Use and Out‐of‐Pocket Cost of Sacubitril‐Valsartan in Patients With Heart Failure

BACKGROUND: Current guidelines recommend use of sacubitril‐valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Early data suggested low uptake of sacubitril‐valsartan, but contemporary data on real‐world use and their associated cost are limited. METHODS AND RESULTS: This was a retrospective study of individuals enrolled in Optum Clinformatics, a national insurance claims data set from 2016 to 2018. We included all adult patients with HFrEF with 2 outpatient encounters or 1 inpatient encounter with an International Classification of Diseases, Tenth Revision (ICD‐10), diagnosis of HFrEF and 6 months of continuous enrollment, also receiving β‐blockers and angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers within 6 months of HFrEF diagnosis. We included 70 245 patients with HFrEF, and 5217 patients (7.4%) received sacubitril‐valsartan prescriptions. Patients receiving care through a cardiologist compared with a primary care physician alone were more likely to receive sacubitril‐valsartan (odds ratio, 1.61 [95% CI, 1.52–1.71]). Monthly out‐of‐pocket (OOP) cost for sacubitril‐valsartan, compared with angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, was higher for both commercially insured patients (mean, $69 versus $6.74) and Medicare Advantage (mean, $62 versus $2.52). For patients with commercial insurance, OOP cost was lower in 2016 than in 2018. For patients with Medicare Advantage, there was a significant geographic variation in the OOP costs across the country, ranging from $31 to $68 per month across different regions, holding all other patient‐related factors constant. CONCLUSIONS: Sacubitril‐valsartan use was infrequent among patients with HFrEF. Patients receiving care with a cardiologist were more likely to receive sacubitril‐valsartan. OOP costs remain high, potentially limiting use. Significant geographic variation in OOP costs, unexplained by patient factors, was noted.