OBJECTIVES: Sacubitril/Valsartan (SAC/VAL) is the preferred renin-angiotensin-aldosterone system inhibitor (RAASi) for treatment of adult CHF. This study aimed to assess impacts of formulary adoption of SAC/VAL on uptake and adherence as well as overall utilization of RAASi in Medicare patients with CHF.

METHODS: Retrospective cohort study using Medicare administrative claims data. The “exposed” group included patients with CHF enrolled in Part D prescription drug plans (PDPs) that adopted SAC/VAL on their formulary in March 2016 (“intervention”). The “control” group included patients with CHF enrolled in PDPs with no coverage of SAC/VAL throughout 18-month follow-up. To control for patient selection, analysis was limited to non low-income subsidy patients enrolled in “exposed” or “control” plans for the entire analysis period pre- and post-intervention. Chi-squared and t- tests were performed to compare the uptake of SAC/VAL within 6, 12, and 18 months post-intervention, 12-month medication adherence among new SAC/VAL users, and overall utilization of RAASi.

RESULTS: For the “exposed” and “control” groups, we identified 111,826 and 12,595 patients, respectively. The groups had comparable demographic and risk profiles (mean age: 79 vs. 81 years; 52% vs. 53% female; mean risk score: 2.2 vs. 2.3). SAC/VAL uptake rates per 1,000 patients with CHF were higher for the “exposed” vs. “control” group: 4.0 vs. 2.9 at 6 months, 9.1 vs. 6.9 at 12 months, and 14.9 vs. 11.7 at 18 months (p-values: .08, .01, .01). Mean 12-month SAC/VAL proportion of days covered for new users was similar (72% vs. 70%; p-value: .72) and overall use of RAASi was slightly higher (63% vs. 61% of patients with CHF; p-value: <0.0001) for the “exposed” and “control” groups.

CONCLUSIONS: We observed slightly higher uptake of SAC/VAL and overall use of RAASi between groups following SAC/VAL addition to formulary, with minimal differences in SAC/VAL adherence.