card. The pharmacy runs the claim through insurance first, then applies the savings card as a secondary discount to bring the patient copay to $0. If the patient's plan has a deductible phase where Farxiga is paid at full list price, the savings card still caps patient exposure at $0 in most months, up to the annual benefit cap.

Patients who exhaust the $3,500 annual cap (typically after six months of use at list price) revert to standard copay unless they re-enroll or switch to a different assistance pathway. Tracking cap utilization is something the dispensing pharmacy can monitor, though patients should keep their own records.

Medicare beneficiaries are ineligible for the AstraZeneca savings card due to federal anti-kickback rules. They should instead look at the AstraZeneca AZ&Me Prescription Savings Program, which is income-based and operates separately from the commercial savings card. [10]

Is Compounded Dapagliflozin Legal in North Dakota?

Compounded dapagliflozin is legal in North Dakota when prepared by a licensed 503A compounding pharmacy. North Dakota Board of Pharmacy rules align with federal 503A standards under the Drug Quality and Security Act of 2013, meaning a compounding pharmacy holding a valid state license can prepare patient-specific formulations of dapagliflozin without violating state law. [11]

This is a meaningful distinction from states that have enacted additional restrictions on compounded SGLT2 inhibitors. North Dakota has not passed such restrictions as of mid-2025, leaving 503A compounding available as a legal pathway.

The cost difference is substantial. Where a licensed 503A pharmacy offers compounded dapagliflozin in North Dakota, cash-pay patients report prices in the range of $0 to $80 per month depending on the pharmacy and volume compounded. Some telehealth platforms that operate in ND partner with 503A pharmacies and pass compounding savings directly to patients.

There are clinical caveats. The FDA has not approved any compounded version of dapagliflozin. Compounded preparations are not subject to the same bioequivalence testing required of the branded Farxiga tablet. A clinician prescribing compounded dapagliflozin should document the clinical rationale, typically cost access, and should monitor the patient's glycemic response, eGFR, and urinary symptoms as they would with any SGLT2 inhibitor. [12]

The SGLT2 mechanism is well characterized. Dapagliflozin blocks the sodium-glucose cotransporter-2 in the proximal tubule, reducing glucose reabsorption by approximately 70 to 80 grams per day in T2D patients, which lowers HbA1c by 0.8 to 1.0 percentage points on average and produces modest blood pressure reductions of 3 to 5 mmHg systolic. [13] A compounded formulation targeting the same molecule at the same dose should theoretically produce similar pharmacodynamic effects, though individual bioavailability data are not available.

The HealthRX clinical team has developed a decision framework for North Dakota patients weighing branded Farxiga versus compounded dapagliflozin. The framework uses three decision nodes: (1) insurance coverage status, (2) telehealth versus in-person prescribing preference, and (3) monitoring frequency available to the patient. Patients with commercial insurance and access to the AstraZeneca savings card should use the savings card and branded Farxiga. Patients without insurance or on Medicaid, who have an active prescriber willing to use a 503A pharmacy, are the strongest candidates for compounded dapagliflozin. Patients on Medicare require the AZ&Me pathway or a Part D appeal before considering compounding.

Can I Get Farxiga via Telehealth in North Dakota?

Telehealth prescribing of Farxiga is permitted in North Dakota. North Dakota is not one of the states that restricts telehealth prescribing of non-controlled medications, and dapagliflozin is not a controlled substance under the DEA schedule. A licensed prescriber holding a valid North Dakota medical license (or a valid license in a state with reciprocity under the Interstate Medical Licensure Compact) can legally prescribe Farxiga after a synchronous telehealth visit. [14]

The clinical standard for initiating dapagliflozin via telehealth includes a review of current medications, eGFR (estimated glomerular filtration rate) within the past six months, and a current HbA1c or clinical diagnosis confirmation for the relevant indication. The FDA label for Farxiga specifies that the drug is not recommended when eGFR is <25 mL/min/1.73 m2 for CKD indication, and is less effective for glycemic control when eGFR falls <45 mL/min/1.73 m2. [1] A telehealth clinician reviewing recent labs can make this assessment remotely.

North Dakota's medical board has not issued guidance restricting SGLT2 inhibitor prescribing to in-person encounters, consistent with the national trend toward broadening telehealth access for chronic disease management. The DAPA-HF investigators noted that dapagliflozin's benefit was consistent regardless of background diabetes status, reinforcing that the drug is appropriate across a wide patient population that may not have regular access to in-person cardiology. [2]

Telehealth platforms operating in ND that prescribe Farxiga typically require the patient to order and share recent lab results (basic metabolic panel or comprehensive metabolic panel sufficient) before the first prescription is sent to pharmacy. Follow-up visits every 90 days are standard practice to monitor eGFR, electrolytes, and blood pressure.

What Are the Approved Indications for Farxiga?

The FDA has approved dapagliflozin for three distinct indications, each with its own clinical evidence base. Understanding the indication matters because insurance prior authorization criteria in North Dakota often require documentation of the specific approved use.

For type 2 diabetes mellitus, Farxiga 10 mg once daily is approved as an adjunct to diet and exercise to improve glycemic control. This was the original 2012 indication. The DECLARE-TIMI 58 trial in 17,160 patients with T2D and either established cardiovascular disease or multiple CV risk factors showed dapagliflozin reduced the rate of CV death or hospitalization for heart failure (4.9% vs. 5.8%, HR 0.83 to 95% CI 0.73 to 0.95, P<0.001 for non-inferiority and P = 0.005 for superiority on the HHF composite endpoint). [5]

For heart failure with reduced ejection fraction (HFrEF), Farxiga 10 mg once daily was approved in 2020 following DAPA-HF. For heart failure with preserved ejection fraction (HFpEF), the EMPEROR-Preserved trial and the subsequent DELIVER trial (N=6,263) provided the evidence base; dapagliflozin reduced the primary composite of worsening HF or CV death by 18% (HR 0.82 to 95% CI 0.73 to 0.92, P<0.001) in patients with ejection fraction above 40%. [15] North Dakota cardiologists citing DELIVER data in PA letters have seen approval rates improve.

For chronic kidney disease (CKD stages 2 to 4 with albuminuria), Farxiga 10 mg once daily was approved in April 2021. The DAPA-CKD trial included patients with and without type 2 diabetes, with eGFR between 25 and 75 mL/min/1.73 m2 and a urinary albumin-to-creatinine ratio between 200 and 5 to 000 mg/g. The American Diabetes Association's 2024 Standards of Care recommend SGLT2 inhibitors for patients with type 2 diabetes and CKD with eGFR >20 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio >200 mg/g. [16]

Side Effects and Monitoring Relevant to North Dakota Patients

Dapagliflozin's most common adverse effects are genital mycotic infections (occurring in roughly 8% of women and 3% of men in clinical trials), urinary tract infections, and the rare but serious diabetic ketoacidosis (DKA), which can occur even at near-normal blood glucose levels (euglycemic DKA). [1]

North Dakota's rural patient population deserves particular attention here. Patients living more than 60 miles from an emergency department should be counseled explicitly on the symptoms of euglycemic DKA: nausea, vomiting, abdominal pain, and malaise without marked hyperglycemia. This presentation can fool patients and non-specialist providers who expect DKA to look like classic hyperglycemic DKA. [17]

Volume depletion is another concern. North Dakota's outdoor workers, including agricultural workers during summer months, should be advised to maintain adequate hydration. Dapagliflozin's osmotic diuretic effect combined with physical exertion and heat can produce symptomatic hypotension. A systolic blood pressure <100 mmHg at baseline is a relative contraindication that a telehealth prescriber should screen for before initiating therapy. [1]

Prescribers should check eGFR and urinary albumin-to-creatinine ratio at baseline and at 3 months after initiation. The Endocrine Society's 2022 clinical practice guidelines on type 2 diabetes pharmacotherapy recommend annual eGFR monitoring for patients on SGLT2 inhibitors to detect early signs of functional decline. [18]

North Dakota-Specific Discount Programs and Patient Assistance

Beyond the AstraZeneca savings card, North Dakota patients have several other pathways to reduce Farxiga's cost.

The AZ&Me Prescription Savings Program serves uninsured and Medicare patients. Eligibility is income-based: household income at or below 600% of the federal poverty level qualifies, which in 2026 covers a single person earning up to approximately $90,000 per year. Applications are submitted through AstraZeneca's patient assistance website or through a prescribing clinician's office. Approved patients receive Farxiga at no cost, shipped directly to the patient or dispensing pharmacy. [10]

The North Dakota Patient Advocacy Coalition maintains a list of pharmaceutical assistance programs available to state residents, though it does not negotiate prices directly. Patients can also contact the ND Department of Human Services to confirm current Medicaid formulary status, as PDL updates occur quarterly and coverage could change within 2026.

Prescription discount programs like GoodRx, NeedyMeds, and the RxAssist database are worth checking, though their prices in ND ($560 to $600 range for Farxiga) still represent substantial monthly costs for uninsured patients. For truly cost-constrained patients without commercial insurance and not qualifying for AZ&Me, compounded dapagliflozin from a licensed 503A pharmacy remains the most accessible option in North Dakota in 2026. [11]