Contemporary Patterns of Medicare and Medicaid Utilization and Associated Spending on Sacubitril/Valsartan and Ivabradine in Heart Failure

Key PointsQuestionWhat are the patterns of use and associated costs of sacubitril/valsartan and ivabradine for Medicare Part D and Medicaid? FindingsIn this US nationwide claims-based study, the number of Medicare beneficiaries prescribed sacubitril/valsartan increased from 35423 to 90606 (156% increase from 2016 to 2017). Medicare beneficiaries prescribed ivabradine increased from 15856 to 23213 (46% increase), the annual Medicare per-beneficiary spending on sacubitril/valsartan and ivabradine was $2512 and $2400, and parallel trends in use patterns and spending were observed among Medicaid beneficiaries. MeaningCurrent use of sacubitril/valsartan and ivabradine is increasing, but ongoing efforts are needed to promote high-value care, while improving affordability and access to established and emerging heart failure therapies. ImportanceIn 2015, the US Food and Drug Administration approved 2 new medications for treatment of heart failure with reduced ejection fraction, sacubitril/valsartan and ivabradine. However, few national data are available examining their contemporary use and associated costs. ObjectiveTo evaluate national patterns of use of sacubitril/valsartan and ivabradine and associated therapeutic spending in Medicare Part D and Medicaid. Design, Setting, and ParticipantsIn this US nationwide claims-based study, we analyzed data from the Medicare Part D Prescription Drug Event and Medicaid Utilization and Spending data sets to compare national patterns of use of sacubitril/valsartan and ivabradine between 2016 and 2017. Main Outcomes and MeasuresChanges in total spending, per-beneficiary/claim spending, number of beneficiaries, and number of claims between 2016 and 2017 for sacubitril/valsartan and ivabradine. ResultsThe number of Medicare beneficiaries prescribed sacubitril/valsartan increased from 35423 to 90606 (156% increase from 2016 to 2017). Medicare beneficiaries prescribed ivabradine increased from 15856 to 23213 (46% increase). In 2017, Medicare Part D spent $227 million and $7.3 million on sacubitril/valsartan and ivabradine, respectively. This represented increases of 241% and 59% compared with 2016 spending, respectively. The annual Medicare per-beneficiary spending on sacubitril/valsartan and ivabradine was $2512 and $2400. Parallel trends in use patterns and spending were observed among Medicaid beneficiaries. Conclusions and RelevanceAlthough initial experiences suggested slow uptake after regulatory approval, these national data demonstrate an increase in use of sacubitril/valsartan and, to a lesser degree, ivabradine in the United States. Current annual per-beneficiary expenditures remain less than spending thresholds that have been reported to be cost-effective. Ongoing efforts are needed to promote high-value care while improving affordability and access to established and emerging heart failure therapies. This study evaluates US national patterns of use of sacubitril/valsartan and ivabradine and associated therapeutic spending in Medicare Part D and Medicaid.