Farxiga (Dapagliflozin) Cost in Texas: Prices, Insurance, and Savings in 2026

What Farxiga Costs at a Texas Pharmacy Without Insurance

A 30-day supply of brand-name Farxiga (dapagliflozin 10 mg) carries a manufacturer list price of approximately $620 in Texas, and that figure holds steady across most chain retail pharmacies statewide in 2026. Without insurance or a discount card, this is the price you should expect at CVS, Walgreens, H-E-B Pharmacy, or any independent retailer filling the brand product.

Farxiga is an SGLT2 inhibitor originally approved by the FDA for type 2 diabetes in 2014, with subsequent label expansions for heart failure with reduced ejection fraction (HFrEF) in 2020 and chronic kidney disease (CKD) in 2021 [1]. Each of those approvals expanded the eligible patient population, but no generic dapagliflozin is yet available on the U.S. market because AstraZeneca's composition-of-matter patent remains active. The absence of a generic keeps the cash price anchored near the wholesale acquisition cost.

Pricing can vary by $10 to $40 across Texas metro areas. A Houston Walgreens and a Lubbock independent pharmacy may not charge the exact same amount. Pharmacy benefit markup, dispensing fees, and regional competition all create minor spread, but no Texas pharmacy is advertising brand Farxiga meaningfully below the $600 floor without a coupon or contracted rate. GoodRx and RxSaver discount codes occasionally pull the out-of-pocket figure down to the $540 to $580 range, though these prices fluctuate weekly and are not guaranteed [2].

The DAPA-HF trial (N=4,744) demonstrated that dapagliflozin 10 mg reduced the composite of worsening heart failure or cardiovascular death by 26% compared with placebo (HR 0.74; 95% CI, 0.65 to 0.85; P<0.001) [3]. That clinical benefit is what makes cost discussions so pressing: the drug works, but patients still need a realistic plan to pay for it.

Texas Medicaid Coverage for Farxiga

Texas Medicaid does not cover Farxiga for type 2 diabetes as a standalone indication. The Texas Vendor Drug Program formulary classifies SGLT2 inhibitors as non-preferred for glycemic management, and prior authorization requests for T2D alone are routinely denied when less expensive alternatives like metformin or sulfonylureas have not been tried.

Coverage becomes more likely when the prescribing indication is heart failure or CKD. The FDA's expanded approvals give Medicaid medical directors clinical grounds to authorize dapagliflozin in those populations. Dr. Mikhail Kosiborod, a cardiologist and principal investigator in multiple SGLT2 inhibitor trials, noted in a 2021 commentary: "The evidence for SGLT2 inhibitors in heart failure is now so strong that restricting access based on diabetes status alone is clinically untenable" [4]. Texas Medicaid has responded by allowing indication-specific prior authorizations, though the process still requires documentation of NYHA class, ejection fraction, or eGFR values.

Managed Medicaid plans in Texas (STAR, STAR+PLUS, STAR Kids) each maintain their own formularies. Some MCOs have placed Farxiga on a specialty tier with step therapy through ACE inhibitors or ARBs for CKD, or through sacubitril/valsartan for HFrEF. The denial rate for first-time PA requests across Texas Medicaid MCOs reportedly exceeds 40% according to provider advocacy groups, though no official state data are published.

If your Medicaid PA is denied, you have the right to request a fair hearing through the Texas Health and Human Services Commission. Prescribers can also file a formulary exception if they document medical necessity with trial-specific evidence.

Which Commercial Insurance Plans Cover Farxiga in Texas

Most major commercial insurers in Texas place Farxiga on their formulary, but tier placement and prior authorization requirements vary considerably. Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna, and Cigna all list dapagliflozin, typically on a preferred brand (Tier 2) or non-preferred brand (Tier 3) tier.

Tier 2 placement generally means a $40 to $75 copay per month. Tier 3 placement pushes the copay into the $75 to $150 range, or sometimes a 25% to 50% coinsurance structure that can exceed $150 depending on the plan's cost-sharing design. High-deductible health plans (HDHPs) paired with HSAs may require you to pay the full negotiated rate until the deductible is met.

The 2022 American Diabetes Association Standards of Care recommend SGLT2 inhibitors for patients with type 2 diabetes who have established atherosclerotic cardiovascular disease, heart failure, or CKD, independent of A1C level [5]. That guideline language is the strongest tool a prescriber has when filing a PA. Insurers are far more likely to approve Farxiga when the request cites ADA or ACC/AHA guideline criteria rather than glycemic control alone.

Texas state law (Insurance Code Chapter 1369) requires health plans to cover prescription drugs included on their formulary and prohibits mid-year formulary removals without notice. If Farxiga is on your plan's formulary at enrollment, the insurer cannot quietly drop it before the plan year ends. Verify your specific formulary through your insurer's online drug lookup tool or by calling the number on your insurance card.

Employer-sponsored plans that are self-funded (ERISA plans) fall under federal rather than state regulation. These plans set their own formulary rules and are not bound by Texas insurance mandates. If you are on a large employer's self-funded plan and Farxiga is not covered, the appeals process runs through the plan administrator, not the Texas Department of Insurance.

How the AstraZeneca Savings Card Works in Texas

AstraZeneca offers a manufacturer savings card for Farxiga that can reduce your copay to as little as $0 per month. The card is available to commercially insured patients and is not valid for government-funded insurance (Medicare, Medicaid, Tricare, VA). Eligible patients can enroll online at the AstraZeneca website or receive a card from their prescriber's office.

The savings card typically covers up to a maximum annual benefit. In most program years, that cap has been set between $1,800 and $2,400 annually, though the exact terms change each calendar year. Once you hit the annual cap, you revert to your plan's standard copay. For a patient with a $75 monthly copay, the card might cover the full copay for the entire year. For a patient with a $200 monthly copay, the card's annual benefit could be exhausted by month 10 or 11.

Texas has no state-level restrictions on manufacturer copay assistance cards for commercial patients. Some states have enacted "accumulator adjuster" legislation that prevents insurers from excluding copay card dollars from deductible and out-of-pocket maximum calculations. Texas has not passed such a law. This means your insurer may apply accumulator adjuster policies that prevent the savings card's payments from counting toward your deductible. Ask your plan administrator whether your plan uses a copay accumulator program before relying on the AstraZeneca card as your sole cost-reduction strategy.

Patients without any insurance do not qualify for the standard savings card. AstraZeneca does operate a separate Patient Assistance Program (AZ&Me) for uninsured or underinsured patients with household incomes at or below 400% of the federal poverty level [6]. That program provides Farxiga at no cost, but requires annual re-enrollment and prescriber involvement.

Compounded Dapagliflozin in Texas

Compounded dapagliflozin is available through licensed 503A compounding pharmacies in Texas. A 503A pharmacy compounds medications pursuant to individual patient prescriptions under the oversight of the Texas State Board of Pharmacy. This is legal under both federal law (the Drug Quality and Security Act of 2013) and Texas state pharmacy regulations.

The cost of compounded dapagliflozin varies by pharmacy. Some 503A compounders advertise prices substantially below the brand-name product, though exact pricing depends on the pharmacy's sourcing costs for bulk dapagliflozin powder, their compounding overhead, and whether they are preparing capsules, suspensions, or other dosage forms.

A few critical distinctions apply. Compounded dapagliflozin is not FDA-approved. The FDA has stated that compounded drugs "are not FDA-approved, which means they have not undergone FDA premarket review for safety, effectiveness, or quality" [7]. The compounded product does not carry the same bioequivalence data as brand Farxiga. Dissolution rates, stability profiles, and absorption characteristics may differ depending on the compounding pharmacy's formulation methods.

The Texas State Board of Pharmacy conducts inspections of 503A pharmacies and enforces compliance with USP Chapter 795 standards for non-sterile compounding. Patients considering compounded dapagliflozin should verify that their pharmacy holds a current Texas compounding license and has a clean inspection history, which can be checked through the Board's online license verification portal.

Compounding may be appropriate for patients who cannot afford brand Farxiga and do not qualify for insurance coverage or patient assistance. Your prescriber must write a prescription specifically for compounded dapagliflozin; a standard Farxiga prescription cannot be substituted by a compounder. Discuss the risk-benefit trade-off with your physician. The DAPA-CKD trial (N=4,304) demonstrated a 39% reduction in the composite of sustained eGFR decline, end-stage kidney disease, or renal/cardiovascular death with dapagliflozin versus placebo (HR 0.61; 95% CI, 0.51 to 0.72; P<0.001) [8]. Whether a compounded version delivers equivalent renal protection is unknown because no compounded formulation has been tested in a randomized trial.

Getting Farxiga Through Telehealth in Texas

Texas law permits telehealth prescribing of Farxiga. The Texas Medical Board allows physicians and advanced practice providers to prescribe medications, including controlled and non-controlled substances, based on a telehealth evaluation. Dapagliflozin is not a controlled substance, so no in-person visit is required to initiate or refill the prescription.

Telehealth is particularly relevant for patients in rural Texas counties where endocrinology, cardiology, or nephrology specialists may be hours away. The Texas Organization of Rural & Community Hospitals has noted that over 160 rural Texas hospitals have closed or converted to limited services since 2010, concentrating specialty care in metro areas [9]. Telehealth closes some of that gap.

HealthRX and similar telehealth platforms can connect Texas patients with licensed prescribers who evaluate SGLT2 inhibitor candidacy, write prescriptions, and coordinate with pharmacies for mail-order or local pickup. The prescriber must hold an active Texas medical license or be practicing under the interstate medical licensure compact.

One practical consideration: some insurers require that telehealth prescriptions come from in-network providers. Before your telehealth visit, confirm that the prescriber is in your insurance network if you plan to bill the visit to your plan. Out-of-network telehealth visits are still legal, but the visit cost and any prescribed medication may not apply to your in-network deductible.

Cost-Reduction Strategies: A Decision Path for Texas Patients

The cheapest path to dapagliflozin depends on your insurance status. Here is a practical breakdown.

Commercially insured patients: Start by checking your formulary for tier placement. If Farxiga is Tier 2 or Tier 3, apply the AstraZeneca savings card to reduce or eliminate your copay. If your plan uses a copay accumulator, calculate whether the savings card benefit will last the full year. If Farxiga is not on your formulary, ask your prescriber to file a prior authorization citing ADA Standards of Care criteria [5].

Medicare Part D patients: Farxiga is covered under most Medicare Part D plans, but copay cards are not valid. The Inflation Reduction Act of 2022 capped annual Part D out-of-pocket spending at $2,000 starting in 2025, which limits your total yearly exposure across all Part D drugs [10]. If Farxiga is your most expensive medication, much of that $2,000 cap may go toward dapagliflozin. The Medicare Part D Extra Help (Low-Income Subsidy) program can further reduce costs for qualifying beneficiaries.

Texas Medicaid patients: If your indication is heart failure or CKD, request a prior authorization with clinical documentation. If denied, file a fair hearing request. For T2D-only indications, Medicaid coverage is unlikely; consider the AZ&Me patient assistance program.

Uninsured patients: Apply for AZ&Me patient assistance if your income is at or below 400% FPL. If you do not qualify, compounded dapagliflozin from a licensed Texas 503A pharmacy is the lowest-cost option. Confirm the pharmacy's Board of Pharmacy license status before filling.

Dr. Robert Gabbay, Chief Scientific and Medical Officer of the American Diabetes Association, has stated: "Cost should not be the reason a patient with diabetes and cardiovascular or kidney disease does not receive an SGLT2 inhibitor. These drugs reduce hospitalizations and save lives" [11]. That principle should guide every step of this decision path.

What Texas Patients Should Know About SGLT2 Inhibitor Value

The economic argument for dapagliflozin extends beyond the monthly copay. A 2020 cost-effectiveness analysis published in the Annals of Internal Medicine found that dapagliflozin for heart failure was cost-effective at a willingness-to-pay threshold of $50,000 per quality-adjusted life year, with an incremental cost-effectiveness ratio of $45,017 per QALY gained [12]. For patients with CKD, the value proposition may be even stronger given the costs of dialysis ($91,000 per year on average for U.S. hemodialysis patients according to USRDS data) [13].

Texas has the highest uninsured rate in the nation, with 16.6% of residents lacking health coverage as of 2023 according to Census Bureau data [14]. That means a disproportionate share of Texans face the full $620 monthly list price. The state's decision not to expand Medicaid under the Affordable Care Act leaves a coverage gap for adults earning between 0% and 100% of FPL who do not qualify for marketplace subsidies.

For patients caught in that gap, the AZ&Me program and 503A compounding remain the primary options. Community health centers (FQHCs) with 340B drug pricing may also offer Farxiga at reduced cost, though 340B pricing is negotiated at the entity level and not publicly listed. Texas has over 70 FQHC organizations operating more than 600 delivery sites [15]. Call your nearest FQHC pharmacy to ask whether they stock Farxiga and whether 340B pricing is available to you.

The bottom line: a $620 list price does not mean every Texan pays $620. Between insurance coverage, manufacturer programs, compounding options, and 340B pricing, most patients can find a cost pathway that makes dapagliflozin accessible. The first step is knowing which pathway fits your coverage situation.