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Out-of-pocket payments for part d covered medications by medicare fee-for-service beneficiaries with heart failure with reduced ejection fraction.

Publication ,  Journal Article
Fendrick, AM; Djatche, L; Pulungan, Z; Teigland, C; Yang, M; Lautsch, D; Hilkert, R; Mentz, R
Published in: Am Heart J
April 2022

BACKGROUND: Out-of-pocket (OOP) drug costs for Medicare Fee-for-Service (FFS) beneficiaries with heart failure with reduced ejection fraction (HFrEF) are not well characterized. This study evaluated Part D OOP spending by Medicare beneficiaries with chronic HFrEF, stratified by those with and without a worsening HF event (WHFE). METHODS: Medicare FFS 100% Part D claims were used to identify HFrEF patients with 12 months of continuous Part D enrollment in 2018. HFrEF was defined as 1 inpatient or 2 outpatient claims of systolic HF or 1 systolic HF plus 1 HF outpatient claim. WHFE was defined as having a HF hospitalization or intravenous diuretic use within 12 months of HFrEF index date. OOP costs by Medicare Part D coverage phase for all covered drugs were calculated for HFrEF patients, and those with and without WHFE. RESULTS: Of 305,373 Medicare patients with HFrEF, 26% had a WHFE. Total mean (SD) OOP drug costs among all HFrEF patients was $1,166 (1,205)/year. Patients with WHFE and patients without WHFE had respectively a mean (SD) annual OOP costs of $1,302 (1,273) and $1,117 (1,176). Over 39% of HFrEF patients entered the "donut hole" (44% and 37% of patients with WHFE and without WHFE, respectively), while 11% of HFrEF patients entered the catastrophic phase (13% and 10% of patients with and without WHFE, respectively). CONCLUSIONS: More than 1 in 10 patients with heart failure entered the catastrophic phase within Medicare-Fee-For-Service, whereas in 2018 only 10% of costs were attributable to heart failure medication and 90% to comorbidities.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2022

Volume

246

Start / End Page

74 / 81

Location

United States

Related Subject Headings

  • United States
  • Stroke Volume
  • Medicare Part D
  • Humans
  • Heart Failure
  • Health Expenditures
  • Fee-for-Service Plans
  • Cardiovascular System & Hematology
  • Aged
  • 3201 Cardiovascular medicine and haematology
 

Citation

APA
Chicago
ICMJE
MLA
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Fendrick, A. M., Djatche, L., Pulungan, Z., Teigland, C., Yang, M., Lautsch, D., … Mentz, R. (2022). Out-of-pocket payments for part d covered medications by medicare fee-for-service beneficiaries with heart failure with reduced ejection fraction. Am Heart J, 246, 74–81. https://doi.org/10.1016/j.ahj.2021.10.189
Fendrick, A Mark, Laurence Djatche, Zulkarnain Pulungan, Christie Teigland, Mei Yang, Dominik Lautsch, Robert Hilkert, and Robert Mentz. “Out-of-pocket payments for part d covered medications by medicare fee-for-service beneficiaries with heart failure with reduced ejection fraction.Am Heart J 246 (April 2022): 74–81. https://doi.org/10.1016/j.ahj.2021.10.189.
Fendrick AM, Djatche L, Pulungan Z, Teigland C, Yang M, Lautsch D, et al. Out-of-pocket payments for part d covered medications by medicare fee-for-service beneficiaries with heart failure with reduced ejection fraction. Am Heart J. 2022 Apr;246:74–81.
Fendrick, A. Mark, et al. “Out-of-pocket payments for part d covered medications by medicare fee-for-service beneficiaries with heart failure with reduced ejection fraction.Am Heart J, vol. 246, Apr. 2022, pp. 74–81. Pubmed, doi:10.1016/j.ahj.2021.10.189.
Fendrick AM, Djatche L, Pulungan Z, Teigland C, Yang M, Lautsch D, Hilkert R, Mentz R. Out-of-pocket payments for part d covered medications by medicare fee-for-service beneficiaries with heart failure with reduced ejection fraction. Am Heart J. 2022 Apr;246:74–81.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2022

Volume

246

Start / End Page

74 / 81

Location

United States

Related Subject Headings

  • United States
  • Stroke Volume
  • Medicare Part D
  • Humans
  • Heart Failure
  • Health Expenditures
  • Fee-for-Service Plans
  • Cardiovascular System & Hematology
  • Aged
  • 3201 Cardiovascular medicine and haematology