As expensive therapeutics rise to the fore of heart failure management, out-of-pocket (OOP) medication costs have become increasingly relevant to patient care. Prescription medication costs influence medical decision-making and affect adherence. Yet individualized cost estimates are seldom available during clinical encounters when prescription decisions are made. The lack of transparency around medication costs prohibits cost-sensitive shared decision-making and can lead to financial toxicity and delays in therapeutic management. Upcoming policy changes will impact the availability and affordability of heart failure medications in the U.S., such as the implementation of a $2,000 cap on OOP drug spending for Medicare Part D Plans in 2025. This state-of-the-art review summarizes the current landscape of cost transparency efforts using heart failure management guidelines and the U.S. healthcare system as an illustrative example. Understanding the variables involved in determining medication costs and the resources available to reduce OOP cost are paramount for heart failure clinicians and their patients worldwide.

Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC 

CME Editor
Ragavendra R. Baliga, MD

Author
Barbara Wiggins, PharmD, FACC

Important Dates
Date of Release: January 27, 2025
Term of Approval/Date of CME/MOC Expiration: January 26, 2026