Critical heart drug too pricey for some Medicare patients

An effective drug to treat chronic heart failure may cost too much for senior citizens with a standard Medicare Part D drug plan, said a study co-authored by a John A. Burns School of Medicine (JABSOM) researcher at the University of Hawaii at Manoa.

The therapy is a combination of sacubitril/valsartan called Entresto®. Researchers found that, even with insurance, the cost to Medicare patients may be more than $1,600 a year.

“This drug is the standard of care for the people with significant congestive heart failure according to both the American Heart Association and American College of Cardiology guidelines, yet it’s priced so high that, even with insurance, patients may not be able to afford it,” said senior author Chien-Wen Tseng, HMSA Endowed Chair in Health Services and Quality Research at JABSOM and physician investigator with Honolulu’s Pacific Health Research and Education Institute.

The study co-authors worry that, since Entresto® is a pricey, brand-name drug, such high copayments may result in patients not taking it at all. And that comes with a steep price.

“The science shows that this drug can help save lives,” said Tseng, pointing to clinical studies showing the therapy has reduced deaths from heart failure by 20 percent. “We need to figure out a way to deal with its $5,000 price tag, and how folks on Medicare can afford to pay $1,600 each year in copayments to benefit from it.”

Current laws prohibit the U.S. Department of Health and Human Services from negotiating drug prices with pharmaceutical companies on behalf of Medicare Part D beneficiaries. As a result, said lead researcher Colette DeJong of the University of California at San Francisco, “Paying $1,600 per year for a single drug could be a huge hardship for many older adults who lived on an average income of less than $25,000 in 2017. Changing the laws that prevent Medicare from negotiating drug prices on behalf of seniors and people living with disabilities would be one step toward curbing these skyrocketing out-of-pocket costs.”

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