Medicare patients may not be able to afford life-saving heart failure drug, reports JAMA Cardiology study. UH’s Dr. Chien-Wen Tseng is senior author.
By Tina Shelton, JABSOM Communications Director
An effective drug for chronic heart failure may cost too much for senior citizens with a standard Medicare Part D drug plan, according to a new study in the Journal of the American Medical Association (JAMA) Cardiology.
The therapy is a combination of sacubitril/valsartan called Entresto®. The researchers found that even with insurance, it can end up costing Medicare patients 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 the 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 Dr. Chien-Wen Tseng, HMSA Endowed Chair in Health Services and Quality Research at the University of Hawaii (UH) John A. Burns School of Medicine (JABSOM) and Physician Investigator with Honolulu’s Pacific Health Research and Education Institute.
What worries the study’s authors is that because it is a pricey, brand-name drug, those high co-payments may be causing patients not to take the drug. And that comes with a steep price.
“The science shows that this drug can help save lives,” said Tseng, pointing to clinical studies that showed the therapy reduced deaths from heart failure by 20%. “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 co-payments to benefit from it.”
“The science shows that this drug can help save lives,” said UH Professor and senior author Chien-Wen Tseng, MD.
Lead author Colette DeJong, MD of the University of California at San Francisco explained that 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. “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 towards curbing these skyrocketing out-of-pocket costs,” she said.
That conclusion was echoed by Joseph A. Hill, MD, PhD, Chief of Cardiology at the University of Texas Southwestern Medical Center, whom we asked for his independent comment on the research. “Spiraling drug costs in many domains, including cardiology, are unquestionably limiting patient access to evidence-based therapies,” said Dr. Hill, who was not involved in the study conducted by DeJong, Tseng and their colleagues. “We, as physician advocates for our patients, must continue to work with both pharma and Congress to identify novel solutions. Among these, legislation that prohibits the federal government from negotiating with the pharmaceutical industry should be revisited,” said Dr. Hill, the Frank M. Ryburn, Jr. Chair in Heart Research and Director of the Harry S. Moss Heart Center at UT Southwestern. Hill also is Editor-in Chief of the journal Circulation.
Read the JAMA Cardiology abstract.
What should Medicare patients know?
Medicare patients should know that Entresto® is an important new treatment for heart failure, but with high monthly copays that can vary throughout the year. Physicians rarely discuss cost with their patients, and too often, people are put in a position where they can’t afford to pick up the medicine that their doctor prescribed. Since heart failure is a chronic condition, we encourage people to talk to their doctor early about cost to make sure their treatment plan will work for them financially.
Why does the copayment under Medicare Part D fluctuate during the year?
Medicare Part D requires patients to pay part of the cost (for a drug). Annually on January 1st, patients have a deductible where they pay the full cost of the drug until they’ve met their deductible (about $400). Then they reach a coverage phase where patients will pay either a set dollar copayment per prescription or a percentage of the drug price for each prescription. This continues until the total cost of their drugs exceeds a set limit and they reach the coverage gap phase. During the gap, patients are responsible for paying 25% of the price of their brand-name drugs. This continues until they’ve spent over $5000-plus out-of-pocket and they qualify for catastrophic coverage, where they pay 5% of drug prices until the end of the year.
More about the article
(#HLD190002) Assessment of National Coverage and Out-of-Pocket Costs for Sacubitril/Valsartan Under Medicare Part D
Authors: Dhruv S Kazi, Beth Israel Deaconess Medical Center, Randi Chen, Pacific Health Research and Education Institute (PHREI), Honolulu, Colette DeJong, University of California, San Francisco (UCSF), Chien-Wen W Tseng, UH-JABSOM, R. Adams Dudley, UCSF.
About Dr. Tseng
Dr. Tseng is the Hawaii Medical Service Association (HMSA) endowed chair in health services and quality research, an associate professor, and the associate research director in the Department of Family Medicine and Community Health at UH. In 2016 she was appointed to the U.S. Preventive Services Task Force, the first person from Hawaii appointed to the influential panel. She is a physician-investigator with the nonprofit Pacific Health Research and Education Institute (PHREI), an affiliate of the Veterans Affairs Pacific Islands Health Care System. Dr. Tseng is an active physician and a teacher of primary health care and preventive care to UH medical students and family medicine residents. Her research focuses on improving quality of health care and lowering financial barriers to care, such as reducing the high cost of drugs for chronic and acute diseases. A graduate of Punahou School, Tseng received a B.S. in electrical engineering and a B.A. in mathematical sciences from Rice University, an M.S. in electrical engineering from Stanford University, and an M.P.H. from the University of California, Los Angeles (UCLA). She earned her M.D. from the David Geffen School of Medicine at UCLA and completed her residency in family medicine at the University of Washington. Dr. Tseng was a visiting scholar with the Robert Graham Center for Policy and Research in Washington, D.C. She is also an alumnus of the Robert Wood Johnson Foundation Clinical Scholar Program at UCLA and the Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Program.