A new State-of-the-Art Review published in JACC highlights the major factors contributing to high out-of-pocket (OOP) costs for heart failure (HF) medications, while also recommending potential solutions for reducing costs and enhancing transparency.

“As expensive therapeutics rise to the fore of [HF] management, OOP medication costs have become increasingly relevant to patient care,” write Emily F. Lowe, MD, Denae Gerasta, BA, et al. “The lack of transparency around medication costs prohibits cost-sensitive shared decision-making and can lead to financial toxicity and delays in therapeutic management.”

The review highlights the key determinants of OOP costs for prescription medications, including prescription coverage plans, deductibles, monthly premiums, copay vs. insurance, plan-specific formulary lists, drug tiers, and in-network pharmacies. The authors note that these factors can lead to poor adherence and ultimately worse health outcomes in adult patients, with 25% of adults reporting difficulty in affording medications and 20% saying they do not take their medications as prescribed due to costs.

“Understanding the determinants of OOP cost can prepare clinicians to engage in cost-sensitive discussions and has the potential to reduce cost-related nonadherence and financial toxicity in patients,” say Lowe and colleagues.

The review provides proposed multidisciplinary strategies for the entire cardiovascular care team, ranging from clinicians to case managers and social workers to pharmacy personnel, to engage in discussions around medication costs during patient visits. Examples include asking cost-related questions during intake, screening for financial assistance needs, and employing patient navigators to help with cost estimations.

According to the authors, “upcoming policy changes and cost transparency efforts will impact prescribing and affordability of HF medications” as well. They call out state and federal efforts to enact legislation mandating cost transparency and existing prescription cost comparison tools (e.g., GoodRx, WellRx) as examples. They also underscore the actionable benefits of prescription discount cards, manufacturer discount programs and pharmacy saving plans, such as those offered by Walmart and Target, in helping patients mitigate costs.

“These efforts will have benefits beyond HF to the growing number of individuals with chronic conditions, multimorbidity, and polypharmacy, in the United States and around the world,” the authors write.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Health Expenditures, Prescription Drugs, Heart Failure, Outcome Assessment, Health Care