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Critical heart drug too pricey for some Medicare patients

Even with insurance, the cost to Medicare patients may be more than $1,600 a year, which may prohibit some from even taking the drug at all.

Jeff Lagasse, Associate Editor

An effective drug to treat chronic heart failure may cost too much for senior citizens with a standard Medicare Part D drug plan, said a study co-authored by a John A. Burns School of Medicine researcher at the University of Hawaii at Manoa.

The therapy is a combination of sacubitril/valsartan called Entresto. Researchers found that, even with insurance, the cost to Medicare patients may be more than $1,600 a year.

WHAT'S THE IMPACT

The drug is currently considered the standard for patients with significant congestive heart failure, according to guidelines from the American Heart Association and the American College of Cardiology. The problem is that even with insurance many patients may not be able to afford it.

The study co-authors worry that, since Entresto is a pricey, brand-name drug, such high copayments may result in patients not taking it at all. And that comes with a steep price.

While the science shows the drug can save lives, reducing deaths from heart failure by about 20 percent, it carries a $5,000 price tag, and those on Medicare are asked to pay $1,600 per year in copayments to receive those benefits.

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.

Combined with the fact that many older adults lived on an average income of less than $25,000 based on 2017 statistics, the $1,600 figure could be too prohibitive a hardship. The authors said changing the laws that prevent Medicare from negotiating drug prices would be a step toward curbing rising out-of-pocket costs.

THE LARGER TREND

In February, the Department of Health and Human Services proposed lowering the cost of prescription drugs by taking away kickback protections on rebates.

Reaction to the proposal was varied. America's Health Insurance Plans and pharmacy benefit managers said it's the drug manufacturers that set the prices, and it's hard not to point the blame at pharmaceutical companies when prices for orphan drugs to treat rare diseases have sometimes increased by thousands of dollars, for no discernable reason.

But the reality is not that simple, and there are opposing viewpoints about who and what is to blame for the already high and still rising prices.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com