Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review - (JACC January 2025-3)-Article: Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review

Article: Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review

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The state-of-the-art review titled "Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications" addresses the escalating issue of out-of-pocket (OOP) costs for heart failure (HF) medications, which are increasingly affecting patient care and adherence. Despite the critical role of prescription costs in medical decision-making, individualized cost estimates often remain unavailable during clinical encounters. This lack of transparency hinders cost-sensitive shared decision-making, potentially leading to financial strain and delays in therapeutic management.<br /><br />The review outlines upcoming policy changes, including a $2,000 cap on OOP drug spending for Medicare Part D Plans set to be implemented in 2025, which may improve medication affordability. Current guidelines advocate for guideline-directed medical therapy (GDMT) for HF, which includes expensive therapies such as sacubitril/valsartan and sodium-glucose cotransporter 2 (SGLT2) inhibitors. These patented therapies are often associated with high costs. The financial burden is intensified for patients on polypharmacy regimens for concurrent comorbidities.<br /><br />The review argues that discussions around the OOP costs of HF medications are vital but currently under-emphasized due to insufficient clinician training, variability, complexity of costs, and limited resources. It suggests using real-time pharmacy benefit tools to provide clinicians with cost estimates during consultations. There are also various strategies available to reduce OOP costs, such as using prescription discount cards, manufacturer discounts, and patient assistance programs. Additionally, emerging direct-to-consumer pharmacies present a novel cost-reduction approach.<br /><br />The review concludes that an understanding of the determinants of OOP costs can better prepare clinicians for cost-sensitive discussions, potentially reducing medication nonadherence and financial toxicity. It advocates for systemic changes to further improve cost transparency and access, ultimately benefiting patients with HF and other chronic conditions globally.

Keywords

out-of-pocket costs

heart failure medications

Medicare Part D

guideline-directed medical therapy

sacubitril/valsartan

SGLT2 inhibitors

polypharmacy

real-time pharmacy benefit tools

prescription discount cards

financial toxicity