What is the cheapest SGLT‑2 inhibitor for an adult with type 2 diabetes and an estimated glomerular filtration rate of at least 45 mL/min/1.73 m² with no contraindications?

Cheapest SGLT2 Inhibitor for Type 2 Diabetes

No generic SGLT2 inhibitors are currently available in the United States; dapagliflozin, empagliflozin, and canagliflozin are all brand-name products with similar pricing, so the cheapest option depends on your specific insurance formulary coverage and manufacturer assistance programs. 1

Cost Considerations and Access Strategies

• All three FDA-approved SGLT2 inhibitors with cardiovascular outcomes data—empagliflozin (Jardiance), canagliflozin (Invokana), and dapagliflozin (Farxiga)—are brand-name medications with comparable retail prices in the $500–600 per month range without insurance. 2, 1

• Check your insurance formulary first, as tier placement varies widely between plans; one SGLT2 inhibitor may have significantly lower copays than the others on your specific plan. 1

• Manufacturer patient assistance programs can substantially reduce out-of-pocket costs for eligible patients:

  • AstraZeneca's AZ&Me program for dapagliflozin
  • Boehringer Ingelheim's patient assistance for empagliflozin
  • Janssen CarePath for canagliflozin 1

Clinical Equivalence for Decision-Making

• All three agents provide similar cardiovascular and renal protection when used at evidence-based doses:

  • Empagliflozin 10 mg or 25 mg daily reduces cardiovascular death by 38% and heart failure hospitalization by 35% 2, 3
  • Canagliflozin 100 mg or 300 mg daily reduces the composite cardiovascular outcome by 14% 2
  • Dapagliflozin 10 mg daily reduces cardiovascular death or heart failure hospitalization by 26–29% and kidney disease progression by 39–44% 1

• The choice between agents should be driven by formulary coverage rather than clinical superiority, as all three have Class I, Level A guideline recommendations for patients with type 2 diabetes and established cardiovascular disease, heart failure, or chronic kidney disease. 2

Dosing and eGFR Thresholds

• For patients with eGFR ≥45 mL/min/1.73 m², all three agents can be initiated at standard doses for both glycemic control and cardiorenal protection:

  • Empagliflozin 10 mg daily (can increase to 25 mg if additional glucose lowering needed) 2, 3
  • Dapagliflozin 10 mg daily (fixed dose for all indications) 1
  • Canagliflozin 100 mg daily (can increase to 300 mg if eGFR ≥60 mL/min/1.73 m²) 2

• For patients with eGFR 30–44 mL/min/1.73 m², empagliflozin and dapagliflozin remain appropriate at 10 mg daily for cardiovascular and renal protection, though glucose-lowering efficacy is reduced; canagliflozin should not exceed 100 mg daily in this range. 2, 1, 3

• For patients with eGFR 25–29 mL/min/1.73 m², dapagliflozin 10 mg daily can be initiated for cardiorenal protection based on 2025 ADA guidelines, whereas empagliflozin should not be started below eGFR 30 mL/min/1.73 m². 2, 1

Practical Algorithm for Selection

1. Confirm eGFR ≥45 mL/min/1.73 m² (or ≥25 mL/min/1.73 m² if using dapagliflozin solely for cardiorenal protection). 2, 1

2. Contact your insurance plan to identify which SGLT2 inhibitor has the lowest tier placement and copay. 1

3. If all three have similar copays, choose based on dosing convenience:

   • Dapagliflozin requires no titration (fixed 10 mg dose for all indications) 1
   • Empagliflozin 10 mg provides equivalent cardiovascular benefit to 25 mg, so titration is optional 3
   • Canagliflozin requires dose limitation at lower eGFR ranges 2

4. Apply for manufacturer assistance if out-of-pocket costs exceed $50–100 per month, as most programs can reduce costs to $0–35 monthly for eligible patients. 1

Common Pitfalls to Avoid

• Do not assume generic availability—no SGLT2 inhibitors have lost patent protection in the United States as of 2025. 1

• Do not discontinue an SGLT2 inhibitor when eGFR falls below 45 mL/min/1.73 m² after initiation, as cardiovascular and renal benefits persist even when glucose-lowering efficacy diminishes. 2, 1

• Do not substitute a sulfonylurea (e.g., gliclazide, glipizide) to save money, as sulfonylureas provide no cardiovascular or renal protection and increase hypoglycemia risk. 4

• Do not combine SGLT2 inhibitors with DPP-4 inhibitors (e.g., sitagliptin), as the combination offers no additional clinical advantage. 4