Jardiance Cost in South Dakota 2026: Prices, Coverage, and Alternatives

What Does Jardiance Actually Cost at South Dakota Pharmacies?

The cash-pay list price for Jardiance is $680 per month at most South Dakota retail pharmacies in 2026, which matches the national Boehringer Ingelheim / Eli Lilly wholesale acquisition cost. Without insurance or a savings program, that figure does not change much from chain to chain. GoodRx coupons bring the price to roughly $580, $680 depending on the specific pharmacy and which coupon the counter accepts that day.

The FDA approved empagliflozin under the brand name Jardiance in August 2014, first for type 2 diabetes mellitus, and has since expanded the label to include heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, and chronic kidney disease [1]. Each of those approvals is backed by large cardiovascular outcomes or kidney outcomes trials, which is partly why payers treat the drug as a specialty-tier product and why the list price sits so high.

The EMPA-REG OUTCOME trial (N=7,020 patients with type 2 diabetes and established cardiovascular disease) demonstrated a 38% relative reduction in cardiovascular death versus placebo over a median of 3.1 years, and a 35% relative reduction in hospitalization for heart failure [2]. Results that definitive drive both prescriber demand and manufacturer pricing confidence.

The EMPEROR-Reduced trial (N=3,730) showed empagliflozin reduced the composite of cardiovascular death or hospitalization for heart failure by 25% (HR 0.75; 95% CI 0.65, 0.86; P<0.001) versus placebo in patients with heart failure with reduced ejection fraction [3]. The FDA cited that trial in its 2021 label expansion [1].

For CKD, the EMPA-KIDNEY trial (N=6,609) found empagliflozin reduced the risk of kidney disease progression or cardiovascular death by 28% versus placebo (HR 0.72; 95% CI 0.64, 0.82; P<0.001) [4]. These data explain why cardiology, nephrology, and endocrinology societies now recommend the drug across multiple patient types, adding to the population of South Dakotans who may be prescribed it [5].

Does South Dakota Medicaid Cover Jardiance?

South Dakota Medicaid does not cover Jardiance as of 2026. This is a hard exclusion: the drug does not appear on the South Dakota Medicaid preferred drug list for any of its FDA-approved indications, including type 2 diabetes, heart failure, or CKD.

South Dakota Medicaid covers roughly 130,000 enrollees, many of whom carry diagnoses where empagliflozin would be clinically appropriate [6]. The gap between clinical evidence and formulary access is substantial. Patients who receive Medicaid and are prescribed Jardiance by a physician have four realistic options: prior authorization appeal (rarely approved based on current PDL criteria), switching to a covered SGLT2 inhibitor if one is listed, using a manufacturer patient assistance program, or moving to a compounded formulation through a licensed 503A pharmacy.

The American Diabetes Association's 2024 Standards of Care in Diabetes state that "in patients with type 2 diabetes and established CVD, an SGLT2 inhibitor with demonstrated cardiovascular benefit is recommended" [7]. That guideline does not specify empagliflozin by name, meaning a covered SGLT2 inhibitor such as dapagliflozin (if listed on the South Dakota PDL) could satisfy the recommendation while preserving Medicaid payment.

Patients on South Dakota Medicaid who believe the exclusion causes medical harm may file a formulary exception. Supporting documentation from a prescriber citing the EMPA-REG OUTCOME or EMPA-KIDNEY data and explaining why a covered alternative is clinically inferior strengthens such appeals. Success rates for SGLT2 inhibitor exceptions on Medicaid PDLs nationally remain low, typically below 20% based on pharmacy benefit management audit data [8].

Is Compounded Empagliflozin Legal in South Dakota?

Compounded empagliflozin is available through licensed 503A compounding pharmacies operating in South Dakota, and the practice is currently legal under state and federal pharmacy law. A 503A pharmacy compounds for individual patients based on a valid prescription from a licensed prescriber. State Board of Pharmacy rules and the federal Food, Drug, and Cosmetic Act govern what those pharmacies can and cannot compound.

Empagliflozin is not on the FDA's list of drug products that may not be compounded under section 503A [9]. That means a 503A pharmacy with appropriate facilities and a valid prescription can legally prepare empagliflozin in a different strength, form, or without certain inactive ingredients. Oral capsule and oral suspension formulations of compounded empagliflozin appear most commonly in clinical practice. Cost varies by pharmacy and formulation, but some compounding programs affiliated with telehealth platforms have offered compounded empagliflozin at or near zero cash cost to the patient as part of a bundled care fee [10].

The legal distinction matters. A 503B outsourcing facility operates differently: it compounds in bulk without patient-specific prescriptions and must adhere to Current Good Manufacturing Practice (cGMP) standards. Most South Dakota patients access compounded empagliflozin through 503A pharmacies tied to telehealth prescribers rather than 503B facilities, which generally supply hospitals and clinics [11].

Patients should verify that the compounding pharmacy is licensed in South Dakota and that the prescriber has a valid South Dakota DEA registration (if applicable) and state license. The South Dakota Board of Pharmacy maintains a public licensee lookup at sdsos.gov. Quality assurance is a real concern: compounded products are not FDA-approved for potency, sterility, or stability in the same way that the manufactured tablet is [9].

Which Insurance Plans Cover Jardiance in South Dakota?

Coverage depends on the specific plan and formulary tier, not simply the insurer's name. Most commercial plans available on the South Dakota marketplace or through employers place Jardiance on Tier 3 (preferred brand) or Tier 4 (non-preferred brand), with monthly patient cost sharing of $50, $150 after deductible.

The Boehringer Ingelheim / Lilly savings card (the "Jardiance Savings Card") caps monthly out-of-pocket at $10 for eligible commercially insured patients. Eligibility requires that the patient have commercial insurance (not Medicare, Medicaid, or any federally funded program) and that Jardiance appears on their plan's formulary at any tier [12]. Patients pay $10 for up to a 30-day supply; the manufacturer pays the remainder of the copay up to a defined maximum per calendar year.

Medicare Part D plans in South Dakota vary considerably. Under the Inflation Reduction Act's 2025 changes to Part D, the maximum out-of-pocket cap for all covered drugs is $2,000 per year. Jardiance coverage under Part D depends on whether the specific plan includes it in its formulary. The CMS Medicare Plan Finder tool allows South Dakota residents to compare which Part D plans cover empagliflozin at the lowest tier before the annual enrollment window closes [13].

Employer-sponsored plans negotiated through large pharmacy benefit managers (PBMs) such as CVS Caremark, Express Scripts, or OptumRx sometimes cover Jardiance at a lower tier when the prescriber provides clinical documentation. The 2022 update to the American College of Cardiology / American Heart Association (ACC/AHA) Heart Failure Guidelines states that SGLT2 inhibitors "are recommended for patients with HFrEF to reduce HF hospitalizations and cardiovascular mortality" [14], and that language can serve as supporting documentation in a coverage appeal.

What Are the Cheapest Ways to Get Jardiance in South Dakota?

The lowest realistic cost pathways in South Dakota, ranked from least expensive to most expensive, work as follows.

Boehringer Ingelheim / Lilly patient assistance: The Lilly Cares Foundation and Boehringer Ingelheim Cares programs may provide Jardiance at no cost for uninsured or underinsured patients who meet income criteria (generally below 400% of the federal poverty level) [15]. Applications require proof of income and a valid prescription.

Compounded empagliflozin through a telehealth platform: Several telehealth companies charge a flat monthly membership fee and include compounded empagliflozin in the program, making effective drug cost $0 when viewed in isolation. The total cost of care (membership plus labs) varies by platform.

Manufacturer savings card for insured patients: The Jardiance Savings Card reduces copay to as low as $10/month for commercially insured patients [12].

GoodRx or similar coupon at retail: Prices range from $580, $680 depending on the pharmacy and coupon. Not meaningfully lower than the list price for most South Dakota pharmacies.

Mark Cuban's Cost Plus Drugs: As of mid-2025, empagliflozin does not appear on the Cost Plus Drugs formulary for the branded or generic version. The generic, if FDA-approved, could change this picture materially. No FDA-approved generic empagliflozin tablet exists in the US market as of the date of this article's review [1].

The HealthRX clinical team uses a four-step cost triage for South Dakota patients who are prescribed empagliflozin: (1) confirm insurance formulary tier and annual deductible exposure, (2) apply the manufacturer savings card if commercially insured, (3) evaluate patient assistance eligibility if uninsured, and (4) discuss compounded empagliflozin via a licensed 503A pharmacy as the fallback when all other pathways fail to reduce cost to under $100/month.

Can You Get a Jardiance Prescription via Telehealth in South Dakota?

Yes. South Dakota permits telehealth prescribing of non-controlled medications including empagliflozin. The prescriber must hold a valid South Dakota medical license, and the telehealth visit must meet standard-of-care requirements for history, physical assessment (which can include review of labs sent ahead of the visit), and documentation [16].

The South Dakota Telemedicine Act and subsequent Board of Medical Examiners rules align with the general post-pandemic consensus that synchronous video or telephone visits satisfy the prescriber-patient relationship requirement for non-controlled drugs. Empagliflozin is not a controlled substance, so the Ryan Haight Online Pharmacy Consumer Protection Act does not apply.

Practical requirements for a telehealth empagliflozin prescription in South Dakota: (a) an established or new patient relationship with a licensed SD provider, (b) recent labs including eGFR (empagliflozin is not recommended when eGFR is <20 mL/min/1.73 m2 based on the FDA label [1]), (c) review of contraindications including type 1 diabetes (where the drug lacks approval) and recurrent UTI or genital mycotic infections, and (d) a prescription sent to a South Dakota-licensed pharmacy or a verified mail-order pharmacy registered to ship into the state.

The CREDENCE trial (N=4,401) provided the nephrology rationale for careful eGFR screening before starting any SGLT2 inhibitor: patients with eGFR <30 were excluded, and meaningful kidney protection was seen in patients with eGFR as low as 30 mL/min/1.73 m2 at baseline [17]. Prescribers doing telehealth visits in South Dakota should review labs before prescribing, not after.

How the Boehringer Ingelheim / Lilly Savings Card Works in South Dakota

The Jardiance Savings Card is a copay assistance program run jointly by Boehringer Ingelheim and Eli Lilly for commercially insured US patients. It applies to all 50 states including South Dakota, with no state-specific restrictions beyond federal eligibility rules.

Eligible patients pay no more than $10 per 30-day supply. The card covers up to a manufacturer-defined annual maximum (typically $150 per fill, $1,800 per year in past program years, subject to annual update). Patients activate the card at jardiance.com or through their prescriber's office and present it at any retail pharmacy that accepts manufacturer copay cards, which includes most major chains in South Dakota: Walgreens, CVS, Hy-Vee, Walmart Pharmacy, and independently owned pharmacies that accept third-party cards.

Exclusions are firm. Medicare Part A, Part B, or Part D patients are ineligible, as are Medicaid patients, CHIP enrollees, and patients covered by any federal or state government health program [12]. South Dakota Medicaid patients are therefore ineligible for the savings card by statute. Veterans receiving care through the VA may access empagliflozin through VA formularies at a different cost structure; the VA added empagliflozin to its national formulary in 2022 following the EMPA-KIDNEY data [4].

The ADA's 2024 Standards of Care note that cost and access barriers remain "among the most significant obstacles to SGLT2 inhibitor use in patients who would benefit" [7]. The savings card does not resolve access for the highest-risk, lowest-income South Dakotans who rely on Medicaid.

Empagliflozin Dosing and Safety: What South Dakota Patients Need to Know

The FDA-approved starting dose for empagliflozin in type 2 diabetes is 10 mg once daily in the morning, with or without food. The dose may be increased to 25 mg once daily for additional glycemic control [1]. For heart failure indications, both the 10 mg dose used in EMPEROR-Reduced and the 10 mg dose used in EMPEROR-Preserved produced significant outcomes benefit; no titration to 25 mg was studied in those trials [3].

Renal dosing matters in South Dakota's patient population, which skews older and includes a significant proportion of patients with CKD given the state's demographics. The FDA label states that empagliflozin's glycemic efficacy is reduced when eGFR falls below 45 mL/min/1.73 m2, and use is not recommended for glycemic control at eGFR <45 [1]. For heart failure and CKD indications, the drug may be continued at lower eGFR thresholds (down to eGFR 20 for CKD per EMPA-KIDNEY results), but this requires clinical judgment and monitoring [4].

The main safety signals are genital mycotic infections (incidence roughly 6 to 10% in women, 2 to 4% in men in phase 3 data [1]), urinary tract infections, euglycemic diabetic ketoacidosis (rare, roughly 0.1% annually, but serious), and volume depletion especially in older patients or those on loop diuretics [18]. The FDA added a label warning for Fournier's gangrene following rare case reports across the SGLT2 inhibitor class [19].

Patients in South Dakota considering empagliflozin through any pathway, brand or compounded, should have a baseline eGFR and urine albumin-to-creatinine ratio checked before starting, consistent with ADA and ACC/AHA guidance [7] [14].

South Dakota-Specific Context: Why This Drug Matters in This State

South Dakota has an estimated adult diabetes prevalence of approximately 10.4% and a cardiovascular disease burden that tracks above some neighboring states, partly driven by rural access gaps and a significant American Indian population with elevated cardiometabolic risk [20]. The Indian Health Service (IHS), which serves tribal communities across South Dakota, maintains its own formulary separate from the state Medicaid PDL. As of the latest IHS national formulary update, empagliflozin coverage under IHS varies by service unit and requires prescriber documentation of clinical indication [21].

Rural pharmacies in South Dakota, particularly in counties west of the Missouri River, may not stock Jardiance regularly given low prescription volume. Patients in those areas may face 3, 5 business day waits for special orders or need to use mail-order pharmacies. Telehealth-linked mail-order programs partially solve this by shipping 90-day supplies directly from a licensed mail-order pharmacy to the patient's home, a model particularly relevant for the 35% of South Dakotans who live in rural or frontier designations [20].

A 90-day supply of Jardiance at list price runs approximately $2,040 before discounts. With the manufacturer savings card, the same 90-day supply costs $30 for a commercially insured patient. That $2,010 difference per quarter illustrates why card enrollment at the time of prescribing, not weeks later, produces the most meaningful savings [12].