Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION: My insurance doesn’t cover my Invokana prescription in 2025. What should I do?

ANSWER: Each year as you evaluate insurance products, one of the primary factors you need to consider is the prescription drug coverage as insurance companies adjust their formularies each year. You should never assume that the drug coverage is going to be the same.

Insurance companies of all types adjust the formularies to reflect the new years business model for them. Medications can be removed from the formulary or they can change within the formulary regarding the rules that apply to them. An insurance company can change:

  • The tier the medication is covered on
  • The prior authorizations required to fill it
  • The quantity limits applied to it
  • Or the Step Therapy rules for the medication

Let’s delve a little deeper into each of these.

An insurance company can remove the medication entirely from the formulary. This is what happened in the case of your Invokana. Each year, we see medications do this. In 2024 we had difficulties with some types of insulins, inhalers and also a relatively inexpensive generic, called celecoxib. In 2025 one of the medications we are having a hard time finding coverage for is Invokana. I can’t explain why a particular medication falls out of favor with the insurance companies, but we can address what to do about it.

In this situation you really have four options.

  1. Talk to your physician who prescribed this medication and see if there are alternative medications that would be appropriate | I recommend getting a copy of the 2025 formulary from your insurance company to take with you, so you and physician don’t have to try this multiple times with alternate medications. If you have the formulary book, your physician can look through it and decide if there is an appropriate alternative medication.
  2. Consider switching your insurance to an insurance product that covers that medication | Although I will say in 2025, Invokana is difficult to find any insurance companies that cover Invokana, there just are not many companies covering the medication.
  3. Work with your physician after 1-1-25 to appeal to the insurance company to cover this particular medication for you | Maybe you and your physician have already worked through the alternatives in the past, and this is the one that works for you. Your insurance company doesn’t know that and maybe by your physician documenting the medication history, they would make an exception and cover for the medication for this year. It is important to understand that if the insurance company makes this exception for you, the medication may very likely move to a higher tier than it was in the past, and your copay may be significantly more when you fill it.
  4. Look into alternative ways to fill that medication | One common way I would suggest is something like GoodRx. This is not insurance, so it doesn’t replace your part D coverage, but you would fill this one medication using this type of alternative coverage.Each pharmacy has its own particular product they offer like GoodRx, so talk to the pharmacists about the alternatives used at their pharmacy. Another common alternative is Cost Plus Drugs. This is a mail order pharmacy which does not use your insurance to cover your medications, but often sells medications for cash, for much less than local pharmacies using your insurance.

    In 2024, we often recommended Cost Plus Drugs to purchase Celecoxib. It is mail order, so you will have to create an account with this company, usually done online, and then your physician notifies Cost Plus Drugs pharmacy of the medication you will fill there. You then order the medication, and usually pay for it with a credit or debit card. Then the medications are mailed to you.

    Today when I checked the price of Invokana on Cost Plus Drugs, a bottle of 90 tables 100mg strength was $727.76. Now that would be a 90 day supply, and you are NOT using your Part D plan, so this spending would never count towards your maximum $2000 spending at the pharmacy with your Part D plan. So there is definitely a downside to using this pharmacy. But it would be a way to get your Invokana, even if you can’t find insurance coverage for it.

I hope this gives you some ideas of how to handle this situation of your insurance no longer covering your Invokana. I know this is frustrating, but I am glad you are looking into now, so you have time to fix the problem before you are out of medication.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

 

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

 

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