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Research Letter
July 10, 2019

Assessment of National Coverage and Out-of-Pocket Costs for Sacubitril/Valsartan Under Medicare Part D

Author Affiliations
  • 1Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
  • 2Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 3Pacific Health Research and Education Institute, Honolulu, Hawaii
  • 4Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu
JAMA Cardiol. 2019;4(8):828-830. doi:10.1001/jamacardio.2019.2223

Sacubitril/valsartan, an angiotensin receptor–neprilysin inhibitor (ARNI), is the first new drug to show mortality benefit for heart failure with reduced ejection fraction (HFrEF) in more than a decade. Based on a 20% reduction in cardiovascular death in patients who received it compared with those who received enalapril in the Prospective Comparison of ARNI With ACEI (Angiotensin-Converting Enzyme Inhibitors) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial,1 sacubitril/valsartan received expedited US Food and Drug Administration approval in 2015 and a class I American Heart Association/American College of Cardiology/Heart Failure Society of America guideline recommendation in 2016.2 However, clinical adoption remains slow, with less than 3% of patients with HFrEF receiving the drug as of 2016.3 Since more than 80% of deaths from heart failure occur in people older than 65 years,4 we examined Medicare Part D plans nationwide to explore whether high cost sharing or a lack of coverage could be barriers to the adoption of sacubitril/valsartan under Medicare Part D.