Jardiance Cost in Hawaii 2026: Cash Price, Insurance, Medicaid, and Compounded Options

What Is Jardiance and Why Does the Price Matter?

Jardiance is the brand name for empagliflozin, an SGLT2 inhibitor manufactured by Boehringer Ingelheim and Eli Lilly. It works by blocking sodium-glucose cotransporter 2 in the proximal tubule of the kidney, causing excess glucose to be excreted in the urine. The drug is FDA-approved for glycemic control in type 2 diabetes, reducing cardiovascular death in adults with type 2 diabetes and established cardiovascular disease, treating heart failure (both reduced and preserved ejection fraction), and slowing the progression of chronic kidney disease [1][2].

EMPA-REG OUTCOME (N=7,020 adults with type 2 diabetes and established cardiovascular disease) found that empagliflozin 10 mg or 25 mg reduced the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke by 14% versus placebo (hazard ratio 0.86 to 95% CI 0.74, 0.99; P<0.001 for non-inferiority, P=0.04 for superiority) [3]. That result fundamentally changed prescribing patterns for SGLT2 inhibitors in high-risk patients, making cost and access a clinically relevant question, not just a financial one.

For Hawaii residents, Jardiance's price tag of roughly $680 per month for a 30-day supply creates a real access barrier, particularly given that the state's Medicaid program (Med-QUEST) does not routinely cover the drug for most beneficiaries.

Jardiance Cash Price in Hawaii in 2026

The manufacturer's list price for Jardiance 10 mg and 25 mg sits at approximately $680 per month across Hawaii retail pharmacies in 2026. That figure holds whether you walk into a Longs Drugs in Honolulu, a Costco Pharmacy in Kapolei, or an independent pharmacy on Maui.

Cash price means the price without insurance or any discount program applied. A 90-day supply at list price would cost roughly $2,040, though some pharmacy chains offer a modest discount on 90-day fills. GoodRx and similar coupon aggregators may reduce the out-of-pocket cost slightly, but for a branded medication with no FDA-approved generic as of early 2025, discounts are often marginal, typically bringing the price to $620 to $650 per month at best.

Hawaii's cost-of-living premium does not add significantly to Jardiance's price because the drug is priced nationally by the manufacturer rather than adjusted by geography. The local pharmacy dispensing fee may vary by $5 to $15, but the drug acquisition cost is essentially the same island-wide.

Hawaii Medicaid (Med-QUEST): Does It Cover Jardiance?

Hawaii Medicaid does not cover Jardiance for the majority of Med-QUEST enrollees in 2026. The Hawaii Department of Human Services administers Med-QUEST through managed care organizations including UnitedHealthcare Community Plan of Hawaii, Aloha Care, and HMSA's Quest Integration plan. Each MCO maintains its own formulary, and empagliflozin is either not listed or requires a prior authorization that is routinely denied for standard type 2 diabetes indications.

This is a meaningful coverage gap. Hawaii's 2023 Medicaid enrollment exceeded 370,000 individuals, according to CMS data [4]. Among low-income adults with type 2 diabetes or heart failure, the absence of Jardiance on the formulary means clinicians must use older agents or pursue costly appeals.

Some limited exceptions exist. A Med-QUEST enrollee with a documented heart failure diagnosis and a failed trial of an ACE inhibitor and beta-blocker may be able to obtain prior authorization approval on clinical grounds. Individual MCO medical directors have the authority to approve non-formulary drugs case by case. If your clinician believes empagliflozin is medically necessary, a formal appeal supported by EMPA-REG OUTCOME data and the 2023 ACC/AHA Heart Failure Guideline recommendation for SGLT2 inhibitors is the strongest path [5].

The 2022 ADA Standards of Care state: "In patients with type 2 diabetes and established or high risk for cardiovascular disease, heart failure, and/or CKD, an SGLT2 inhibitor with demonstrated benefit is recommended as part of the glucose-lowering regimen independent of A1C." [6] That language gives clinicians a strong foundation for a medical necessity letter.

Commercial Insurance Coverage in Hawaii

Most private insurance plans sold in Hawaii place Jardiance on Tier 3 or Tier 4 of the formulary. Tier 3 copays typically range from $50 to $100 per month after the deductible. Tier 4 copays can reach $150 to $200 per month or more, again after the deductible is satisfied.

Major insurers operating in Hawaii include HMSA (Hawaii Medical Service Association, the Blue Cross Blue Shield affiliate), Kaiser Permanente Hawaii, AlohaCare, and UnitedHealthcare. Each plan's specific tier placement for empagliflozin varies by plan year and formulary version.

Checking your specific plan. Call the member services number on your insurance card and ask for the formulary tier for NDC 00597-0167-37 (Jardiance 10 mg, 30-count) or NDC 00597-0168-37 (25 mg). Ask whether prior authorization (PA) is required and what clinical criteria must be met. Common PA criteria include documented type 2 diabetes diagnosis, one prior A1C result, and sometimes a failed or intolerable trial of metformin.

Step therapy. Some Hawaii plans impose step therapy, requiring a trial of a less expensive SGLT2 inhibitor or another diabetes drug class before approving Jardiance. However, if the indication is heart failure or CKD rather than glycemic control alone, step therapy waivers are often available because no other SGLT2 inhibitor has a direct formulary equivalent approved for all four of Jardiance's FDA-approved indications.

The Boehringer Ingelheim and Lilly Savings Card

Boehringer Ingelheim and Eli Lilly co-market Jardiance and offer a manufacturer savings card program. Commercially insured patients who are eligible may pay as little as $10 per month, with a maximum savings of up to $150 per fill and an annual cap that the manufacturer has historically set at $1,800 per calendar year.

The savings card does not apply to patients covered by any federal healthcare program, including Medicare Part D, Medicaid, TRICARE, or VA benefits. Hawaii residents on Med-QUEST are therefore ineligible.

To activate the card, patients or clinicians can visit the Jardiance website or call 1-888-545-6405. The card is processed at the pharmacy counter and does not require prior approval. Because savings cards are subject to change, confirm current terms at the time of prescribing.

For uninsured Hawaii patients, the savings card provides no benefit because it is designed to offset a copay on an insurance claim. Uninsured patients should explore the 503A compounding option described below or the Boehringer Ingelheim patient assistance program, which provides Jardiance at no cost to qualifying low-income uninsured individuals [7].

Compounded Empagliflozin in Hawaii: Legality and Access

503A compounding pharmacies in Hawaii may legally prepare empagliflozin for individual patients when a licensed prescriber issues a valid patient-specific prescription and the patient has a documented clinical need. This is distinct from 503B outsourcing facilities, which compound in bulk without patient-specific prescriptions. The FDA does not list empagliflozin on its drug shortage database as of early 2025, which means 503A pharmacies can compound it under the "essentially a copy" framework only when the prescriber documents a clinical difference from the commercially available product (for example, a specific dose not commercially available, or a patient's documented allergy to an excipient in the brand tablet) [8].

The Hawaii State Board of Pharmacy oversees in-state 503A pharmacies and requires them to comply with USP <795> (non-sterile compounding) standards. Out-of-state 503A pharmacies shipping to Hawaii patients must be licensed in both their home state and Hawaii or must ship under applicable interstate exemptions. Patients should verify that any pharmacy they use holds an active Hawaii non-resident pharmacy permit.

Practical cost comparison. Compounded empagliflozin from a licensed 503A pharmacy can cost $0 to $199 per month depending on the pharmacy's pricing model, the dose, and whether the patient uses a telehealth membership that bundles the medication. Some HealthRX-affiliated pharmacies offer compounded SGLT2 formulations at no additional medication cost as part of a monthly clinical service fee, making the effective out-of-pocket cost dramatically lower than the $680 brand list price.

A word of caution: compound quality varies. Ask any compounding pharmacy for a certificate of analysis (COA) from an independent third-party lab confirming potency and sterility for each batch. A reputable 503A pharmacy will provide this without hesitation.

Telehealth Prescribing of Jardiance in Hawaii

Hawaii permits telehealth prescribing of non-controlled prescription medications including empagliflozin. A clinician licensed in Hawaii may conduct a synchronous audio-video visit, evaluate a patient's chart, order appropriate lab work (creatinine, eGFR, A1C, urine albumin-to-creatinine ratio), and prescribe Jardiance or compounded empagliflozin electronically. Hawaii's telehealth parity law (HRS §431:10A-116.3) requires most commercial insurers to reimburse telehealth visits at the same rate as in-person visits [9].

Patients do not need to be physically present at a brick-and-mortar clinic to start or continue empagliflozin. This is especially relevant for residents on the neighbor islands (Maui, Kauai, Molokai, Lanai, Hawaii Island) who may live hours from an endocrinologist or cardiologist. A telehealth visit with a HealthRX clinician takes roughly 30 minutes, includes review of relevant labs, and can result in a same-day prescription sent to a local or mail-order pharmacy.

Prescribers must hold an active Hawaii medical license and comply with the Hawaii Medical Practice Act. Prescribing empagliflozin via telehealth to a patient with eGFR <20 mL/min/1.73 m2 is generally not appropriate given the reduced glucose-lowering efficacy at very low kidney function, though the cardiorenal protective effects may still apply per the EMPA-KIDNEY trial [10].

Key Safety Considerations That Affect Prescribing (and Cost Decisions)

Understanding why your clinician may hesitate to prescribe or continue Jardiance affects how you approach cost-reduction strategies.

eGFR thresholds. Jardiance is not recommended for initiation when eGFR is <20 mL/min/1.73 m2. Efficacy for glycemic control diminishes below 45 mL/min/1.73 m2, but cardiorenal protection continues at lower eGFR values. Baseline creatinine and eGFR should be checked before starting and monitored annually or more frequently if CKD is present [1].

Diabetic ketoacidosis risk. SGLT2 inhibitors carry an FDA boxed warning for euglycemic diabetic ketoacidosis (DKA). Patients should hold empagliflozin 3 days before elective surgery, major procedures, or extended fasting. Hawaii patients traveling for outpatient procedures should plan their medication timing accordingly.

Urinary tract and genital mycotic infections. Clinical trials show a 2- to 4-fold increase in genital mycotic infections, particularly in women. In EMPA-REG OUTCOME, genital infections occurred in 6.4% of empagliflozin-treated patients versus 1.8% placebo [3]. Patients should be counseled at the time of prescribing.

Volume depletion. In elderly Hawaii patients on diuretics, the osmotic diuresis from SGLT2 inhibition can add to volume depletion risk. Clinicians may need to reduce loop diuretic doses when starting empagliflozin in patients with heart failure.

EMPA-KIDNEY and Expanded Indications: Why More Patients May Need This Drug

The EMPA-KIDNEY trial (N=6,609 adults with CKD and eGFR 20 to <45 mL/min/1.73 m2 or eGFR 45 to <90 mL/min/1.73 m2 with urine albumin-to-creatinine ratio 200 mg/g or greater) demonstrated that empagliflozin 10 mg reduced the composite of kidney disease progression or cardiovascular death by 28% versus placebo (HR 0.72 to 95% CI 0.64, 0.82; P<0.001) [10]. The trial was stopped early at a median follow-up of 2.0 years because of overwhelming benefit.

This finding led to the FDA's approval of Jardiance for CKD in 2023, substantially expanding the eligible patient population. In Hawaii, where a higher proportion of the population has risk factors for CKD, including Native Hawaiian and Pacific Islander heritage with elevated rates of type 2 diabetes, the number of patients who could benefit from empagliflozin is considerable. Native Hawaiians experience type 2 diabetes at nearly twice the prevalence of non-Hispanic white adults in Hawaii, per state Department of Health data [11].

The expansion of indications increases the urgency of solving the cost problem for Hawaii patients. A drug that carries a Class I recommendation for CKD protection is not serving patients who cannot afford $680 per month.

Choosing the Lowest-Cost Path in Hawaii: A Decision Framework

The right cost strategy depends on your insurance status and clinical indication.

Step 1: Confirm your formulary tier. Call your insurer or check the online formulary. If Jardiance is Tier 3 or lower with a copay below $60, brand-name Jardiance with the BI/Lilly savings card may be your cheapest option, bringing total out-of-pocket cost close to $10/month.

Step 2: If you have Medicare Part D. The Inflation Reduction Act caps Medicare out-of-pocket drug spending at $2,000 per year starting in 2025. For high-cost drugs like Jardiance, Part D enrollees who previously faced catastrophic-phase costs will see lower annual exposure. Check whether your specific Part D plan covers empagliflozin and at what tier [12].

Step 3: If you are uninsured or on Med-QUEST. Apply for the Boehringer Ingelheim patient assistance program (Lilly Cares Foundation may also apply depending on your income). If you do not qualify, ask your HealthRX clinician whether compounded empagliflozin is clinically appropriate for your situation and whether a 503A pharmacy partner can serve your needs.

Step 4: If you choose compounded empagliflozin. Obtain a COA from the pharmacy, confirm the pharmacy's Hawaii non-resident permit if it is out of state, and schedule a follow-up eGFR check at 3 months. Dose, formulation, and excipients may differ from the brand tablet, so report any new symptoms promptly.

Step 5: Review annually. Drug pricing, formulary tiers, and compounding regulations change. Set a calendar reminder to review your cost strategy each January when plan formularies reset.

What Clinicians at HealthRX Check Before Prescribing Empagliflozin

A HealthRX telehealth visit for empagliflozin includes review of the following before a prescription is issued: serum creatinine and calculated eGFR (must be >20 mL/min/1.73 m2 for initiation), urine albumin-to-creatinine ratio, recent A1C (for type 2 diabetes indication), blood pressure, current diuretic use, and a history of recurrent urinary tract infections or genital infections. Patients with type 1 diabetes are not candidates for empagliflozin; the drug is not FDA-approved for that indication and carries an elevated DKA risk in that population.

The HealthRX team uses the 2024 ADA Standards of Care algorithm, which places SGLT2 inhibitors as preferred add-on therapy in patients with type 2 diabetes and established or high-risk cardiovascular disease, heart failure, or CKD, independent of baseline A1C level [6].

If your eGFR is between 20 and 44 mL/min/1.73 m2, empagliflozin can still be prescribed for cardiorenal protection based on EMPA-KIDNEY data, though glycemic efficacy is reduced. Your clinician will document this clinical rationale explicitly, which also strengthens any prior authorization or appeal letter to your insurer.