Farxiga Cost in West Virginia 2026: Cash Price, Medicaid, Compounded Options, and Insurance Coverage

What Does Farxiga Actually Cost in West Virginia in 2026?

The retail cash price for Farxiga 10 mg (a 30-tablet supply) sits at approximately $620 per month at West Virginia pharmacies in 2026. That figure comes from AstraZeneca's published list price and is consistent across major WV retail chains. No branded generic dapagliflozin tablet has received FDA approval for US sale as of this writing, so patients who cannot use manufacturer or insurer assistance programs face the full list price without the generic discount that exists for many older diabetes drugs.

The $620 figure is what a cash-paying patient without any coupon, savings card, or insurance adjustment would pay at a pharmacy counter in Charleston, Morgantown, Huntington, or anywhere else in West Virginia. That number has not changed materially since AstraZeneca last adjusted its US wholesale acquisition cost. For context, metformin 500 mg costs roughly $4 to $12 per month as a generic, so Farxiga represents a substantially higher out-of-pocket burden for uninsured West Virginians.

West Virginia consistently ranks among the states with the highest rates of type 2 diabetes and cardiovascular disease, two of Farxiga's three FDA-approved indications. The Centers for Disease Control and Prevention estimated that 15.4% of West Virginia adults had diagnosed diabetes as of its most recent State-Level Data report, well above the national average of 11.6% [1]. That burden makes Farxiga access a clinically meaningful issue for a large share of the WV adult population.

Dapagliflozin's DAPA-HF trial (N=4,744) showed that dapagliflozin 10 mg once daily 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) in patients with heart failure with reduced ejection fraction [2]. Given results like these, access barriers tied to cost carry real clinical weight.

Does West Virginia Medicaid Cover Farxiga?

West Virginia Medicaid does not cover Farxiga for any currently approved indication, including type 2 diabetes, heart failure with reduced or preserved ejection fraction, and chronic kidney disease. This applies to standard West Virginia Medicaid fee-for-service and to managed care organization (MCO) plans operating under WV Medicaid as of the 2026 plan year.

This is a significant gap. Approximately 29% of West Virginia residents are enrolled in Medicaid, one of the highest enrollment rates in the country. Patients in that group who need dapagliflozin for heart failure or CKD, two indications with Level A clinical evidence, have no straightforward path to coverage without a successful prior authorization appeal or a documented step-therapy failure on covered alternatives.

If your prescriber believes you have a medical necessity for Farxiga that cannot be met by a Medicaid-covered alternative, a formal prior authorization appeal is the appropriate first step. WV Medicaid managed care plans are required under federal law to have an internal appeals process and an external independent review process. "Formulary exceptions may be granted when a covered alternative is contraindicated or has been tried and failed," according to general Medicaid managed care regulations at 42 CFR 438.210 [3]. Ask your prescriber to document specific contraindications to metformin, SGLT2 inhibitors on formulary, or empagliflozin (which some WV MCO plans do cover) as part of the appeal.

For Medicaid patients who qualify for Low Income Subsidy (LIS) under Medicare Part D (dual-eligible patients), coverage may be available through the Medicare side of their dual coverage, depending on the specific Part D plan.

Which Commercial Insurance Plans Cover Farxiga in West Virginia?

Most major commercial insurance plans operating in West Virginia do cover Farxiga, though formulary tier placement and cost-sharing vary by plan year and employer group. The three largest commercial insurers in WV are West Virginia Public Employees Insurance Agency (PEIA), Highmark West Virginia, and CareSource WV (on the ACA marketplace).

PEIA, which covers state employees and educators, has historically placed Farxiga on a preferred or non-preferred brand tier depending on plan year. For 2026, members should check the PEIA formulary lookup tool or contact PEIA directly, as tier placement affects cost-sharing under the Plan Year 2026 evidence-based benefit design changes PEIA announced in late 2024.

Medicare Part D plans vary considerably. In 2026, the Inflation Reduction Act caps Medicare Part D out-of-pocket drug spending at $2,000 per year. For patients who hit that cap, Farxiga costs nothing further for the remainder of the calendar year. Reaching the cap mid-year is realistic at $620 per month.

ACA marketplace plans (available through healthcare.gov) generally cover Farxiga on Tier 3 or Tier 4, with cost-sharing ranging from $50 to $150 per fill depending on whether deductibles have been met. Subsidized silver or gold plans may meaningfully reduce that exposure.

How Does the AstraZeneca Savings Card Work in West Virginia?

The AstraZeneca savings card program, sometimes called the Farxiga Savings Card, is open to commercially insured patients in West Virginia who meet eligibility requirements. Eligible patients may pay as little as $0 per month for Farxiga, with AstraZeneca covering the remaining cost up to a defined maximum benefit per year.

Key eligibility requirements include: the patient must have commercial insurance (not Medicaid, Medicare, or any other government-funded program), must reside in the US, and the prescription must be for an FDA-approved indication. West Virginia residents on employer-sponsored health insurance through private employers, PEIA, or ACA marketplace plans generally qualify, provided their plan is not considered a government program. PEIA is a state-funded plan, but it typically qualifies as commercial for savings card purposes. Verify directly with AstraZeneca's program at 1-800-236-9933 or through the Farxiga.com savings page.

Patients enrolled in Medicare, West Virginia Medicaid, or any federal healthcare program are explicitly excluded from the commercial savings card. For those patients, AstraZeneca offers a separate patient assistance program (AZ&Me) that provides Farxiga at no cost for qualifying low-income patients who are uninsured or underinsured. Income eligibility for AZ&Me generally requires a household income at or below 400% of the federal poverty level, though AstraZeneca reviews applications individually [4].

Is Compounded Dapagliflozin Legal in West Virginia?

Compounded dapagliflozin prepared by a licensed 503A compounding pharmacy is legal in West Virginia. A 503A pharmacy is a state-licensed compounding pharmacy operating under Section 503A of the Federal Food, Drug, and Cosmetic Act. These pharmacies compound medications for individual patient prescriptions and are regulated by the West Virginia Board of Pharmacy as well as federal USP standards.

This is meaningfully different from 503B outsourcing facilities, which compound in bulk without individual patient prescriptions and face different FDA oversight rules. For dapagliflozin specifically, a patient in West Virginia would need a valid prescription from a licensed prescriber, and the compounding pharmacy would prepare a dapagliflozin formulation to fill that specific prescription.

The cost of compounded dapagliflozin varies by pharmacy, but patients and prescribers report costs substantially below the $620 Farxiga retail price. Some 503A pharmacies have quoted compounded dapagliflozin at $80 to $150 per month for a 30-day supply, though pricing is not standardized and depends on the pharmacy's sourcing and compounding overhead.

Important clinical and legal caveats apply. Compounded dapagliflozin is not FDA-approved. It has not undergone the same manufacturing quality review, bioavailability testing, or clinical trial validation as brand-name Farxiga. The FDA's position, stated in its compounding guidance documents, is that compounded drugs lack the assurance of safety, efficacy, and quality that FDA-approved drugs carry [5]. Prescribers who recommend compounded dapagliflozin should document the medical rationale, and patients should confirm that the 503A pharmacy is licensed with the West Virginia Board of Pharmacy and uses pharmaceutical-grade bulk active pharmaceutical ingredients from FDA-registered suppliers.

For patients who are excluded from AstraZeneca savings programs (specifically Medicare and Medicaid patients who cannot access the commercial card and who do not qualify for AZ&Me), compounded dapagliflozin from a licensed 503A pharmacy may represent the only affordable access route. That is a clinically uncomfortable situation, given the difference in quality assurance between compounded and FDA-approved products.

Can You Get Farxiga Prescribed via Telehealth in West Virginia?

Yes. Telehealth prescribing of Farxiga is legal in West Virginia, and the state has maintained expanded telehealth prescribing authority that was initially established during the COVID-19 public health emergency. West Virginia Code Chapter 30 and the West Virginia Telehealth Act (W. Va. Code 16-2M) permit licensed West Virginia physicians, nurse practitioners, and physician assistants to prescribe Schedule V and non-controlled medications including Farxiga via telemedicine to patients located in West Virginia [6].

A prescriber conducting a telehealth visit for Farxiga must comply with standard of care requirements, including a documented clinical evaluation appropriate to the indication being treated. For type 2 diabetes, this typically includes a recent HbA1c, eGFR, and urine albumin-to-creatinine ratio. For heart failure indications, an echocardiogram confirming ejection fraction is usually required.

HealthRX's clinical team can evaluate whether Farxiga is appropriate for you in a telehealth visit conducted by a West Virginia-licensed provider. Prescriptions are sent to a pharmacy of your choice, including mail-order pharmacies that may offer slightly lower prices than WV retail chains.

What Are the Approved Clinical Indications, and Why Do They Matter for Coverage?

Farxiga has three distinct FDA-approved indications, and the indication listed on a prescription affects insurance coverage determinations.

Type 2 diabetes (T2D): Farxiga 10 mg once daily is FDA-approved as an adjunct to diet and exercise in adults with T2D. The DECLARE-TIMI 58 trial (N=17,160) showed dapagliflozin reduced the composite of cardiovascular death or hospitalization for heart failure compared to placebo in T2D patients [7]. HbA1c reductions average approximately 0.9 to 1.0 percentage points from baseline.

Heart failure: The DAPA-HF trial (N=4,744) established dapagliflozin's benefit in HFrEF, showing a 26% relative risk reduction in the primary composite endpoint [2]. The DELIVER trial (N=6,263) subsequently demonstrated similar benefit in heart failure with preserved ejection fraction (HFpEF, EF above 40%), with dapagliflozin reducing worsening heart failure or cardiovascular death vs. placebo (HR 0.82 to 95% CI 0.73 to 0.92, P<0.001) [8]. The 2022 AHA/ACC/HFSA Heart Failure Guideline gives dapagliflozin a Class I recommendation (Level of Evidence A) for HFrEF, stating: "SGLT2 inhibitors are recommended to reduce cardiovascular death and HF hospitalizations in patients with HFrEF" [9].

Chronic kidney disease (CKD): The DAPA-CKD trial (N=4,304) showed dapagliflozin reduced the composite of sustained 50% or greater decline in eGFR, end-stage kidney disease, renal death, or cardiovascular death by 39% vs. placebo (HR 0.61 to 95% CI 0.51 to 0.72, P<0.001) in patients with CKD with or without T2D [10]. This led to FDA approval for CKD in 2021.

Insurance plans frequently require that the indication on the prescription match an approved diagnosis code (ICD-10). A prescription written for T2D (E11.xx) may face different formulary rules than one written for heart failure (I50.xx) or CKD (N18.xx). Working with your prescriber to document the correct primary indication can sometimes affect tier placement or prior authorization requirements.

What Are the Cheapest Ways to Get Farxiga in West Virginia?

Ranked from lowest to highest typical out-of-pocket cost:

1. AZ&Me Patient Assistance Program. For uninsured or underinsured West Virginians below 400% of the federal poverty level, AstraZeneca may provide Farxiga at no charge. Applications are processed through AstraZeneca's patient support program [4]. This is the lowest-cost option for qualifying patients.

2. AstraZeneca Farxiga Savings Card. Commercially insured (non-government) patients may pay $0 per month. Cards are available at Farxiga.com or through a prescriber's office.

3. Compounded dapagliflozin from a WV-licensed 503A pharmacy. Estimated $80 to $150/month without insurance. Not FDA-approved; quality and bioavailability are not validated to the same standard as Farxiga.

4. GoodRx or NeedyMeds coupons at WV pharmacies. GoodRx discounts on branded Farxiga are typically modest because there is no generic competition to drive coupon competition. Discounts typically bring the price to $550 to $590, not dramatically below list price.

5. Canadian or international online pharmacies. Legally ambiguous under federal law. The FDA does not generally permit personal importation of prescription drugs from other countries, though enforcement against individual patients is rare [5]. This carries regulatory and quality risks that HealthRX does not endorse.

6. Cash pay at retail WV pharmacies. Approximately $620/month. The baseline if no other program applies.

Monitoring Requirements That Affect Total Treatment Cost

Dapagliflozin requires periodic lab monitoring that adds to the total treatment cost for WV patients, particularly those paying out of pocket for both medication and labs.

Before starting Farxiga, a baseline eGFR is required. Farxiga is contraindicated in patients with eGFR <25 mL/min/1.73 m2 for the T2D indication and has modified dosing guidance for CKD. For patients with eGFR between 25 and 45, the glycemic benefit is attenuated, though cardiorenal benefits persist per DAPA-CKD data [10].

Ongoing monitoring should include eGFR every 3 to 6 months in CKD patients, HbA1c every 3 months until stable in T2D patients, and screening for signs of genital mycotic infections and diabetic ketoacidosis (DKA), which occur rarely but are a class-specific risk of SGLT2 inhibitors. The FDA label for Farxiga recommends patient education on DKA symptoms and witholding the drug before major surgical procedures [11].

West Virginia residents who obtain labs through community health centers (Federally Qualified Health Centers, FQHCs) may access sliding-scale fee lab services that reduce monitoring costs. There are 18 FQHC sites operating across WV as of 2025.

A Note on the WV Uninsured Rate and Access Realities

West Virginia's uninsured rate was approximately 5.7% as of 2023 (US Census Bureau), lower than the national average partly due to Medicaid expansion. But the gap created by Medicaid's non-coverage of Farxiga affects the nearly 29% of WV residents on Medicaid who may clinically need it. For those patients, the AZ&Me program and compounded 503A options are the primary realistic access routes.

Patients navigating these options should ask their prescriber specifically: "Is my primary indication type 2 diabetes, heart failure, or CKD?" The answer determines which coverage argument is strongest in a prior authorization appeal, and which assistance program pathway is most applicable.