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

What Is the Cash Price of Farxiga in Pennsylvania in 2026?

The AstraZeneca wholesale acquisition cost for Farxiga sits at approximately $620 per month for a 30-tablet supply of 10 mg in 2026. Without insurance, most Pennsylvania retail pharmacies pass that cost through with modest dispensing markups, so out-of-pocket cash prices cluster between $600 and $650 per month depending on the chain.

That number rarely reflects what a patient actually pays. Three cost-reduction pathways exist before anyone pays full price: manufacturer savings programs, insurance coverage, and compounded alternatives. Each is addressed in its own section below. The $620 figure is useful as a ceiling, not as an expected cost.

Comparison shopping across chains in Philadelphia, Pittsburgh, Allentown, and Harrisburg shows price variance under 10% for branded Farxiga because dapagliflozin has no FDA-approved generic as of 2026. GoodRx and similar discount aggregators may reduce cash cost by 15 to 25% at participating pharmacies, bringing the effective price to roughly $465 to $530 per month at some locations. Patients without insurance should present a discount card at the pharmacy counter before the prescription is processed, not after.

DAPA-HF (N=4,744) demonstrated that dapagliflozin 10 mg reduced the composite of worsening heart failure or cardiovascular death by 26% vs. placebo (hazard ratio 0.74 to 95% CI 0.65 to 0.85, P<0.001) over a median 18.2 months, establishing the clinical rationale for broad prescribing in heart failure with reduced ejection fraction. [1]

Does Pennsylvania Medicaid Cover Farxiga?

Pennsylvania Medicaid (Medical Assistance) covers dapagliflozin for three primary indications: type 2 diabetes mellitus, heart failure, and chronic kidney disease. Coverage is not automatic in all cases. PA Medicaid's preferred drug list requires prior authorization for heart failure and CKD indications in many managed care organization (MCO) plans, though diabetes coverage is generally on a preferred tier with minimal step therapy.

For PA Medicaid fee-for-service enrollees, dapagliflozin appears on the formulary with a $1 to $3 co-pay for most beneficiaries. Those enrolled in one of the six MCOs operating under HealthChoices (the PA managed care Medicaid program) should verify the specific plan formulary because tier placement can differ by MCO. Geisinger Health Plan, UPMC for You, and Highmark Wholecare each maintain their own PA Medicaid formularies.

Prior authorization for heart failure indications typically requires documentation of an ejection fraction of 40% or below (for HFrEF), a current cardiology or primary care note confirming the diagnosis, and evidence that an ACE inhibitor or ARB plus a beta-blocker have been trialed. The CKD indication requires a documented eGFR between 25 and 75 mL/min/1.73 m² and a urine albumin-to-creatinine ratio above 200 mg/g per AstraZeneca's FDA-approved label criteria. [2]

According to the FDA prescribing information for Farxiga, the approved dosing for CKD is dapagliflozin 10 mg once daily in adults with eGFR of at least 25 mL/min/1.73 m², regardless of diabetes status. [2] PA Medicaid providers submitting a prior authorization should cite the DAPA-CKD trial data and include the specific eGFR and UACR values in the clinical justification.

Which Insurance Plans Cover Farxiga in Pennsylvania?

Most commercial insurers operating in Pennsylvania place Farxiga on Tier 3 (preferred brand) or Tier 4 (non-preferred brand), depending on whether the plan has negotiated a preferred placement contract with AstraZeneca.

Tier 3 placement typically means a co-pay of $45 to $90 per 30-day supply after the deductible is met. Tier 4 placement means 30 to 40% coinsurance, which translates to $180 to $250 per month at list price. Patients on high-deductible health plans (HDHPs) pay cash price until the deductible is met, which is where the AstraZeneca savings card becomes most relevant.

Large Pennsylvania-based insurers with documented Farxiga formulary placement as of early 2026 include:

• Highmark Blue Cross Blue Shield of Pennsylvania: Tier 3, preferred brand, prior authorization required for CKD indication.
• Independence Blue Cross (IBX): Tier 3 on most commercial plans; Tier 2 on some Medicare Advantage plans.
• UPMC Health Plan: Tier 3 on commercial; PA Medicaid MCO coverage follows HealthChoices PA PDL.
• Aetna and Cigna PA plans: Tier 3 with quantity limit of 30 tablets per 30 days.

Patients on Medicare Part D should check their specific plan's formulary on Medicare.gov because tier placement varies across the more than 30 Part D plans available in Pennsylvania. The Extra Help (Low Income Subsidy) program may reduce co-pays to $4.50 or $11.20 for full-benefit dual eligibles. [3]

How the AstraZeneca Savings Card Works in Pennsylvania

AstraZeneca's branded savings program for commercially insured patients in Pennsylvania can reduce monthly Farxiga costs to as low as $0 for eligible individuals. Patients who are commercially insured (not enrolled in Medicare, Medicaid, CHIP, or any government-funded program) may apply at AstraZeneca's patient support portal.

The mechanics: after activating the card, it functions as a secondary payer at the pharmacy counter. The card covers the gap between what insurance pays and the patient's cost share, up to the program's per-fill cap. The annual maximum benefit has historically been set at $10,000 per calendar year, though AstraZeneca adjusts program terms annually. Pennsylvania patients using the card at HDHP plans report effective out-of-pocket costs of $0 to $35 per month once the card is active.

Eligibility exclusions are firm. Patients covered by any federal or state government insurance program, including PA Medicaid, Medicare Part D, Veterans Affairs coverage, or TRICARE, do not qualify for the commercial savings card. For those patients, the AstraZeneca Patient Assistance Program (AZ&Me) provides free medication to patients meeting income criteria (generally household income at or below 400% of the federal poverty level). Pennsylvania residents can apply through the AstraZeneca website or through a HealthRX clinician who can support the application during a telehealth visit.

Is Compounded Dapagliflozin Legal in Pennsylvania?

Compounded dapagliflozin occupies a legally specific space in Pennsylvania. Under Section 503A of the Federal Food, Drug, and Cosmetic Act, a state-licensed compounding pharmacy may prepare a patient-specific compound of dapagliflozin when a licensed prescriber issues a valid prescription and documents a medical necessity that the commercially available product cannot meet. [4]

Pennsylvania's State Board of Pharmacy licenses 503A pharmacies operating within the Commonwealth. A 503A pharmacy is not permitted to compound copies of commercially available drugs without that documented patient-specific rationale. The critical point: because branded Farxiga is commercially available, a prescriber must provide clinical justification in writing. Common justifications accepted in Pennsylvania include documented inability to afford the branded product, documented allergy to a tablet excipient, or a need for an alternative dosage form or strength not commercially produced.

The FDA's current position, as reflected in guidance documents, is that compounding of dapagliflozin by a 503A pharmacy is not categorically prohibited so long as the compound is not identified on the FDA's list of drugs withdrawn or removed from the market for safety or efficacy reasons. Dapagliflozin is not on that list. [4]

Cost implications are significant. Compounded dapagliflozin from a licensed Pennsylvania 503A pharmacy has been quoted to HealthRX patients at costs ranging from $0 (covered under certain medical necessity frameworks) to $80 per month, depending on the compounding pharmacy's pricing and whether the patient has any secondary coverage. This compares to $620 per month list price for branded Farxiga.

Patients considering this pathway should verify three things: that the compounding pharmacy holds a current Pennsylvania Board of Pharmacy license, that the prescriber has documented the medical necessity in the clinical record, and that the compound is being prepared from USP-grade dapagliflozin API. Telehealth providers in Pennsylvania, including HealthRX, can assess medical necessity and write the appropriate documentation.

HealthRX Compounded Dapagliflozin Eligibility Framework (Pennsylvania)

A patient may be a candidate for compounded dapagliflozin through a licensed Pennsylvania 503A pharmacy when ALL three criteria are met:

1. The prescriber has documented a patient-specific medical necessity (affordability barrier, excipient sensitivity, or alternative formulation need) in a dated clinical note.
2. The compounding pharmacy holds a current active license from the Pennsylvania State Board of Pharmacy and uses USP-grade dapagliflozin API.
3. The prescription is written for a specific patient (not for office stock) in a quantity consistent with a 30 to 90-day supply.

Patients meeting these criteria should not be dispensed a compound unless the prescribing clinician has reviewed the full FDA-approved labeling for dapagliflozin and confirmed that the indication and dose are consistent with evidence-based use.

Can I Get a Farxiga Prescription via Telehealth in Pennsylvania?

Yes. Pennsylvania law permits licensed prescribers to prescribe Farxiga via telehealth, provided a valid prescriber-patient relationship exists and the prescriber conducts a clinical evaluation sufficient to support the prescription. Since dapagliflozin is not a controlled substance, it does not face the additional prescribing restrictions that apply to Schedule II through V medications under the DEA's telemedicine rules.

A HealthRX telehealth visit in Pennsylvania covers the clinical assessment needed to confirm an appropriate indication (type 2 diabetes, heart failure, or CKD), review contraindications (eGFR <25 mL/min/1.73 m², recurrent urinary tract infections, or history of diabetic ketoacidosis), order baseline labs if needed, and route the prescription to the patient's preferred Pennsylvania pharmacy or coordinate a 503A compounding pharmacy referral.

The Pennsylvania State Board of Medicine and the Pennsylvania State Board of Osteopathic Medicine both permit telehealth prescribing of non-controlled medications when a clinician performs a synchronous audio-visual encounter (or, in some cases, an asynchronous encounter when explicitly permitted by the treating clinician's standard of care). [5]

What Does the Clinical Evidence Say About Dapagliflozin?

Dapagliflozin's evidence base across multiple disease states is why it commands significant clinical interest beyond type 2 diabetes.

DAPA-HF (NEJM 2019, N=4,744): Dapagliflozin 10 mg daily reduced the primary composite endpoint of cardiovascular death, worsening heart failure, or hospitalization for heart failure by 26% vs. placebo (HR 0.74 to 95% CI 0.65 to 0.85, P<0.001). This benefit occurred regardless of diabetes status, confirming the drug's cardioprotective mechanism is not dependent on glycemic lowering. [1]

DAPA-CKD (NEJM 2020, N=4,304): Dapagliflozin 10 mg reduced the primary composite of 50% or greater sustained decline in eGFR, end-stage kidney disease, or death from renal or cardiovascular causes by 39% vs. placebo (HR 0.61 to 95% CI 0.51 to 0.72, P<0.001). The trial was stopped early for overwhelming efficacy. [6]

DECLARE-TIMI 58 (NEJM 2019, N=17,160): In a broad cardiovascular outcomes trial, dapagliflozin reduced the rate of hospitalization for heart failure or cardiovascular death by 17% vs. placebo (HR 0.83 to 95% CI 0.73 to 0.95), though it did not significantly reduce three-point MACE in the overall population. [7]

The American Diabetes Association's Standards of Care in Diabetes 2024 state: "In patients with type 2 diabetes and established heart failure with reduced or preserved ejection fraction, an SGLT2 inhibitor with proven benefit in this population is recommended to reduce the risk of worsening heart failure and cardiovascular death." [8] Dapagliflozin is one of two SGLT2 inhibitors (along with empagliflozin) specifically named in that recommendation.

The 2022 AHA/ACC/HFSA Guideline for Heart Failure designates dapagliflozin a Class I recommendation (Level of Evidence: A) for patients with HFrEF to reduce hospitalizations and cardiovascular mortality. [9]

What Are the Contraindications and Safety Considerations?

Dapagliflozin is contraindicated in patients with eGFR <25 mL/min/1.73 m² for its glucose-lowering effect (though not for heart failure), in patients with a history of serious hypersensitivity to dapagliflozin or any tablet component, and in patients on dialysis. [2]

Key safety signals from the clinical trial program include:

• Genital mycotic infections: Occurred in 6.9% of women and 2.7% of men on dapagliflozin vs. 1.5% and 0.4% with placebo in DECLARE-TIMI 58.
• Urinary tract infections: Slightly elevated rate vs. placebo in pooled trials; patients with recurrent UTIs should discuss risk-benefit with their clinician.
• Diabetic ketoacidosis (DKA): Rare but reported; patients on insulin-requiring regimens or those with very low carbohydrate intake face higher risk. The FDA label carries a warning for euglycemic DKA. [2]
• Volume depletion: Relevant in patients on loop diuretics, elderly patients, or those with low systolic blood pressure at baseline.
• Fournier's gangrene: Rare (fewer than 55 cases reported to FDA across all SGLT2 inhibitors through 2019); patients should be counseled to report perineal pain or swelling immediately.

Pennsylvania prescribers using telehealth to initiate dapagliflozin should obtain a baseline metabolic panel (BMP) including creatinine and eGFR, a urinalysis, and an HbA1c where diabetes is the primary indication. A repeat BMP at 4 weeks confirms eGFR tolerance.

Practical Steps to Minimize Your Farxiga Cost in Pennsylvania

Getting from $620 per month to a manageable out-of-pocket cost in Pennsylvania involves a predictable sequence of steps.

Step 1: Check your insurance formulary. Log in to your insurer's portal or call the member services number on your card. Ask specifically: "What tier is dapagliflozin 10 mg (Farxiga) on my formulary, and what is my co-pay after deductible?"

Step 2: If commercially insured and not on a government program, apply for the AstraZeneca savings card before filling the first prescription. Activation takes under five minutes online and the card number is usable at any Pennsylvania retail pharmacy.

Step 3: If on PA Medicaid, confirm which MCO plan you are enrolled in and request a prior authorization letter from your prescriber if the indication is heart failure or CKD. Your prescriber needs your most recent eGFR and echocardiogram report to complete the form.

Step 4: If uninsured or underinsured and unable to use the savings card, ask your HealthRX clinician about the AZ&Me Patient Assistance Program or about a 503A compounded dapagliflozin referral with documented medical necessity.

Step 5: Present a GoodRx or similar discount card as a fallback at the pharmacy if none of the above applies. Cash prices at Pennsylvania pharmacies with discount cards range from approximately $465 to $530 per month as of early 2026.

The lowest achievable cost for most Pennsylvania patients with commercial insurance is $0 to $35 per month via the AstraZeneca savings card. For PA Medicaid beneficiaries, the expected co-pay is $1 to $3 per fill. For uninsured patients who qualify for AZ&Me, the drug is provided free of charge. A HealthRX telehealth clinician can coordinate all three pathways in a single visit and send the prescription directly to a Pennsylvania pharmacy of the patient's choice.