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Utilization Management Strategies for Appropriate Treatment


A discussion on utilization management strategies for optimizing the treatment for patients with heart failure.

Jaime Murillo, MD: The beauty and challenge at the same time in heart failure is that we have 4, some people count 5, different lines of therapy for heart failure. The reality is that they all work. Where we have an opportunity is in trying to define the groups that benefit most from X therapy.

We have beta-blockers, we have spironolactone and the like, we have all these ACE inhibitors, we have ARBs, we have SGLT2 therapy. Unfortunately, because of the nature of the trials, there is no way for us to tell who benefits from what. That’s the reality. Most people will start therapies with, “What is the affordable medication I can start with?” That person may benefit from a different approach, but we don’t know that yet. In our health plan [at United Health Care], what we have done is that we essentially opened the approach with few exceptions. Then we will very rarely use a step therapy, as we call it, before people have access to medications for heart failure. I suspect that that landscape will evolve as we learn more about which patients benefit the best or better from a specific line of therapy for heart failure.

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