The Inflation Reduction Act, signed into law this past August, will make guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction more affordable for patients on Medicare, who currently face high out-of-pocket costs.

These high costs are due to the inclusion of brand-name drugs in the regimens, including angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), the researchers write.

“The cost of heart failure medications for Medicare patients is very high, over $2500 per year, for the quadruple therapy regimens that are recommended,” lead author Micah Johnson, MD, resident physician at Brigham and Women’s Hospital, Boston, Massachusetts, told theheart.org | Medscape Cardiology.

“The Inflation Reduction Act is expected to significantly reduce the out-of-pocket cost for heart failure medications by more than $1000 per year. It will help a lot of people,” Johnson said.

Their findings were published online January 11 in JAMA Cardiology.

Dr Micah Johnson

For this report, the researchers created a model that looked at 6 different heart failure medication regimens for a hypothetical patient with heart failure with reduced ejection fraction (HfrEF) and no other medical comorbidities, and asked how much their treatment would cost today, and then how much the cost would be under the new IRA.

They found that, among Part D plans using copayments, annual out of pocket (OOP) costs under the current law were $482 for the generics metoprolol succinate, lisinopril, and spironolactone; $1518 for metoprolol succinate, lisinopril, spironolactone, and empagliflozin (generics plus SGLTA2i); $1917 for metoprolol succinate, sacubitril/valsartan, and spironolactone (generics plus ARNI); and $2644 to $2849 for metoprolol succinate or carvedilol, sacubitril/valsartan, spironolactone or eplerenone, plus empagliflozin or dapagliflozin.

Under the current law, patients who use comprehensive therapy, which includes metoprolol succinate, sacubitril/valsartan, spironolactone, and empagliflozin, would meet their deductible in January, enter the coverage gap in April, and reach the catastrophic phase in September.

Under the IRA and a Part D plan using copayments in the coverage phase, beneficiaries would meet their deductible in January and pay flat copayments for the remainder of the year, without ever reaching the catastrophic cap.

Under the IRA and a plan using co-insurance, beneficiaries would reach the $2000 gap in May and have no out-of-pocket costs thereafter.

“Most patients today who take these heart failure medications enter the coverage gap phase at a certain part of the year. When this happens, they start having to pay more every month for their medications. For instance, February and March, a patient might be paying less than $100 for these medications, but when they get to May and June, they have to pay more than $300 for the exact same medication. This leads to a lot of frustration,” Johnson said.

“Anecdotally, I have seen patients stop filling their medication prescriptions when they are suddenly charged more at the pharmacy. The Inflation Reduction Act eliminates the coverage gap, and this means lower and more predictable costs for their medications throughout the year,” he said.

The IRA also allows Medicare recipients to opt into a program to smooth OOP costs over the year, which could improve affordability of heart failure regimens.

“This will make heart failure meds more affordable, and as physicians, this is something we know really matters. We meet these patients all the time. We know there are treatments that will extend their life, and they can’t afford them. This law is an important first step toward getting patients the treatment they need,” Johnson said.

Lifesaving Medications

The hope is that the IRA will allow more people to be able to afford their heart failure regimens, Sumeet Mitter, MD, an advanced heart failure and transplant cardiologist at Mount Sinai Hospital, New York City, told theheart.org | Medscape Cardiology.

Dr Sumeet Mitter

“This model shows that more of our patients would have less out-of-pocket costs and be able to stabilize costs throughout the year so they can budget better. It assumes that heart failure is the only ailment, and factors in no other costs, but the hope is that this will allow more people to be able to afford their heart failure regimens,” Mitter said.

“Sometimes, the most heartbreaking thing for us as cardiologists is when we know the patient has to decide, ‘Do I pay for my medication or do I pay rent, buy food, or take care of other life expenses?’ ” he said.

“These medications are lifesaving and can extend life in a meaningful way. I have seen many patients having to struggle and yes, it is heartbreaking, because we know the benefit of these medications and the years potentially gained from taking them. But we will have to see how this turns out in real-world practice. We are very optimistic; we just have to see how it works in practice,” Mitter said.

Johnson and Mitter report no relevant financial relationships.

JAMA Card. Published online January 11, 2023. Research Letter

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