My nephrologist wants me to take Jardiance for CKD?

@mnsansei That must be so difficult knowing that you can get sick from a simple outing.
Thankfully I don't "catch" colds and such easily. It's the other stuff that gets me.
I had a gout attack while sleeping 2 months ago. Never had it before and I couldn't figure out what was going on. My toes and my thumbs hurt so bad and I couldn't move them. My toes was red and swollen and it finally hit me that it must be gout. It has left my left hand so weak that I can't even hold a fork. I had labs done 2 weeks later and they checked my Uric Acid and it was very high. I told my PCP nurse practitioner and she said that I must have irritated a nerve in my hand. That was it. My nephrologist wants another test and I have an appt. to go over everything.
Before I start any meds, I check them for all of the side effects. I started doing this after being put on Effexor in 1995. .When I would forget to refill and thus run out of it, I would have a terrible withdrawal after just 2 days. Upon research I found just how bad it can be to stop it. Almost all of my meds are bad for anyone with CKD which I do not understand. Fix one thing but break something else.
I am on Blue Cross Advantage but everything keeps going up. ER visits used to be $90 and now they are $150+. And with CHF they tell you to go to the ER if you gain more than 2 lbs a week. Yeah sure.
It is crazy that we have to be such advocates for ourselves when these doctors are supposed to know what we can and can't take.

@tntwo99

I don't know how easily it is for you to choose which doctor you want to see and I am not a doctor. But--it sounds like your health is at least complicated as mine and my hematologist told me I need an MD to be my PCP. Just saying.

Also, I was sent to rheumatology after my first "likely gout" flare which in the HMO I use, is where decisions about gout are made. I had been sent to a Foot and Ankle Specialist after having an x-ray at Same Day Care which was said to be difficult to read. The F&A said the same thing about a new set of x-rays weeks later. A few days later I saw my nephrologist for my quarterly appt. He apparently saw the F&A's conclusion and had ordered a uric acid test. It was 9.2 so he started colchicine. The toe in question had been inflamed for months by then but eventually the pain went down. The swelling and redness stuck around for perhaps a year during which he had me tested for allergy to the uric acid lowering med, allopurinol. (People with East Asian heritage are more likely to be allergic. I have wondered if he was on top of that since his family is Taiwanese. You never know what experience your doctor brings to the table.) When that allergy test was negative, he started me on a low dose of allopurinol. Of course, a few months later, I developed an itchy spot on my hand which was never diagnosed but allopurinol was paused and re-started when he got back from a family vacation in Iceland. This time, no itchy spot. Eventually the dose was increased and uric acid fell to within the normal range. At the same time he put me on what we call the gout diet--no red meat (including beef, pork, game), no avocadoes, no almonds, and as we say, nothing fun to eat and sent me to rheumatology for more care.

I don't know if I got the bottom of the barrel in that dept or a typical rheumatologist but she wouldn't see me because I hadn't had a tophus (swollen joint filled with sodium urate) aspirated. A picture of the crystals is attached and while they are beautiful, they look like they'd do a fabulous job lacerating kidneys. My current PCP just referred me back to Rheumatology now that I've had another presumed gout flare (that was put out in just hours after a dose of colchicine I took when I thought another toe was in pain from gout.) The first rheumatologist left and I am hoping the second one will at least let me in the door. I'd like a referral to an informed dietician about the gout diet. The other one I saw probably googled it just before seeing me.

All this to say, knowing the little bit I know, I am glad that my "presumed gout" is getting attention.

BTW, my husband confirmed that the $2000 limit came into effect this year for Medicare Advantage plans. He topped out in January and has not paid a co-pay on meds since.

Do you use an insurance broker? Ours has been very helpful keeping us informed of changes like this. If you're in MN, I can ask ours if he'd take you on.

Dinner time. Back later.

@mnsansei thanks for sharing that. Actually, my experience is not as dramatic as yours. I've got a DO for primary care, plus a hematologist for MGUS and thrombocytopenia and a MD for my CKD. Best of luck to you!

No, the out-of-pocket maximum for Medicare Advantage plans can vary, but in 2025, the federal cap for in-network maximum out-of-pocket limits is $9,350, while the combined in- and out-of-network cap is $14,000. The $2,000 limit applies specifically to out-of-pocket spending for prescription drugs under Medicare Part D.
mutualofomaha.com panfoundation.org

Medicare Advantage Out-of-Pocket Limits
Annual Out-of-Pocket Maximum
In 2025, Medicare Advantage plans have a maximum out-of-pocket limit, but it is not capped at $2,000. Instead, the federal cap for in-network services is set at $9,350. For combined in- and out-of-network services, the cap can reach $14,000.

Medicare Part D Cap
The $2,000 limit applies specifically to out-of-pocket costs for prescription drugs under Medicare Part D. This cap includes all costs related to covered medications, such as deductibles, copayments, and coinsurance.

Summary of Limits
Plan Type Out-of-Pocket Limit (2025)
Medicare Advantage Up to $9,350 (in-network)
Combined (in- and out-of-network) Up to $14,000
Medicare Part D $2,000 for prescription drugs

WOW! Wow! I think I have reached the bottom of that barrel too. I am in TN. My nephrologist is formerly a Mayo doc but said he had to get his family out of the MN winters. I'm lucky to have him.
I do have an MD, but had to see his NP as getting an appt with him would have put me in January. I have reported her twice to him and the office manager.
My Uric Acid was 8.8 at last lab test. I asked my nephologists office what I should do about it and was told they don't handle that???? Then I got a call back that my doc wanted an appt to go over the labs. I swear incompetency is running rampant.

@bandritsch

I take Jardiance for CKD for about 2 years. My primary prescribed it but my nephrologist is happy that I am taking it. Cost was an issue this year as first month cost the Part D deductible. Monthly went up also. But checked now during Medicare enrollment period going on now. The first month still costs Part D deductible but monthly will be half of current monthly.
Haven't experienced any issues. Good for reducing sugar and cardiovascular protection. Recheck cost now during the enrollment period.

@steveutnv It sounds like you're in good hands. My understanding is that a DO's education is equivalent to an MD's but the philosophy behind the training is different. DO's and MD's can train side by side during their residencies.

I have used the same HMO since I started working in 1978. It's grown by leaps and bounds from a couple of clinics and one hospital to a clinic each of the major communities in the Twin Cities plus Hudson, WI. I can think of at least five hospitals they operate. Groundbreaking for another took place this summer--the one it replaces is slated become a center for women's health and includes a birth center. I am hoping that the expansion means that they have many satisfied patients. I've only encountered a couple of duds (like the rheumatologist I mentioned.) But her performance is more than matched by the Ob/Gyn that saved my life and the pediatrician that save our son's.

Hello, my nephrologist wanted me to take jardiance for my CKD which is 3b and egfr is 38 and I am currently on Farziga. I am also diabetic which for the most part is controlled. I am still working so my medication cost isn’t tough on the family now. Reading some of these comments is basically preparing me for what is in store when I get older. Thank you all and I pray you all are always in good spirits no matter what the situation.

I'm on a Medicare Part D plan. To this point I've been taking only generic drugs, but now the Nephrologist has prescribed a tier 1 drug, which means I have to pay my annual deductible (about $550) before the plan pays for the drug - total about $850. I'm investigating a similar drug from Canada that would be $90/month with no deductible payment. Unfortunately the tariffs make it more complicated as well. Getting old a a LOT of fun!

@natelew Does your nephrologist want you to take both Jardiance and Farziga? Just curious because my Mayo nephrologist recommended Farziga but changed the order when insurance would only cover Jardiance. He said they had the same properties which include reducing urine protein. I see ads for both meds pitched on TV to get the attention of diabetic patients. I am not diabetic but I have terrible proteinuria.

@tntwo99

I was confused. I thought we were only looking at the cost of medications, not of all contact with the medical world. Yes, I only pay a maximum of $2K for meds per year. I do have to pay $35 for an appt with a specialist but no co-pay to see my PCP.

I see two specialists four times a year, three more once a year (most years) and the occasional specialist a couple times a year which would be under $500 a year.

I had had bilateral total hip replacement last year with complications that turned my outpatient surgeries (!) into inpatient. (I passed out the first time the nurse got me out of bed. You should have seen the crowd in my room when I came to about two minutes later. I had triggered the emergency response team.) My total cost for the two surgeries was about $1000. I can't easily find the bills, just the payments, but suspect it was a bargain. My husband's triple bypass heart surgery three years ago (for a congenital defect) with a four day hospitalization was about the same. We were shocked, pleasantly surprised, (and had been prepared to pay much more.) I think it cost me more to put our son up in a nearby hotel (because I had covid for 22 days around this time) and taxi transportation from the airport (45 min away) because no family member was isolating from covid. There is no public transportation to our small town/now suburb which is 7 min from where my husband worked.

We have BCBS of MN Medicare Advantage Choice Plans, mid-range plans. We have also benefitted from the large in-network list which includes Mayo in Rochester as well as access to clinics in Duluth and Hudson, WI (the closest clinic to our home.) My husband chose an in network eye surgeon outside the HMO we usually use who is part of a small eye doctor only group. His cataract surgery was at least 5 years after mine and was only minimally more expensive but surprisingly inexpensive.