Abstract 4140588: Temporal Variation in Out-of-Pocket Costs for Guideline-Directed Medical Therapy Among Patients with Heart Failure

Background: Patients with HF average >$4000/year in out-of-pocket (OOP) costs for their care, including GDMT. High OOP costs lead to nonadherence and poor outcomes. The OOP costs of GDMT often fluctuate over the course of the year due to deductibles and other variable cost-sharing requirements. Poor understanding of these changes present a barrier to cost-conscious treatment decisions. Objective: To characterize fluctuations in OOP GDMT costs over the course of the year for patients with HF. Methods: We used electronic health record and real-time prescription benefit (RTPB) data to conduct a retrospective analysis of insured adults (Medicare, Medicaid, or private) with a diagnosis of HF at a large academic system in Jan 2021-Dec 2023. We described RTPB-estimated 30-day OOP costs of all 4 major HF drug classes. We compared OOP costs at end-of-year (Oct-Dec) vs beginning-of-year (Jan-March) using Kruskal-Wallis test. An ordinary least-squares model was used to assess differences after adjustment for age, sex, race, and comorbidities. Results: Of 2965 patients with HF, 86% were enrolled in Medicare, 10% in private insurance, and 4% in Medicaid. Among patients with private insurance, median 30-day OOP costs for ARNi were $9.54 (IQR $0.00-$28.81) in Oct-Dec and increased seven-fold to $71.14 (IQR $26.68-$115.99) in Jan-March (p=0.03) ( Figure ). SGLT2i costs increased from $0.00 (IQR $0.00-$21.58) in Oct-Dec to $35.57 (IQR $28.81-$115.61) in Jan-March (p<0.001). For patients with Medicare, 30-day OOP costs for ARNi increased from $35.40 (IQR $2.00-$68.65) in Oct-Dec to $41.80 (IQR $10.89-$84.08) in Jan-March (p<0.001), while no differences were noted for SGLT2i. Costs varied minimally for patients with Medicaid and for medications with generic options available, regardless of payor type. In an adjusted model, between-period differences persisted for those with private insurance (ARNi $49.99, 95% CI 11.27-88.71, p=0.01; SGLT2i $23.63, 95% CI 3.10-44.16, p=0.02). Conclusion: Among patients with HF, OOP costs for 30 days of GDMT varied significantly over the course of a year, especially for patients with private insurance. The largest variations were for patented drug classes (ARNi and SGLT2i). These findings can inform cost-conscious treatment decisions for clinicians and patients.