Current Market Access to Chronic Heart Failure Medications

The FDA recently expanded the label of Novartis’ Entresto (sacubitril/valsartan) to reduce the risk of cardiovascular death and hospitalization for heart failure in adult patients with chronic heart failure. It became the first and only FDA-approved drug for both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) in patients whose left ventricular ejection fraction (LVEF) is below normal levels. For chronic heart failure treatments, the majority of insured people have plans that put them under the preferred/preferred (prior authorization and/or step therapy) tiers and covered/covered (PA/ST) tiers, as of February 2021. Most payer pharmacy benefit formularies do not require step therapy or prior authorization for Entresto.

NOTE: The numbers of total covered lives under commercial, health exchange, Medicare and Medicaid formularies are 171.1 million, 10.5 million, 47.5 million and 68.0 million, respectively.

SOURCE: Managed Markets Insight & Technology, LLC database as of February 2021.

Jinghong Chen

Jinghong Chen Reporter

Jinghong produces infographics and data stories on health insurance and specialty pharmacy for AIS Health. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting. Before joining AIS in 2018, she worked at WBEZ, Al Jazeera English and The New York Times Chinese.

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