Addressing Finerenone Cost, Access in Heart Failure: Trejeeve Martyn, MD

In an interview on emerging therapies for heart failure with preserved ejection fraction (HFpEF), Trejeeve Martyn, MD, an advanced heart failure cardiologist and director of Heart Failure Population Health, Cleveland Clinic, discussed how to weigh the costs of newer nonsteroidal mineralocorticoid receptor agonists (MRAs) such as finerenone (Kerendia; Bayer) and how health systems of all sizes can improve access using pharmacist-led models.

Martyn emphasized that for clinicians, the primary cost concern should be the patient’s out-of-pocket expense, not just the health system’s formulary spend. He argued that finerenone merits a place on both inpatient and outpatient formularies because of its demonstrated benefits in diabetic kidney disease and heart failure, including reductions in events soon after hospitalization. Although head-to-head data comparing finerenone with traditional steroidal MRAs, such as spironolactone (Aldactone; Pfizer) and eplerenone (Inspra; Pfizer), are lacking, current evidence points to additional kidney benefits not yet proven with older agents, along with rapid heart failure–related event reduction.

From a health system perspective, Martyn suggested that broader formulary access to finerenone makes sense as long as patient cost-sharing is not “egregious.” He noted that pharmacy access teams and payer assistance programs can systematically mitigate affordability barriers.

Turning to implementation, Martyn described the growing role of pharmacist-driven access models, including prior authorization support, transitions-of-care outreach, and virtual consult services. While large academic centers may have more pharmacy resources, he believes the core elements are adaptable to smaller or rural systems.

He recommended that organizations build a business case around outcomes such as reduced readmissions and improved quality metrics associated with timely initiation of therapies like sodium-glucose cotransporter 2 inhibitors, angiotensin receptor-neprilysin inhibitors, and nonsteroidal MRAs in acute heart failure. Even when full-time clinical pharmacists are not feasible, pharmacy technicians can deliver high-value services, such as estimating a patient’s likely out-of-pocket cost at their local pharmacy before discharge. This transparency helps prevent “sticker shock” and changes prescriber behavior by increasing confidence that patients can actually fill prescribed medications.

Overall, Martyn sees pharmacist- and technician-led access infrastructure as a practical, scalable strategy to close treatment gaps in HFpEF while balancing clinical benefit and affordability.