Does Humana Cover Farxiga?
The verdict
Covered on most plans
Yes — Humana covers Farxiga for type 2 diabetes, heart failure, and CKD across Medicare Part D and its other lines of business, typically as a preferred brand. Medicare prior authorization is essentially nil: nationally only 0.2% of Medicare plans require PA and 0.3% require step therapy for Farxiga (MMIT, as of Sept 11, 2025). As a Part D sponsor, Humana must apply the IRA negotiated Maximum Fair Price of $178.50 per 30-day supply, effective January 1, 2026. Generic dapagliflozin is also available and may offer a lower cost-share than the brand tier.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Humana using your member ID.
Key facts
Farxiga coverage on Medicare Part D is near-universal at 95.1% nationally; only 0.2% of Medicare plans require prior authorization, making it one of the lowest-UM SGLT2 inhibitors on Medicare (MMIT, as of Sept 11, 2025).
MMIT via GoodRx (as of Sept 11, 2025)
The 2026 IRA Maximum Fair Price for Farxiga is $178.50 per 30-day supply — a 68% reduction from the prior list price of approximately $556; all Humana Part D plans must apply this price.
CMS Medicare Drug Price Negotiation Program, 2026 MFP
Generic dapagliflozin (Farxiga's generic) is now available, offering a lower-cost option than the brand tier. AstraZeneca reports an average Medicare Part D out-of-pocket of approximately $38.82 per month for Farxiga (manufacturer-reported, not guaranteed).
AstraZeneca patient support; FDA drug approvals
Medicare vs. commercial coverage
Whether Humana covers Farxiga depends heavily on which kind of plan you hold. They follow completely different rules — here's each one, side by side.
Medicare
Part D & Advantage plans
Farxiga is covered on Humana's 2026 Medicare Part D plans, typically as a preferred brand. Prior authorization and step therapy on Medicare are near-zero for Farxiga: nationally 0.2% of Medicare Part D plans require PA and 0.3% require step therapy (MMIT, as of Sept 11, 2025). As a Part D sponsor, Humana must apply the IRA negotiated Maximum Fair Price of $178.50 per 30-day supply effective January 1, 2026 — a 68% reduction from the prior list price of approximately $556. AstraZeneca reports an average Medicare Part D out-of-pocket cost of approximately $38.82 per month for Farxiga; this is a manufacturer-reported average and not a guarantee for your specific plan. Humana's Part D plans carry a $2,100 annual out-of-pocket cap in 2026, limiting total exposure. Using CenterWell, Humana's preferred mail-order pharmacy, typically results in lower cost-sharing. Note: the coinsurance-shift caveat applies — the MFP is a payer-side ceiling, and your actual cost depends on whether your plan uses a fixed copay or a percentage (coinsurance). LIS/Extra Help enrollees pay $0–$12.65 per month. Medicare beneficiaries cannot use the AstraZeneca commercial copay card.
Commercial / Employer
Group & marketplace plans
Humana's commercial and ACA footprints are limited relative to its Medicare Part D operations. Where Humana commercial or ACA plans are offered, Farxiga is covered for its on-label indications — nationally 92.1% commercial and 96.6% ACA coverage (MMIT, Sept 11, 2025). Commercial step therapy is the critical nuance: nationally 45.8% of commercial plans require a metformin-first step for Farxiga and 17.1% require prior authorization (MMIT, Sept 11, 2025), the highest step-therapy rate in this drug class. If a Humana commercial plan requires step therapy, your prescriber should document prior metformin use at the maximum tolerated dose or a clinical contraindication (for example, renal impairment). Humana Medicaid MCOs cover Farxiga with nominal cost-share ($0–$10 typical); prior authorization and metformin-first step therapy are common in Medicaid (nationally 30.6% PA, 25.4% step — MMIT, Sept 11, 2025). Verify your state's Preferred Drug List. Generic dapagliflozin is available and may appear on a lower formulary tier, offering a cost savings worth discussing with your prescriber.
The 3 boxes you must tick to get approved
Commercial plans that will consider Farxiga require prior authorization. Check off what applies to you to see how close you are — this is a guide, not a guarantee of approval.
Meet all 3 and you have a documented case for approval. Missing any one is the most common reason requests are denied.
Your cost, three ways
What Farxiga actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
Approximately $400–$600 or more per 30-day supply at retail pharmacy for brand Farxiga (pharmacy-variable estimate). Generic dapagliflozin is available at substantially lower cash prices.
List price with no coverage — before any manufacturer savings card.
With coverage
Medicare Part D (Humana): preferred brand tier; IRA Maximum Fair Price $178.50 per 30-day supply effective January 1, 2026; AstraZeneca reports an average Part D out-of-pocket of approximately $38.82 per month (manufacturer-reported, not guaranteed); $2,100 annual out-of-pocket cap; LIS/Extra Help $0–$12.65 per month. Medicaid: $0–$10 typical. Commercial: AstraZeneca average commercial copay approximately $26 per fill (manufacturer-reported, commercially insured only). All figures are estimates — verify with your specific Humana plan.
Typical monthly copay once prior authorization is approved.
All dollar figures are estimates. Your actual cost depends on your Humana plan's tier structure, deductible status, and benefit phase. The AstraZeneca $38.82 and $26 figures are manufacturer-reported averages and are not guaranteed for any specific plan. The MFP is a payer-side ceiling — your copay depends on whether your plan uses a fixed copay or coinsurance. Medicare beneficiaries cannot use the AstraZeneca commercial copay card. Ask your prescriber about generic dapagliflozin, which may offer lower cost-share. Confirm your cost-share on the Humana formulary or at CenterWell.
Check YOUR exact coverage in 3 steps
General answers only get you so far. Here's how to confirm your own plan's decision in a few minutes.
- 1
Look up Farxiga on the Humana plan formulary tool
Visit Humana.com and use the drug pricing or formulary search for your 2026 plan. Search for Farxiga or dapagliflozin to confirm the tier, any prior authorization or step-therapy requirement, and your estimated cost-share. Also check whether generic dapagliflozin is listed on a lower tier. Confirm whether your plan uses a fixed copay or coinsurance for the preferred brand tier, since the coinsurance structure affects your per-fill cost even under the negotiated MFP.
- 2
Ask your prescriber to document metformin history if on commercial or Medicaid
If you are on a Humana commercial or Medicaid plan, a metformin-first step-therapy requirement is common for Farxiga. Ask your prescriber to document prior metformin use (dose, duration, and reason for discontinuation or contraindication such as renal impairment) with the prescription. This documentation is the standard evidence needed to satisfy the step-therapy requirement and should resolve most requests without a lengthy appeals process.
- 3
Use CenterWell or call Humana member services to confirm your cost
CenterWell is Humana's preferred mail-order pharmacy and typically offers the lowest cost-sharing tier for Part D enrollees. Call the number on the back of your Humana ID card and ask: (1) Which tier is Farxiga or generic dapagliflozin on my plan? (2) Is prior authorization or step therapy required? (3) Has my deductible been met? Have your plan ID and drug dosage ready.
Options if Humana won't cover Farxiga
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Generic dapagliflozin
Generic dapagliflozin is already available and may sit on a lower formulary tier than brand Farxiga on Humana plans, reducing your cost-share. Discuss with your prescriber whether switching to the generic is appropriate for your indication (T2D, heart failure, or CKD).
Jardiance (empagliflozin)
Another SGLT2 inhibitor for T2D, heart failure, and CKD. No generic is currently available, but the 2026 IRA negotiated price is $197 per 30-day supply. Boehringer Ingelheim reports that approximately 84% of Medicare Part D patients pay $0–$50 per month (manufacturer-reported average). Discuss with your prescriber whether empagliflozin or dapagliflozin better fits your clinical needs.
Metformin (generic)
First-line oral diabetes medication; Tier 1 at approximately $4 per month cash price. If step therapy requires metformin first, your prescriber will document this before approving Farxiga. Metformin is covered on all Humana formularies at very low cost-share.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
Yes — Humana covers Farxiga for type 2 diabetes, heart failure, and CKD on its 2026 Medicare Part D plans, typically as a preferred brand with essentially no prior authorization (nationally 0.2% of Medicare plans require PA — MMIT, Sept 11, 2025). On Humana commercial and Medicaid plans, a metformin-first step therapy is common. The 2026 IRA negotiated Maximum Fair Price is $178.50 per 30-day supply. Generic dapagliflozin is also available.
CMS negotiated a Farxiga Maximum Fair Price of $178.50 per 30-day supply, effective January 1, 2026 — a 68% reduction from the prior list price of approximately $556. All Humana Part D plans must apply this price. However, the MFP is a payer-side ceiling: your actual copay depends on your plan's tier structure and whether Humana uses a fixed copay or coinsurance. The $2,100 annual Part D out-of-pocket cap limits your worst-case exposure for 2026.
On Humana Medicare Part D, a metformin-first step therapy is not expected — nationally only 0.3% of Medicare plans require step therapy for Farxiga (MMIT, Sept 11, 2025). On Humana commercial or Medicaid plans, metformin-first step therapy is common (45.8% of commercial plans and 25.4% of Medicaid plans nationally require step therapy for Farxiga — MMIT, Sept 11, 2025). Your prescriber can resolve this by documenting prior metformin use or a contraindication.
Generic dapagliflozin (the generic version of Farxiga) is now available and should appear on Humana formularies, potentially on a lower tier than the brand. Generics are typically placed on Tier 1 or Tier 2, which can significantly reduce your cost-share compared to the brand preferred tier. Confirm generic dapagliflozin's tier on your specific Humana plan using the online formulary tool or by calling member services.
Only if you have a Humana commercial plan — not Medicare or Medicaid. The AstraZeneca commercial savings card (approximately $26 average per fill, manufacturer-reported) is available for commercially insured patients not enrolled in any government health program. If you have Humana Medicare Part D, Medicare Advantage, or Humana Medicaid, you cannot use the savings card. LIS/Extra Help enrollees on Medicare may pay $0–$12.65 per month through the federal subsidy instead.
Related Articles
Does Aetna Cover Vyvanse? 2026 CVS Caremark Formulary
Aetna covers Vyvanse via CVS Caremark — generic lisdexamfetamine preferred, brand non-preferred. 70 mg/day QL per Policy 5.60.024; age-22 PA required.
Read moreDoes Aetna Cover Prolia? CVS Caremark Medical Benefit | Curex
Aetna covers Prolia under the medical benefit with PA — a q6-month clinic injection, not Part D. Jubbonti biosimilar now preferred on CVS Caremark.
Read moreDoes Anthem Cover Adderall? 2026 Coverage Guide | Curex
Anthem covers Adderall through CarelonRx — generic preferred, brand non-preferred. Step therapy may apply on some plans. Verify your Anthem plan.
Read moreDoes Anthem Cover Contrave? 2026 Brand Coverage Guide | Curex
Anthem covers Contrave only if your plan has a weight-loss benefit. Many plans carve it out. CurAccess ~$99/mo is often the fastest path.
Read moreDoes Aetna Cover Contrave? 2026 CVS Caremark Guide | Curex
Aetna (CVS Caremark) often excludes Contrave under AOM carve-outs. Where covered, CVS BMI prior auth applies. Medicare bars it by law. CurAccess ~$99/mo.
Read moreDoes Aetna Cover Forteo? 2026 Coverage Guide
Aetna (CVS) often excludes brand Forteo in favor of generic teriparatide or Bonsity. Teriparatide is covered with PA and bisphosphonate step therapy. 2026.
Read moreThis content is for informational purposes only and does not constitute medical, financial, or insurance advice. Coverage rules, prior-authorization criteria, and copay amounts change frequently and vary by plan, formulary tier, and effective date — always verify current benefits directly with Humana before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.