{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T18:09:15Z","timestamp":1789236555421,"version":"build-2803163510"},"reference-count":38,"publisher":"Elsevier BV","issue":"25","license":[{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,6,1]],"date-time":"2022-06-01T00:00:00Z","timestamp":1654041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":392,"URL":"http:\/\/www.elsevier.com\/open-access\/userlicense\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["KL2 TR001862"],"award-info":[{"award-number":["KL2 TR001862"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL144644"],"award-info":[{"award-number":["R01HL144644"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HS025164"],"award-info":[{"award-number":["R01HS025164"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009827","name":"Laura and John Arnold Foundation","doi-asserted-by":"publisher","award":["K12HL138046"],"award-info":[{"award-number":["K12HL138046"]}],"id":[{"id":"10.13039\/100009827","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS022882"],"award-info":[{"award-number":["R01HS022882"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014941","name":"Cytokinetics","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014941","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001146","name":"Greenwall Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001146","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jacc.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of the American College of Cardiology"],"published-print":{"date-parts":[[2022,6]]},"DOI":"10.1016\/j.jacc.2022.04.031","type":"journal-article","created":{"date-parts":[[2022,6,20]],"date-time":"2022-06-20T16:49:50Z","timestamp":1655743790000},"page":"2516-2525","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":64,"title":["Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart\u00a0Failure"],"prefix":"10.1016","volume":"79","author":[{"given":"Kamil F.","family":"Faridi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias J.","family":"Dayoub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph S.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-2032","authenticated-orcid":false,"given":"Sanket S.","family":"Dhruva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"11","key":"10.1016\/j.jacc.2022.04.031_bib1","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1056\/NEJMoa1409077","article-title":"Angiotensin-neprilysin inhibition versus enalapril in heart failure","volume":"371","author":"McMurray","year":"2014","journal-title":"N\u00a0Engl J Med"},{"issue":"6","key":"10.1016\/j.jacc.2022.04.031_bib2","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.jacc.2017.04.025","volume":"70","author":"Yancy","year":"2017","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"21","key":"10.1016\/j.jacc.2022.04.031_bib3","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in patients with heart failure and reduced ejection fraction","volume":"381","author":"McMurray","year":"2019","journal-title":"N\u00a0Engl J Med"},{"issue":"15","key":"10.1016\/j.jacc.2022.04.031_bib4","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart failure","volume":"383","author":"Packer","year":"2020","journal-title":"N\u00a0Engl J Med"},{"issue":"9","key":"10.1016\/j.jacc.2022.04.031_bib5","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1016\/j.jacc.2020.05.037","article-title":"2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes: a report of the American College of Cardiology Solution Set Oversight Committee","volume":"76","author":"Das","year":"2020","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"36","key":"10.1016\/j.jacc.2022.04.031_bib6","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"issue":"6","key":"10.1016\/j.jacc.2022.04.031_bib7","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1016\/j.jacc.2020.11.022","volume":"77","author":"Maddox","year":"2021","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"6","key":"10.1016\/j.jacc.2022.04.031_bib8","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1001\/jamacardio.2016.1747","article-title":"Cost-effectiveness analysis of sacubitril\/valsartan vs enalapril in patients with heart failure and reduced ejection fraction","volume":"1","author":"Gaziano","year":"2016","journal-title":"JAMA Cardiol"},{"issue":"5","key":"10.1016\/j.jacc.2022.04.031_bib9","first-page":"392","article-title":"Cost-effectiveness of sacubitril-valsartan combination therapy compared with enalapril for the treatment of heart failure with reduced ejection fraction","volume":"4","author":"King","year":"2016","journal-title":"J\u00a0Am Coll Cardiol HF"},{"issue":"11","key":"10.1016\/j.jacc.2022.04.031_bib10","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1001\/jamacardio.2020.2822","article-title":"Cost-effectiveness of sacubitril-valsartan in hospitalized patients who have heart failure with reduced ejection fraction","volume":"5","author":"Gaziano","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"8","key":"10.1016\/j.jacc.2022.04.031_bib11","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1001\/jamacardio.2021.1437","article-title":"Cost-effectiveness of dapagliflozin for treatment of patients with heart failure with reduced ejection fraction","volume":"6","author":"Parizo","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"7","key":"10.1016\/j.jacc.2022.04.031_bib12","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.14501","article-title":"Cost-effectiveness of dapagliflozin for the treatment of heart failure with reduced ejection fraction","volume":"4","author":"Isaza","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"1","key":"10.1016\/j.jacc.2022.04.031_bib13","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.35064","article-title":"Trends in within-class changes in US average wholesale prices for brand-name medications for common conditions from 2015 to 2020","volume":"4","author":"Liu","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"19","key":"10.1016\/j.jacc.2022.04.031_bib14","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1016\/j.jacc.2019.02.015","article-title":"Titration of medical therapy for heart failure with reduced ejection fraction","volume":"73","author":"Greene","year":"2019","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"6","key":"10.1016\/j.jacc.2022.04.031_bib15","first-page":"469","article-title":"Contemporary treatment patterns and clinical outcomes of comorbid diabetes mellitus and HFrEF: the CHAMP-HF Registry","volume":"8","author":"Vaduganathan","year":"2020","journal-title":"J\u00a0Am Coll Cardiol HF"},{"issue":"4","key":"10.1016\/j.jacc.2022.04.031_bib16","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.jacc.2018.04.070","article-title":"Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF Registry","volume":"72","author":"Greene","year":"2018","journal-title":"J\u00a0Am Coll Cardiol"},{"issue":"2","key":"10.1016\/j.jacc.2022.04.031_bib17","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.117.004302","article-title":"Adoption of sacubitril\/valsartan for the management of patients with heart failure","volume":"11","author":"Sangaralingham","year":"2018","journal-title":"Circ Heart Fail"},{"issue":"9377","key":"10.1016\/j.jacc.2022.04.031_bib18","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/S0140-6736(03)13800-7","article-title":"Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial","volume":"362","author":"Poole-Wilson","year":"2003","journal-title":"Lancet"},{"issue":"10","key":"10.1016\/j.jacc.2022.04.031_bib20","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1056\/NEJM199909023411001","article-title":"The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators","volume":"341","author":"Pitt","year":"1999","journal-title":"N\u00a0Engl J Med"},{"issue":"14","key":"10.1016\/j.jacc.2022.04.031_bib21","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction","volume":"348","author":"Pitt","year":"2003","journal-title":"N\u00a0Engl J Med"},{"issue":"1","key":"10.1016\/j.jacc.2022.04.031_bib22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms","volume":"364","author":"Zannad","year":"2011","journal-title":"N\u00a0Engl J Med"},{"key":"10.1016\/j.jacc.2022.04.031_bib24","author":"Boehringer"},{"issue":"12","key":"10.1016\/j.jacc.2022.04.031_bib25","doi-asserted-by":"crossref","first-page":"895","DOI":"10.7326\/M17-1823","article-title":"Medicare formulary coverage restrictions for prescription opioids, 2006 to 2015","volume":"167","author":"Samuels","year":"2017","journal-title":"Ann Intern Med"},{"issue":"14","key":"10.1016\/j.jacc.2022.04.031_bib26","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1161\/CIRCULATIONAHA.119.040580","article-title":"Evolution of Medicare formulary coverage changes for antithrombotic therapies after guideline updates","volume":"140","author":"Dayoub","year":"2019","journal-title":"Circulation"},{"issue":"2","key":"10.1016\/j.jacc.2022.04.031_bib27","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.jacc.2016.10.053","article-title":"Medicare formulary changes after the 2013 American College of Cardiology\/American Heart Association cholesterol guideline","volume":"69","author":"Dhruva","year":"2017","journal-title":"J\u00a0Am Coll Cardiol"},{"key":"10.1016\/j.jacc.2022.04.031_bib28","author":"Walmart"},{"issue":"6","key":"10.1016\/j.jacc.2022.04.031_bib29","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1056\/NEJMoa1812851","article-title":"Angiotensin-neprilysin inhibition in acute decompensated heart failure","volume":"380","author":"Velazquez","year":"2019","journal-title":"N\u00a0Engl J Med"},{"issue":"19","key":"10.1016\/j.jacc.2022.04.031_bib30","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.1161\/CIRCULATIONAHA.118.039331","article-title":"Clinical outcomes in patients with acute decompensated heart failure randomly assigned to sacubitril\/valsartan or enalapril in the PIONEER-HF trial","volume":"139","author":"Morrow","year":"2019","journal-title":"Circulation"},{"issue":"8","key":"10.1016\/j.jacc.2022.04.031_bib31","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1001\/jamacardio.2020.0898","article-title":"Association of optimal implementation of sodium-glucose cotransporter 2 inhibitor therapy with outcome for patients with heart failure","volume":"5","author":"Bassi","year":"2020","journal-title":"JAMA Cardiol"},{"issue":"8","key":"10.1016\/j.jacc.2022.04.031_bib32","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/ejhf.2283","article-title":"Clinical inertia and medical therapy for heart failure: the unintended harms of 'first, do no harm'","volume":"23","author":"Greene","year":"2021","journal-title":"Eur J Heart Fail"},{"issue":"9","key":"10.1016\/j.jacc.2022.04.031_bib33","first-page":"725","article-title":"Care gaps in adherence to heart failure guidelines: clinical inertia or physiological limitations?","volume":"8","author":"Jarjour","year":"2020","journal-title":"J\u00a0Am Coll Cardiol HF"},{"issue":"2","key":"10.1016\/j.jacc.2022.04.031_bib34","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1001\/jamainternmed.2021.7457","article-title":"Assessment of hypothetical out-of-pocket costs of guideline-recommended medications for the treatment of older adults with multiple chronic conditions, 2009 and 2019","volume":"182","author":"Zhou","year":"2022","journal-title":"JAMA Intern Med"},{"key":"10.1016\/j.jacc.2022.04.031_bib35","author":"Koma"},{"issue":"14","key":"10.1016\/j.jacc.2022.04.031_bib36","article-title":"Out-of-pocket annual health expenditures and financial toxicity from healthcare costs in patients with heart failure in the United States","volume":"10","author":"Wang","year":"2021","journal-title":"J\u00a0Am Heart Assoc"},{"issue":"19","key":"10.1016\/j.jacc.2022.04.031_bib37","article-title":"Financial toxicity in atherosclerotic cardiovascular disease in the United States: current state and future directions","volume":"9","author":"Khera","year":"2020","journal-title":"J\u00a0Am Heart Assoc"},{"issue":"1","key":"10.1016\/j.jacc.2022.04.031_bib38","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s12872-017-0495-4","article-title":"Exploring the impact of financial barriers on secondary prevention of heart disease","volume":"17","author":"Dhaliwal","year":"2017","journal-title":"BMC Cardiovasc Disord"},{"issue":"11","key":"10.1016\/j.jacc.2022.04.031_bib40","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s11886-021-01598-w","article-title":"The price of progress: cost, access, and adoption of novel cardiovascular drugs in clinical practice","volume":"23","author":"Varghese","year":"2021","journal-title":"Curr Cardiol Rep"},{"issue":"16","key":"10.1016\/j.jacc.2022.04.031_bib41","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1001\/jama.2019.2633","article-title":"Novel therapies for an aging population: grappling with price, value, and affordability","volume":"321","author":"Gurwitz","year":"2019","journal-title":"JAMA"}],"container-title":["Journal of the American College of Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0735109722048896?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0735109722048896?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:49:58Z","timestamp":1760017798000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0735109722048896"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":38,"journal-issue":{"issue":"25","published-print":{"date-parts":[[2022,6]]}},"alternative-id":["S0735109722048896"],"URL":"https:\/\/doi.org\/10.1016\/j.jacc.2022.04.031","relation":{},"ISSN":["0735-1097"],"issn-type":[{"value":"0735-1097","type":"print"}],"subject":[],"published":{"date-parts":[[2022,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart\u00a0Failure","name":"articletitle","label":"Article Title"},{"value":"Journal of the American College of Cardiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jacc.2022.04.031","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 by the American College of Cardiology Foundation. Published by Elsevier.","name":"copyright","label":"Copyright"}]}}