Contributors and Solutions to High Out-of-Pocket Costs for Heart Failure Medications: A State-of-the-Art Review.

Abstract

As expensive therapeutics rise to the fore of heart failure management, out-of-pocket (OOP) medication costs have become increasingly relevant to patient care. Prescription medication costs influence medical decision-making and affect adherence. Yet, individualized cost estimates are seldom available during clinical encounters when prescription decisions are made. The lack of transparency around medication costs prohibits cost-sensitive shared decision-making and can lead to financial toxicity and delays in therapeutic management. Upcoming policy changes will affect the availability and affordability of heart failure medications in the United States, such as the implementation of a $2,000 cap on OOP drug spending for Medicare Part D Plans in 2025. This state-of-the-art review summarizes the current landscape of cost transparency efforts using heart failure management guidelines and the U.S. health care system as an illustrative example. Understanding the variables involved in determining medication costs and the resources available to reduce OOP cost are paramount for heart failure clinicians and their patients worldwide.