Does Oscar Health Cover Jardiance?
The verdict
Covered on most plans
Oscar Health covers Jardiance for type 2 diabetes on its commercial and ACA plans. National MMIT data shows Jardiance is covered on 99.7% of commercial plans and 99.9% of ACA plans. Oscar does not publicly publish drug-level formulary tiers for its state-specific plans, so your exact cost-share must be verified via Oscar's drug lookup. A metformin-first step therapy is likely on some plans given the national commercial pattern (38.9%). Oscar's Medicare and Medicaid footprint is limited.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Oscar Health using your member ID.
Medicare vs. commercial coverage
Whether Oscar Health covers Jardiance 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
Oscar Health has a limited Medicare Part D presence. Where Oscar Medicare plans exist, Jardiance is covered under the Part D benefit. The 2026 IRA Maximum Fair Price for Jardiance is $197/30-day supply, effective 1/1/2026. The $2,100 Part D out-of-pocket cap applies. National Medicare UM for Jardiance is near-zero (MMIT: 0% PA, 0.1% step, as of Aug 8, 2025). If you have an Oscar Medicare Advantage plan, verify Jardiance coverage and cost-share on your plan's Evidence of Coverage.
Commercial / Employer
Group & marketplace plans
Covered on Oscar's commercial/small group and ACA/Individual plans (Oscar's core market). National MMIT data shows Jardiance is covered on 99.7% of commercial plans and 99.9% of ACA plans. Oscar does not publish drug-level tier data publicly for its state-specific plans — your specific copay and formulary tier are only accessible via the Oscar member app or drug lookup tool. A metformin-first step is likely on some Oscar commercial and ACA plans consistent with the 38.9% national commercial and 27.7% ACA step-therapy rates (MMIT, as of Aug 8, 2025). Oscar's Medicaid and Medicaid managed-care presence is limited; where applicable, nominal cost-share and a step may apply.
The 1 boxes you must tick to get approved
Commercial plans that will consider Jardiance 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 1 and you have a documented case for approval. Missing any one is the most common reason requests are denied.
Your cost, three ways
What Jardiance actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
~$600+ retail (pharmacy-variable estimate, brand Jardiance, no generic available)
List price with no coverage — before any manufacturer savings card.
With coverage
Oscar plan-specific cost-share not publicly published at the drug level; verify via the Oscar member app or drug lookup
Typical monthly copay once prior authorization is approved.
Bridge program
Boehringer Ingelheim savings card ~$10/month for commercially insured (not Medicare/Medicaid); check acceptance at your preferred pharmacy
Reduced copay through the assistance program, where eligible.
All cost figures are estimates; Oscar does not publicly post drug-level tiers. Confirm your exact copay through the Oscar app's drug lookup or by calling Oscar Member Services. For Medicare enrollees, the $197 MFP and $2,100 OOP cap apply in 2026.
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
Use the Oscar app or website drug lookup
Log in to the Oscar Health member portal (hioscar.com) or the Oscar app. Navigate to Pharmacy or Drug Coverage and search for Jardiance (empagliflozin). Oscar's drug lookup is the most reliable source for your plan-specific tier and estimated copay, since Oscar does not publish these at the drug level outside the member portal.
- 2
Ask your doctor to document metformin history proactively
Given the national commercial step-therapy rate for SGLT2 inhibitors, a metformin-first step is possible on your Oscar plan. Ask your prescribing physician to document any prior metformin use (or a clinical reason it cannot be used) before submitting the Jardiance prescription. This can prevent delays if Oscar's plan does apply a step.
- 3
Call Oscar Member Services for step-therapy and PA specifics
Call the Member Services number on your Oscar ID card and ask: Is Jardiance covered on my plan? Is there a step-therapy or PA requirement? What is my copay? Oscar's concierge-style member service can often clarify formulary details not available in the app.
Options if Oscar Health won't cover Jardiance
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Metformin (generic)
First-line T2D generic, near-universally Tier 1 at ~$4/month. A metformin trial may be required before Oscar approves Jardiance on some commercial and ACA plans.
Farxiga (dapagliflozin) or generic dapagliflozin
Another SGLT2 in the same class; generic dapagliflozin is now available and may be lower cost. Farxiga carries even higher national commercial step therapy (MMIT: 45.8%) and a $178.50 2026 MFP. Oscar's tier for Farxiga is also not publicly published — verify on the Oscar drug lookup.
Januvia (sitagliptin) or generic sitagliptin
DPP-4 inhibitor alternative for T2D. Generic sitagliptin launched May 2026, significantly reducing cash cost. Different mechanism than SGLT2; discuss with your physician.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
No — Oscar Health does not publish drug-level formulary tiers publicly for its state-specific commercial and ACA plans. Your specific copay for Jardiance (empagliflozin) is only accessible via the Oscar member app's drug lookup or by calling Oscar Member Services. This is a known feature of Oscar's plan design; coverage itself is not in doubt, but the specific cost must be verified per your plan.
A metformin-first step is likely on some Oscar commercial and ACA plans, consistent with the 38.9% national commercial step-therapy rate for Jardiance (MMIT, as of Aug 8, 2025). Oscar's specific step-therapy criteria are not publicly confirmed at the drug level. Ask your physician to document metformin history proactively, and verify whether a step applies on your plan via the Oscar drug lookup.
Anthem publishes CarelonRx formulary details, including tier placement and step-therapy requirements, on its member portal. Oscar does not publish drug-level tier data publicly for its state-specific plans, making this a 'verify your plan' page rather than one where specific tiers can be stated. Both likely apply metformin-first step therapy on commercial plans at roughly similar rates nationally.
Jardiance has FDA approval for type 2 diabetes, heart failure with reduced ejection fraction, and chronic kidney disease. Oscar generally covers FDA-approved on-label indications. Have your prescribing physician note the specific approved indication on the prescription. Because Oscar does not publish drug-level formulary details publicly, verify coverage for each indication via the Oscar member portal or Member Services.
The 2026 IRA Maximum Fair Price for Jardiance is $197/30-day supply, effective January 1, 2026. Oscar's Medicare presence is limited, but where Oscar Medicare plans exist, they must honor this MFP as Part D sponsors. The $2,100 annual out-of-pocket cap also applies. For Oscar commercial and ACA plans, the MFP does not directly apply — your cost-share is per your plan's tier structure.
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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 Oscar Health before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation.