OBJECTIVES: Given the lack of novel therapies and stagnant survival outcomes, there remains a high unmet need in chronic heart failure (HF). However, after years of limited development, the HF treatment pipeline looks promising. This research investigated the current chronic HF payer landscape, comparing Health Technology Assessment (HTAs) decisions and evidence packages submitted for key products to determine payer requirements and to understand how these requirements may evolve as new, more effective treatments are launched. METHODS: HTAs published by key agencies from 2011-2016 for eplerenone, ivabradine and sacubitril/valsartan in the treatment of chronic HF were identified. Submissions and decision rationale, including economic and clinical critiques, were compared across the products. RESULTS: CONCLUSIONS: With a sizeable patient population and only a limited number of treatment options for chronic HF available, proving clinical efficacy in reducing hospitalisation rates and cost-effectiveness have historically been sufficient for a positive payer recommendation. As superior treatments come to market, pressure from payers for survival endpoints, superiority versus an active comparator, cost-offsets and budget impact data will increase.