{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:14:07Z","timestamp":1789132447586,"version":"build-2803163510"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,9,6]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Current guidelines recommend use of sacubitril\u2010valsartan in patients with heart failure with reduced ejection fraction (HFrEF). Early data suggested low uptake of sacubitril\u2010valsartan, but contemporary data on real\u2010world use and their associated cost are limited.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              This was a retrospective study of individuals enrolled in Optum Clinformatics, a national insurance claims data set from 2016 to 2018. We included all adult patients with HFrEF with 2 outpatient encounters or 1 inpatient encounter with an\n              <jats:italic>International Classification of Diseases, Tenth Revision<\/jats:italic>\n              (\n              <jats:italic>ICD\u201010<\/jats:italic>\n              ), diagnosis of HFrEF and 6\u2009months of continuous enrollment, also receiving \u03b2\u2010blockers and angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockers within 6\u2009months of HFrEF diagnosis. We included 70\u2009245 patients with HFrEF, and 5217 patients (7.4%) received sacubitril\u2010valsartan prescriptions. Patients receiving care through a cardiologist compared with a primary care physician alone were more likely to receive sacubitril\u2010valsartan (odds ratio, 1.61 [95% CI, 1.52\u20131.71]). Monthly out\u2010of\u2010pocket (OOP) cost for sacubitril\u2010valsartan, compared with angiotensin\u2010converting enzyme inhibitors\/angiotensin receptor blockers, was higher for both commercially insured patients (mean, $69 versus $6.74) and Medicare Advantage (mean, $62 versus $2.52). For patients with commercial insurance, OOP cost was lower in 2016 than in 2018. For patients with Medicare Advantage, there was a significant geographic variation in the OOP costs across the country, ranging from $31 to $68 per month across different regions, holding all other patient\u2010related factors constant.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Sacubitril\u2010valsartan use was infrequent among patients with HFrEF. Patients receiving care with a cardiologist were more likely to receive sacubitril\u2010valsartan. OOP costs remain high, potentially limiting use. Significant geographic variation in OOP costs, unexplained by patient factors, was noted.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.023950","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T09:07:02Z","timestamp":1661332022000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Use and Out\u2010of\u2010Pocket Cost of Sacubitril\u2010Valsartan in Patients With Heart Failure"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5436-6097","authenticated-orcid":false,"given":"Supriya","family":"Shore","sequence":"first","affiliation":[{"name":"Division of Internal Medicine University of Michigan Ann Arbor MI"},{"name":"Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanima","family":"Basu","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine University of Michigan Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Kamdar","sequence":"additional","affiliation":[{"name":"Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Brady","sequence":"additional","affiliation":[{"name":"Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7933-7794","authenticated-orcid":false,"given":"Edo","family":"Birati","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine University of Pennsylvania Philadelphia PA"},{"name":"Division of Cardiology Poriya Medical Center, Bar Ilan University Tiberias Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0924-3135","authenticated-orcid":false,"given":"Scott L.","family":"Hummel","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine University of Michigan Ann Arbor MI"},{"name":"Ann Arbor Veterans Affairs Health System Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Chopra","sequence":"additional","affiliation":[{"name":"University of Colorado Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4331-6649","authenticated-orcid":false,"given":"Brahmajee K.","family":"Nallamothu","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine University of Michigan Ann Arbor MI"},{"name":"Institute of Healthcare Policy and Innovation University of Michigan Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31829e8807"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1409077"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.592"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.00000000000005095"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.12.018"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.117.004302"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2006.099523"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.021048"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1700244"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.3451"},{"key":"e_1_3_1_12_2","unstructured":"Hoadley J Cubanski J Neuman T. 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