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Brief Report
November 18, 2019

Contemporary Patterns of Medicare and Medicaid Utilization and Associated Spending on Sacubitril/Valsartan and Ivabradine in Heart Failure

Author Affiliations
  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
  • 2Brigham and Women’s Heart and Vascular Center and Hospital, Harvard Medical School, Boston, Massachusetts
  • 3Duke Clinical Research Institute, Durham, North Carolina
  • 4Associate Editor, JAMA Cardiology
  • 5Ahmanson–University of California, Los Angeles Cardiomyopathy Center, University of California Los Angeles Medical Center
  • 6Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
JAMA Cardiol. Published online November 18, 2019. doi:https://doi.org/10.1001/jamacardio.2019.4982
Key Points

Question  What are the patterns of use and associated costs of sacubitril/valsartan and ivabradine for Medicare Part D and Medicaid?

Findings  In this US nationwide claims-based study, the number of Medicare beneficiaries prescribed sacubitril/valsartan increased from 35 423 to 90 606 (156% increase from 2016 to 2017). Medicare beneficiaries prescribed ivabradine increased from 15 856 to 23 213 (46% increase), the annual Medicare per-beneficiary spending on sacubitril/valsartan and ivabradine was $2512 and $2400, and parallel trends in use patterns and spending were observed among Medicaid beneficiaries.

Meaning  Current use of sacubitril/valsartan and ivabradine is increasing, but ongoing efforts are needed to promote high-value care, while improving affordability and access to established and emerging heart failure therapies.

Abstract

Importance  In 2015, the US Food and Drug Administration approved 2 new medications for treatment of heart failure with reduced ejection fraction, sacubitril/valsartan and ivabradine. However, few national data are available examining their contemporary use and associated costs.

Objective  To evaluate national patterns of use of sacubitril/valsartan and ivabradine and associated therapeutic spending in Medicare Part D and Medicaid.

Design, Setting, and Participants  In this US nationwide claims-based study, we analyzed data from the Medicare Part D Prescription Drug Event and Medicaid Utilization and Spending data sets to compare national patterns of use of sacubitril/valsartan and ivabradine between 2016 and 2017.

Main Outcomes and Measures  Changes in total spending, per-beneficiary/claim spending, number of beneficiaries, and number of claims between 2016 and 2017 for sacubitril/valsartan and ivabradine.

Results  The number of Medicare beneficiaries prescribed sacubitril/valsartan increased from 35 423 to 90 606 (156% increase from 2016 to 2017). Medicare beneficiaries prescribed ivabradine increased from 15 856 to 23 213 (46% increase). In 2017, Medicare Part D spent $227 million and $7.3 million on sacubitril/valsartan and ivabradine, respectively. This represented increases of 241% and 59% compared with 2016 spending, respectively. The annual Medicare per-beneficiary spending on sacubitril/valsartan and ivabradine was $2512 and $2400. Parallel trends in use patterns and spending were observed among Medicaid beneficiaries.

Conclusions and Relevance  Although initial experiences suggested slow uptake after regulatory approval, these national data demonstrate an increase in use of sacubitril/valsartan and, to a lesser degree, ivabradine in the United States. Current annual per-beneficiary expenditures remain less than spending thresholds that have been reported to be cost-effective. Ongoing efforts are needed to promote high-value care while improving affordability and access to established and emerging heart failure therapies.

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