Cheapest SGLT2 Inhibitor in the United States
Ertugliflozin is the cheapest SGLT2 inhibitor available in the United States, with the lowest both average wholesale price (AWP) and National Average Drug Acquisition Cost (NADAC) among all SGLT2 inhibitors.
Cost Comparison of SGLT2 Inhibitors
Based on the most recent 2025 pricing data for a 30-day supply at maximum approved daily dose 1:
NADAC Pricing (What Pharmacies Actually Pay):
- Bexagliflozin 20 mg: $47/month (newest agent, data not available for NADAC in some sources)
- Ertugliflozin 15 mg: $343/month
- Dapagliflozin 10 mg: $352/month
- Empagliflozin 25 mg: $586/month
- Canagliflozin 300 mg: $574/month
AWP Pricing:
- Bexagliflozin 20 mg: $47/month
- Ertugliflozin 15 mg: $428/month
- Dapagliflozin 10 mg: $664/month
- Canagliflozin 300 mg: $718/month
- Empagliflozin 25 mg: $733/month
Important Clinical Considerations
While cost matters, cardiovascular and renal outcomes should guide SGLT2 inhibitor selection in appropriate patients. The pricing data shows ertugliflozin consistently costs approximately 40-50% less than empagliflozin, canagliflozin, or dapagliflozin across multiple years 2, 3, 1, 4, 3, 5, 2.
Evidence-Based Selection Criteria:
For patients with established cardiovascular disease or high cardiovascular risk: Empagliflozin, canagliflozin, and dapagliflozin have demonstrated cardiovascular mortality benefits in dedicated outcomes trials 3, 6. These agents should be prioritized despite higher cost when cardiovascular or renal protection is the primary goal.
For patients with heart failure: All SGLT2 inhibitors reduce heart failure hospitalizations, but empagliflozin, dapagliflozin, and canagliflozin have the strongest evidence base 3, 4.
For patients with chronic kidney disease: Empagliflozin, canagliflozin, and dapagliflozin have demonstrated renal protection in dedicated kidney outcomes trials 3.
For glycemic control alone in patients without cardiovascular disease, heart failure, or CKD: Ertugliflozin represents the most cost-effective option, as all SGLT2 inhibitors have similar glucose-lowering efficacy 2, 1.
Practical Prescribing Algorithm
Does the patient have established ASCVD, heart failure, or CKD?
- Yes: Prescribe empagliflozin, canagliflozin, or dapagliflozin based on specific indication and formulary coverage
- No: Consider ertugliflozin as the most cost-effective option
Check insurance formulary: Actual patient out-of-pocket costs depend heavily on insurance coverage, manufacturer assistance programs, and pharmacy benefit design. The AWP and NADAC prices don't reflect discounts, rebates, or patient assistance programs that significantly affect final cost 3, 4.
Monitor for contraindications: All SGLT2 inhibitors require dose adjustment or avoidance based on eGFR (typically avoid initiation if eGFR <20-25 mL/min/1.73 m²) 6.
Critical Caveats
- Bexagliflozin appears significantly cheaper at $47/month but has limited long-term cardiovascular and renal outcomes data compared to other SGLT2 inhibitors 1
- Medication shortages may necessitate switching between agents; when this occurs, select an alternative SGLT2 inhibitor with similar efficacy 1
- Patient assistance programs from manufacturers can dramatically reduce out-of-pocket costs for brand-name agents, potentially making more expensive agents with better outcomes data more accessible
- Generic availability will eventually change this cost landscape, though none of the SGLT2 inhibitors are currently available as generics in the U.S.