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If you’ve been told you should be on a blood sugar medication called an SGLT2 inhibitor for type 2 diabetes, heart failure, or chronic kidney disease, you’re not alone. Empagliflozin (Jardiance) and dapagliflozin (Farxiga) started as type 2 diabetes medications, but their real 2026 story is bigger: both are now cornerstone drugs in heart failure and chronic kidney disease (CKD) care, often with or without diabetes, depending on the indication.
And yet, in 2026, the decision many patients face still comes down to a deceptively simple question: Are you choosing the best fit for your physical health or economic health?
New U.S. Medicare negotiated prices and Canada’s expanding generic landscape have changed the cost side of this decision in a way that didn’t exist a few years ago. Read on to compare how these medications affect your health and your wallet.
What Is an SGLT2 Inhibitor and What Does It Do?
Gliflozins, also known as SGLT2 inhibitors, are a class of prescription medications that treat type 2 diabetes and are also used in many people to help with heart failure and chronic kidney disease. They work in your kidneys by blocking a protein called SGLT2, which normally helps your body reabsorb glucose back into your bloodstream. When SGLT2 is blocked, more glucose leaves your body in your urine, which lowers blood sugar and can also increase the amount of fluid and salt your kidneys pass.
Common SGLT2 inhibitors include:
• Empagliflozin (Jardiance)
• Dapagliflozin (Farxiga)
• Canagliflozin (Invokana)
• Ertugliflozin (Steglatro)
Benefits can include lower blood sugar and modest weight loss, and these medications may also help protect your heart and kidneys in appropriate patients.
For more information on SGLT2 inhibitors, see here.
Jardiance vs. Farxiga: They’re Similar, But Your Choice Is Personal
Empagliflozin and dapagliflozin are both SGLT2 inhibitors, but research suggests their use may differ slightly.
In broad strokes:
• Heart-risk history patients often hear more about empagliflozin (Jardiance) because its landmark outcomes trial showed a striking reduction in cardiovascular death in people with type 2 diabetes and established cardiovascular disease.
• Kidney-first framing often highlights dapagliflozin (Farxiga) because a major kidney-outcomes trial that included patients with and without diabetes showed strong cardiovascular disease protection.
That said, both drugs now have substantial evidence and Food and Drug Administration (FDA)-labelled uses in heart failure and cardiovascular disease, so your doctor may decide on either depending on your individual circumstances.
Side Effects and Safety: Similar Class, Similar Warnings
Because empagliflozin and dapagliflozin are in the same class, their key safety issues overlap.
Side effects of these medications may include:
• More urination
• Dizziness
• Vaginal yeast infections
The most serious risk is the possibility of having low blood sugar. Excessively low blood sugar can be life-threatening. For this reason, you should ensure your blood sugar is monitored as per your doctor’s instructions.
According to the Cleveland Clinic, other risks include:
• Urinary tract infections: Excess sugar in your urine can create an environment for bacteria to grow.
• Dehydration: The medication has a diuretic effect. As noted above, this can make you pee more, possibly leading to dehydration.
• Diabetes-related ketoacidosis: Ketone levels can build up in your blood when your body breaks down fat (instead of sugar) for energy. If ketone levels get too high, it can cause ketoacidosis, which is a medical emergency. Tests can monitor for this side effect.
• Low blood pressure: Urinating more often could lead to low blood pressure.
Talk to your doctor for a complete list of side effects and risks.
The Costs in 2026: Medicare Negotiation vs. Canadian Generics
This is where the landscape around SGLT2 inhibitors has truly changed in 2026, and it’s good news for your wallet.
The U.S. Medicare Shift (2026)
The Centers for Medicare and Medicaid Services (CMS) negotiated maximum fair prices (MFPs) for the first set of drugs under the Medicare Drug Price Negotiation Program. These became effective January 1, 2026. The CMS fact sheet table shows the following prices:
• Dapagliflozin (Farxiga): $178.50 USD for a 30-day supply
• Empagliflozin (Jardiance): $197.00 USD for a 30-day supply
For many Medicare beneficiaries, those numbers represent a significant reduction when compared to prior list prices.
However, Medicare-negotiated pricing doesn’t automatically solve out-of-pocket costs for everyone, because real patient costs depend on health insurance plan design, coverage phase, deductibles, and other medication spending.
The Canadian Generic Savings (Especially for Dapagliflozin)
When you look north of the border, cost is a major differentiator—particularly for dapagliflozin. Health Canada has approved a generic dapagliflozin product, and it is currently on the market.
• Dapagliflozin (the generic version of Farxiga) costs around $116- $ 172 USD for a 100-day supply (depending on dosage) in Canada. This works out to around $35- $52 USD for a 30-day supply.
These significant savings are important to consider when selecting an SGLT2 inhibitor.
Other generics for SGLT2 inhibitors are currently under review in Canada.
(Pricing varies by pharmacy, dispensing fees, and exchange rates. Figures are an estimate, not a guarantee.)
What This Means When You Look at Your Wallet
Even with Medicare’s negotiated prices, if you’re paying cash—or navigating coverage gaps—you may still find that a Canadian generic option can be meaningfully less expensive.
Is Empagliflozin or Dapagliflozin Better in 2026?
All SGLT2 inhibitors may initially look the same. However, if your doctor is choosing within-class based on your particular situation, the conversation might look like this:
• If you have type 2 diabetes and cardiovascular disease, Empagliflozin (Jardiance) may be favored because of the New England Journal of Medicine article’s headline result around mortality. It showed that patients with type 2 diabetes at high risk for cardiovascular events who received empagliflozin had a lower rate of some cardiovascular complications and death from any cause.
• If CKD protection is the main priority: Farxiga (dapagliflozin) is backed by this major study, which showed a reduced risk of sustained estimated glomerular filtration rate (eGFR) decline, end-stage kidney disease, or renal or cardiovascular death in people with chronic kidney disease, including those without diabetes. Jardiance (empagliflozin) has similarly strong kidney outcomes support from this study, which found a reduced risk of kidney disease progression or cardiovascular death in a broad CKD population, also including many without diabetes. Your health specifics may lead a doctor toward one medication or the other.
• If heart failure is the main priority: Both medications have strong research behind them for heart failure, including people with different ejection fractions (EF) levels. Major heart failure guidelines now list SGLT2 inhibitors as a core part of standard treatment.
With Medicare and Medicaid Services’ negotiated maximum fair prices, the price gap between these brands is smaller than it used to be—but generic dapagliflozin in Canada is a different matter for some people.
The Tie-Breaker Questions to Ask Your Doctor
Everyone wants to choose the best medication for their health. If you’re looking at choosing an SGLT2 inhibitor, these are the questions that turn a confusing comparison into a personalized plan:
1. “Given my latest eGFR and urine albumin results, which SGLT2 inhibitor fits my kidney status best—and what labs should we monitor?”
2. “Do my heart risks point more toward the evidence base behind empagliflozin, or is dapagliflozin just as appropriate for me?”
3. “Do any of the other medications I take affect the SGLT2 inhibitor choice?”
4. “Is there anything else I should take into consideration when selecting a medication in my case?”
These four questions should give you the answers you need to assess what will help your health the most.
Doctors understand that cost can be an important factor, so you may also wish to ask: “If cost is a barrier, can we switch safely within the class?
What should I watch for during the transition?”
That question can help you decide whether switching is worth it and alert you to the issues that may arise if you choose to do so.
Don’t hesitate to ask your doctor any additional clarifying questions. Remember, they work for you and are there to help you.
The Bottom Line: Protect Your Health Without Overpaying
Jardiance and Farxiga are more alike than different, and for many people, either one can be a strong option for type 2 diabetes, heart failure, or kidney protection. The best choice usually comes down to your personal health details (like your heart history, eGFR, and other medications) plus what you can realistically afford long-term. The good news in 2026 is that you don’t necessarily have to choose between taking care of your body and taking care of your budget.
Before you fill a prescription, bring the tie-breaker questions to your next appointment and be honest about cost concerns. If you and your doctor decide an SGLT2 inhibitor is right for you, the right plan is the one you can safely stick with, because consistent treatment is what delivers the real heart and kidney benefits over time.
Sources
1. Centers for Medicare & Medicaid Services. (2024). Medicare Drug Price Negotiation Program: Negotiated Prices for initial price applicability year 2026. In Centers for Medicare & Medicaid Services. Retrieved March 4, 2026, from https://www.cms.gov/files/document/fact-sheet-negotiated-prices-initial-price-applicability-year-2026.pdf
2. Cleveland Clinic. (2025, July 31). SGLT2 inhibitors. Retrieved March 4, 2026, from https://my.clevelandclinic.org/health/treatments/sglt2-inhibitors
3. Heerspink, H. J., Stefánsson, B. V., Correa-Rotter, R. et al. (2020). Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 383(15), 1436–1446. https://doi.org/10.1056/nejmoa2024816
4. Heidenreich, P. A., Bozkurt, B., Aguilar, D. et al. (2022). 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18), e895–e1032. https://doi.org/10.1161/cir.0000000000001063
5. The EMPA-KIDNEY Collaborative Group. (2022). Empagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine, 388(2), 117–127. https://doi.org/10.1056/nejmoa2204233
6. Zinman, B., Wanner, C., Lachin, J. M. et al. (2015). Empagliflozin, cardiovascular outcomes, and mortality in Type 2 diabetes. New England Journal of Medicine, 373(22), 2117–2128. https://doi.org/10.1056/nejmoa1504720
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