Sacubitril/Valsartan Treatment for HFrEF Results in Removal of Prior Authorization Requirement

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Study results demonstrate the multimillion-dollar savings achieved among patients with heart failure with reduced ejection fraction (HFrEF) following treatment initiation with sacubitril and valsartan.

A Platinum award–winning poster presented at this year’s Academy of Managed Care Pharmacy Nexus shows the cost and utilization benefits associated with combination treatment of sacubitril/valsartan among patients with heart failure with reduced ejection fraction (HFrEF).

Despite already having FDA approval for patients with HFrEF who have New York Heart Association class II-IV disease, with benefits that included both decreased mortality and hospitalization rates, few data exist on a real-world impact outside of the study setting.

There were 2 primary outcomes, and they involved a comparison of a 10-month period before sacubitril/valsartan initiation (the “pre” period) and the 10 months after (the “post” period): (1) total cost of care, and (2) events: hospitalizations and emergency department visits.


Results show the following:

  • 21.3% decrease in mean (SD) total cost of care from the pre to the post period: from $46,242 ($89,058) to $36,383 ($64,251), or a $9859 difference (95% CI, $2675-$17,042)
  • 12.5% decrease in median costs between the periods: from $18,973 to $16,593 (P < .01)
  • 144% average pharmacy cost increase (P < .01)
  • 39.5% medical cost decrease (P < .01)
  • 63% drop in members requiring hospitalization: from 34.8% to 12.8% (P < .01)
  • 44% drop in members visiting the emergency department (P < .01)

“There was a 2-month wash-out period pre and post the sac-val initiation date where medical costs and events were excluded because sac-val is generally initiated as a result of HF [hospitalization],” the authors noted.

The study period of October 2018 to September 2019 encompassed 15 million commercially insured and continuously enrolled members with integrated medical and pharmacy claims data. Those included in the final analysis (n = 658) were 18 to 65 years old, had HFrEF, and had only recently started treatment with sacubitril/valsartan and were adherent for at least 80% of their treatment days.

In total, the 658 study participants who initiated and adhered to their sacubitril/valsartan treatment for 1 year were shown to have saved $6.5 million in total care costs compared with what was spent before the treatment.

“These significant real-world findings along with a pharmaceutical manufacturer value-based contract [VBC], clinical trial data, and clinical guidelines resulted in the removal of sac-val prior authorization,” the authors concluded. “Integrated medical and pharmacy benefits provide ability to execute VBCs, feasibility to assess medication value, and inform insurers management decisions.”

The poster presented by Prime Therapeutics was 1 of 4 to receive a Platinum award this year because of its performance on criteria for relevance, originality, quality, bias, and clarity.


Burke J, Sahli B, Gleason P. Sacubitril-valsartan real-world assessment of total cost of care and resource utilization pre/post initiation among commercially insured members with reduced ejection fraction heart failure. Presented at: Academy of Managed Care Pharmacy Nexus; October 19-23, 2020; Poster I9.