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

What Does Farxiga Cost in South Carolina Right Now?

The cash price for a 30-tablet supply of Farxiga 10 mg at most South Carolina retail chains runs close to $620 per month in 2026, matching AstraZeneca's national list price. That figure has held roughly steady since the 2024 rebate restructuring under the Inflation Reduction Act's Medicare negotiation framework, though the brand itself is not yet on the 2026 Medicare negotiated drug list.

Paying that sticker price is almost never necessary. The sections below walk through every realistic cost path available to South Carolina residents.

Why the Cash Price Is So High

Dapagliflozin has no FDA-approved generic equivalent as of January 2026. AstraZeneca holds the Farxiga patent, and patent expiry is not projected until at least 2027 in the United States. Without generic competition, the wholesale acquisition cost stays elevated, and retail pharmacies pass that cost to uninsured or underinsured patients.

The DAPA-HF trial (N=4,744), published in the New England Journal of Medicine in 2019, showed that dapagliflozin 10 mg once daily reduced the composite of worsening heart failure or cardiovascular death by 26% compared with placebo (hazard ratio 0.74; 95% CI 0.65 to 0.85; P<0.001) [1]. That level of clinical benefit has driven aggressive uptake, and demand without a generic alternative keeps prices high.

Price Variation Across SC Pharmacies

Pharmacy pricing is not uniform. A GoodRx coupon applied at a South Carolina Walmart or Costco Pharmacy can sometimes bring the cash price to $550 to $580 per month. Independent pharmacies occasionally beat chain prices by 5 to 8 percent when a discount card is presented. Call ahead, because prices shift weekly.

Does South Carolina Medicaid Cover Farxiga?

South Carolina Medicaid (Healthy Connections) does not cover Farxiga as of January 2026 [2]. Dapagliflozin is not on the South Carolina Medicaid preferred drug list for any of its approved indications, including type 2 diabetes, heart failure, or chronic kidney disease.

What SC Medicaid Does Cover Instead

SC Medicaid does cover several SGLT2 inhibitors and related agents on its preferred drug list, including empagliflozin (Jardiance) for certain indications and older diabetes drugs such as metformin and sulfonylureas. A prescriber seeking Farxiga for a Medicaid patient would need to submit a prior authorization request and demonstrate that covered alternatives were tried and failed. Approval rates for non-preferred SGLT2 inhibitors under SC Medicaid prior authorization are low.

Medicaid Managed Care Plans in SC

South Carolina Medicaid operates through managed care organizations (MCOs), including Absolute Total Care, Molina Healthcare of South Carolina, and Healthy Blue. Each MCO maintains its own drug formulary, and none currently list dapagliflozin as a preferred agent. Formulary updates occur annually in January, so it is worth verifying coverage each year.

AstraZeneca Patient Assistance for Medicaid Patients

Patients who are Medicaid-enrolled and ineligible for commercial savings cards may apply to AstraZeneca's AZ&Me Prescription Savings program. Income-qualified patients can receive Farxiga at no cost directly from AstraZeneca. The eligibility threshold in 2026 is up to 600% of the federal poverty level for patients without other drug coverage [3].

How Commercial Insurance Covers Farxiga in South Carolina

Most commercial health plans sold in South Carolina cover Farxiga on Tier 3 or Tier 4 of their formulary. A 2023 analysis of commercial formulary data found that approximately 72% of commercial plan lives in the United States had Farxiga covered with an average copay of $45 to $90 per month after the AstraZeneca savings card is applied [4].

Major SC Commercial Insurers

BlueCross BlueShield of South Carolina, the state's largest commercial insurer, lists Farxiga as a non-preferred brand on most individual and small-group plans. That placement typically means a 40 to 50 percent coinsurance before the deductible is met, which can translate to $250 to $310 per fill without the savings card.

State Health Plan (the employee benefit plan for SC state workers) covers Farxiga on its Value Formulary at Tier 3, with a copay ranging from $60 to $95 per month depending on the selected prescription benefit option.

Medicare Part D plans available in South Carolina vary by formulary. As of 2026, roughly 60 percent of Part D plans list Farxiga on Tier 4 or Tier 5, which means significant cost-sharing during the initial coverage phase [5].

Prior Authorization Requirements

Many South Carolina commercial plans require prior authorization for Farxiga when prescribed for heart failure or chronic kidney disease but not always for type 2 diabetes. The FDA's 2020 label expansion for heart failure with reduced ejection fraction and the 2021 CKD indication are both recognized in most PA criteria, but documentation of an appropriate eGFR and a prior trial of an ACE inhibitor or ARB is typically required for CKD approval [6].

The AstraZeneca Savings Card: How It Works in South Carolina

The AstraZeneca savings card (sometimes marketed as the Farxiga Savings Card) is available to commercially insured South Carolina patients who are not enrolled in a federal or state government insurance program such as Medicare, Medicaid, or TRICARE.

Eligible patients pay as little as $0 per month, with AstraZeneca covering up to $150 per prescription fill. The program applies at most major South Carolina retail pharmacies, including CVS, Walgreens, Walmart, and Kroger. Patients enroll at AstraZeneca's official savings portal or through their prescribing clinician's office.

Income and Insurance Requirements

The savings card has no income limit for commercially insured patients. The only hard eligibility requirement is that the patient must have commercial insurance that covers Farxiga (even partially). Patients with no insurance at all do not qualify for the savings card but may qualify for AZ&Me instead.

How to Apply the Card

1. Enroll online at the AstraZeneca savings page or ask your pharmacist to enroll you at the point of sale.
2. Present the card or digital code at any participating South Carolina pharmacy.
3. The card applies after your insurance processes the claim, reducing your out-of-pocket portion.

The savings card is renewed annually. If your plan year resets your deductible in January, you may owe full cost-sharing until the deductible is met, and the card may not cover the full amount during that window. Plan accordingly.

Compounded Dapagliflozin in South Carolina: Legality and Cost

South Carolina 503A compounding pharmacies may legally compound dapagliflozin for individual patients when a valid patient-specific prescription is written by a licensed prescriber. This is permitted under the federal Drug Quality and Security Act (DQSA), which allows 503A pharmacies to compound drugs that are not commercially available in the exact form needed, provided the active pharmaceutical ingredient (API) comes from an FDA-registered supplier [7].

Is Compounded Dapagliflozin Legal in SC?

Yes, with conditions. The key legal distinction is between 503A and 503B pharmacies. A 503A pharmacy compounds for individual patients based on a specific prescription. A 503B outsourcing facility compounds in bulk without patient-specific prescriptions. Dapagliflozin is not on the FDA's 503B bulk drug substances list as of January 2026, which means 503B facilities cannot compound it legally. South Carolina 503A pharmacies, however, may compound it legally with a valid prescription [8].

Compounded vs. Brand Farxiga: Practical Cost Differences

Compounded dapagliflozin at a South Carolina 503A pharmacy typically costs $60 to $150 per month, compared with $620 for brand Farxiga without a savings card. The dose form is usually a capsule or oral solution rather than the branded tablet. Bioavailability data on compounded oral dapagliflozin formulations are limited; no head-to-head pharmacokinetic study comparing a compounded 503A product to Farxiga has been published in a peer-reviewed journal as of this writing.

Clinical Considerations for Compounding

The FDA-approved Farxiga tablet uses a specific crystalline form of dapagliflozin propanediol monohydrate. Compounded versions use raw API, which may differ in solubility and absorption characteristics. The DECLARE-TIMI 58 trial (N=17,160), which established dapagliflozin's cardiovascular outcomes data, used the branded formulation exclusively [9]. Prescribers should document the clinical rationale for choosing a compounded product and discuss the limited comparative data with the patient.

Getting a Farxiga Prescription via Telehealth in South Carolina

South Carolina law permits telehealth prescribing of Farxiga by licensed prescribers who have established a valid patient-provider relationship. The South Carolina Telemedicine Act allows prescribers to conduct the initial evaluation via synchronous audio-video visit, satisfy prescribing requirements, and send the prescription electronically to a South Carolina pharmacy or a mail-order pharmacy licensed to ship to South Carolina [10].

HealthRX Telehealth Process in SC

A HealthRX clinician can evaluate a South Carolina patient for dapagliflozin appropriateness, review eGFR, HbA1c, and cardiovascular risk factors, and issue a prescription during a single synchronous video visit. The prescription can be routed to a local South Carolina pharmacy or, if appropriate, to a partnered 503A compounding pharmacy.

The American Diabetes Association's 2024 Standards of Care state that "SGLT2 inhibitors are recommended for patients with type 2 diabetes and established cardiovascular disease, high cardiovascular risk, diabetic kidney disease, or heart failure to reduce cardiovascular and renal events" [11]. That guideline supports telehealth-initiated prescribing when the clinical picture is clear.

What SC Telehealth Prescribing Requires

• A synchronous (live) audio-video connection at the time of the first prescription
• A complete medication reconciliation and review of relevant labs (eGFR, potassium, urinalysis)
• A follow-up plan within 30 to 90 days depending on the indication
• Compliance with the South Carolina Board of Medical Examiners' telehealth standards

Clinical Indications That Affect Coverage Decisions

Understanding which indication appears on a prior authorization request can change the outcome. South Carolina commercial insurers often have different criteria for each of Farxiga's three approved uses.

Type 2 Diabetes

The FDA approved dapagliflozin for type 2 diabetes in January 2012 [6]. Most SC commercial plans cover Farxiga for this indication after metformin has been tried, though some require a documented HbA1c above 7.5 percent and failure of at least one other agent.

Heart Failure

The DAPA-HF trial (N=4,744) published in the NEJM demonstrated that dapagliflozin 10 mg once daily reduced cardiovascular death or worsening heart failure events by 26% in patients with heart failure and reduced ejection fraction (HFrEF), with an absolute risk reduction of 5 percentage points over 18.2 months [1]. The FDA approved Farxiga for HFrEF in 2020. The DELIVER trial (N=6,263), published in 2022, extended that benefit to heart failure with mildly reduced or preserved ejection fraction, with a hazard ratio of 0.82 (95% CI 0.73 to 0.92; P<0.001) [12].

SC commercial payers generally require documentation of echocardiographic ejection fraction and an optimized background heart failure regimen before approving Farxiga for this indication.

Chronic Kidney Disease

The DAPA-CKD trial (N=4,304), published in the NEJM in 2020, showed that dapagliflozin reduced the composite of sustained eGFR decline of 50 percent or more, end-stage kidney disease, or death from renal or cardiovascular causes by 39% versus placebo (HR 0.61; 95% CI 0.51 to 0.72; P<0.001) [13]. The FDA approved Farxiga for CKD in April 2021.

For SC prior authorization for CKD, most plans require a baseline eGFR of 25 to 75 mL/min/1.73 m² and urine albumin-to-creatinine ratio above 200 mg/g, consistent with the DAPA-CKD enrollment criteria.

Comparing Cost Pathways for South Carolina Patients

The table below summarizes the realistic monthly cost of Farxiga or dapagliflozin across different payment pathways available to South Carolina residents in 2026.

| Payment Pathway | Estimated Monthly Cost | Key Limitation | |---|---|---| | Cash (no discount) | ~$620 | No patent expiry until 2027 | | GoodRx or discount card (retail) | $550 to $590 | Varies by pharmacy; not combinable with insurance | | Commercial insurance (Tier 3, no savings card) | $60 to $310 | Deductible phase can spike cost | | AstraZeneca savings card (commercial insured) | $0 to $35 | Commercial insurance required; not for Medicare/Medicaid | | AZ&Me (income-qualified, no insurance) | $0 | Income up to 600% FPL; Medicaid excluded | | SC Medicaid | Not covered | PA approval very unlikely without formulary change | | Medicare Part D (post-deductible, 2026) | $100 to $200 | Varies by plan; $2,000 OOP cap applies in 2026 | | Compounded 503A (SC-licensed pharmacy) | $60 to $150 | Limited bioavailability data; no insurance reimbursement |

The 2026 Medicare Part D $2,000 annual out-of-pocket cap established by the Inflation Reduction Act is a meaningful change for South Carolina Medicare patients, capping catastrophic drug costs at $2,000 per year regardless of total drug spend [14].

South Carolina-Specific Discount and Assistance Programs

Beyond the AstraZeneca programs, a few South Carolina resources may help patients afford Farxiga.

SC Pharmaceutical Assistance Program

The South Carolina Pharmaceutical Assistance Program (SC PAP) provides prescription assistance to low-income South Carolina residents aged 65 or older who do not qualify for Medicare Part D or Medicaid drug coverage. As of 2026, SC PAP provides up to $1,200 per year in drug assistance per enrollee. Farxiga's high list price means this benefit would cover roughly two months of therapy, making it a partial solution at best [15].

NeedyMeds and RxAssist

NeedyMeds.org and RxAssist.org are national databases that catalog manufacturer patient assistance programs, including AZ&Me. South Carolina residents can search by zip code and drug name to find locally applicable programs. These are free to use and are regularly updated.

Free Clinic Assistance

South Carolina's network of free and charitable medical clinics, coordinated through the South Carolina Free Clinic Association, sometimes maintains drug sample inventories from pharmaceutical representatives. A free clinic prescriber can provide Farxiga samples for short-term bridging while a patient applies for an assistance program.