ArticleJournal of the American College of Cardiology2022
Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure.
Article in Journal of the American College of Cardiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- Pooled it
- Patient Perspectives on a Polypill Strategy for Heart Failure With Reduced Ejection Fraction: A Convergent-Parallel Mixed Methods Study Embedded in a Randomized Clinical Trial.Circulation. Population health and outcomes · 2026Trial
- Integrating Out-of-Pocket Costs Into Shared Decision-Making for Heart Failure With Reduced Ejection Fraction: A Stepped-Wedge Trial (POCKET-COST-HF).Circulation. Cardiovascular quality and outcomes · 2025Trial
- Historical Drug Costs Among Elderly Patients Hospitalized with Heart Failure in Canada, 2013-2014 to 2018-2019.CJC open · 2026Article
- Medicaid coverage for fixed-dose combination antihypertensive medications - fifty states and Washington, D.C., 2022.Journal of human hypertension · 2026Article
- Discontinuation of Heart Failure Pharmacotherapy in Older Adults With Frailty.Journal of the American Heart Association · 2026Article
- Association Between Medicare Drug Plan Ratings and Coverage Barriers for Non-Generic, Evidence-Based Cardiovascular Medications.Circulation. Population health and outcomes · 2026Article
- A Pragmatic Trial Evaluating the Impact of the Anumana Clinical Decision Support Tool for Guideline-Directed Management of Heart Failure (ACT-HF): Clinical trial design and methods.American heart journal plus : cardiology research and practice · 2026Article
- Changes in health insurance status and mortality in patients with acute heart failure.American heart journal plus : cardiology research and practice · 2025Article
- Direct-to-Physician Marketing and Uptake of Optimal Medical Therapy for Heart Failure With Reduced Ejection Fraction.JACC. Heart failure · 2025Article
- High long-term mortality in ischaemic heart disease accentuated among ethnic minorities in Eastern Europe: findings from a prospective all-comers percutaneous coronary intervention registry in Romania.Journal of epidemiology and community health · 2025Article
- Challenges Related to Out-of-Pocket Costs in Heart Failure Management.Circulation. Heart failure · 2025Review
- Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure.Circulation. Heart failure · 2025Article
- Heart Failure Beyond the Diagnosis: A Narrative Review of Patients' Perspectives on Daily Life and Challenges.Journal of clinical medicine · 2024Review
- Health Care Expenditure in United States Adults With Heart Failure With and Without Diabetes.The American journal of cardiology · 2024Article
- Use of Sodium-Glucose Cotransporter 2 Inhibitors in Hospitalized Patients.JACC. Advances · 2024Review
- County-Level Variation in Triple Guideline-Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction.JACC. Advances · 2024Article
- Healthcare Cost Burden and Self-Reported Frequency of Depressive/Anxious Feelings in Older Adults.Journal of gerontological social work · 2024Article
- Improving Guideline-Directed Medical Therapy for Patients With Heart Failure With Reduced Ejection Fraction: A Review of Implementation Strategies.Journal of cardiac failure · 2024Review
- A Costly Cure: Understanding and Addressing Financial Toxicity in Cardiovascular Disease Health Care Within the Domain of Social Determinants of Health.Methodist DeBakey cardiovascular journal · 2024Review
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundBeta-blockers, angiotensin receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors (SGLT2i), known as quadruple therapy, are recommended for patients with heart failure with reduced ejection fraction (HFrEF).
objectivesThis study sought to determine Medicare coverage and out-of-pocket (OOP) costs of quadruple therapy and regimens excluding ARNI or SGLT2i.
methodsThis study assessed cost sharing, prior authorization, and step therapy in all 4,068 Medicare prescription drug plans in 2020. OOP costs were determined during the standard coverage period and annually based on the Medicare Part D standard benefit, inclusive of deductible, standard coverage, coverage gap, and catastrophic coverage.
resultsTier ≥3 cost sharing was required by 99.1% of plans for ARNI and 98.5% for at least 1 SGLT2i. Only ARNI required prior authorization (24.3% of plans), and step therapy was required only for SGLT2is (5.4%) and eplerenone (0.8%). The median 30-day standard coverage OOP cost of quadruple therapy was $94 (IQR: $84-$100), including $47 (IQR: $40-$47) for ARNI and $45 (IQR: $40-$47) for SGLT2i. The median annual OOP cost of quadruple therapy was $2,217 (IQR: $1,956-$2,579) compared with $1,319 (IQR: $1,067-$1,675) when excluding SGLT2i and $1,322 (IQR: $1,025-$1,588) when including SGLT2i and substituting an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for ARNI. The median 30-day OOP cost of generic regimens was $3 (IQR: $0-$9).
conclusionsMedicare drug plans restrict coverage of quadruple therapy through cost sharing, with OOP costs that are substantially higher than generic regimens. Quadruple therapy may be unaffordable for many Medicare patients with HFrEF unless medication prices and cost sharing are reduced.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.