Does Medicare cover Farxiga in Oregon?

What Farxiga is used for

Farxiga is an SGLT2 inhibitor tablet. Its FDA label covers lowering blood sugar in type 2 diabetes, reducing the risk of hospitalization for heart failure in adults with type 2 diabetes and heart disease or risk factors, reducing the risk of cardiovascular death and hospitalization in adults with heart failure, and reducing the risk of kidney decline in adults with chronic kidney disease at risk of progression.

This page explains Medicare coverage only. Questions about whether Farxiga is right for you belong with your prescriber.

Which part of Medicare covers Farxiga

Farxiga is a once-daily pill, so it's a Part D drug, covered by a standalone Part D plan or by a Medicare Advantage plan that includes drug coverage. If you're in a Medicare Advantage plan without drug coverage, you generally can't add a standalone Part D plan, so the Advantage plan's own drug coverage is what counts.

Is Farxiga on Medicare's negotiated-price list?

CMS selected Farxiga in the first round of the Medicare Drug Price Negotiation Program. Its negotiated price (the "maximum fair price") took effect January 1, 2026, and Farxiga is still on CMS's selected list for 2027. A negotiated price is what Medicare drug plans and pharmacies pay; it isn't your copay. What you pay still depends on your plan's cost sharing.

Farxiga for kidney disease

Chronic kidney disease is one of Farxiga's FDA-approved uses, so a Part D plan can cover it for that reason alone. If you also have end-stage renal disease and get dialysis, Part B covers dialysis and certain dialysis-related drugs, but Farxiga, as a pill you take at home, stays under Part D. Bring your full medication list when you compare plans so kidney and heart drugs are checked together.

What you pay for Farxiga in 2027: the out-of-pocket cap

Your cost for Farxiga depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:

• 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
• The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
• Only covered drugs count. If your plan doesn't cover Farxiga and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.

Spreading the cost: the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?

Extra Help with Farxiga

Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have OHP (Medicaid), a Medicare Savings Program or SSI; otherwise apply through Social Security at 1-800-772-1213 or ssa.gov/extrahelp. See Extra Help in Oregon.

Getting Farxiga covered in Oregon

Oregon and Washington share Part D region 30, so standalone Part D plans are offered region-wide. For 2027, Oregon has 8 standalone Part D plans from 4 companies, plus Medicare Advantage plans with drug coverage in most counties (61 open to everyone statewide). Each plan has its own formulary, so one plan's coverage of Farxiga tells you nothing about another's.

Where you live in Oregon changes your choices. CMS data show no Medicare Advantage plan open to everyone in Grant, Harney, Lake, Umatilla or Union counties for 2027 (only employer group plans), and only a special needs plan in Curry County. If you live there, coverage for Farxiga usually comes from a standalone Part D plan alongside Original Medicare, unless you have employer or other drug coverage. Check your county's numbers on Oregon counties.

If you have both Medicare and OHP, OHP doesn't pay for drugs that Part D covers. The Oregon Health Authority calls this "OHP with Limited Drug": you need a Part D plan (or a Medicare Advantage plan with drug coverage) for Farxiga, and you qualify for Extra Help automatically. See OHP and Medicare.

How to check whether a plan covers Farxiga

1. Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Farxiga and not another.
2. Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Farxiga and any rules.
3. Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
4. Check your 2027 notice. Your plan's Annual Notice of Change says whether Farxiga stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
5. Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.

If your plan doesn't cover Farxiga, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Oregon?

Sources

• National Library of Medicine — DailyMed: Farxiga prescribing information (FDA label)
• Medicare.gov — Drug coverage (Part D)
• CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold and Extra Help copays)
• Medicare.gov — Medicare Prescription Payment Plan
• Social Security — Extra Help with Medicare prescription drug plan costs
• CMS — Part D plan files record layout (PDP Region 30: Oregon, Washington)
• Oregon Health Authority — OHP and Medicare

Frequently asked questions

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