Overview
Payers were originally extremely worried about the potential cost burden of Entresto, however, the level of concern surrounding the drug is currently moderate as physician uptake has been lower than expected. Payers suggest that it will take some time for routine prescribing habits to change to incorporate Entresto, as physicians have been treating chronic heart failure patients with cheap angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for many years. If physicians begin requesting Entresto on a frequent basis, then payers across the US and five major EU markets (France, Germany, Italy, Spain, and the UK) indicate that their approaches to the drug’s reimbursement may change.
Payers across Europe and the US have implemented patient population and line of therapy restrictions for Entresto, to various degrees, which tend to be in line with the patient characteristics of the Phase III PARADIGM-HF trial. However, access to Entresto in the first-line treatment setting is significantly more open in the US than in Europe, suggesting that US insurers are not as concerned about the potential budget impact of Entresto. This is likely due to the low physician demand for the product, the deterrent of high patient co-pay, and/or the drug’s relatively reasonable cost in comparison to other cardiovascular therapies such as the proprotein convertase subtilisin kexin 9 inhibitors. In addition to patient population and line of therapy restrictions, the majority of the markets surveyed. Entresto should be prescribed initially by a hospital specialist.
Table of Contents
OVERVIEWEXECUTIVE SUMMARY
Companies Mentioned
- NICE
- SMC
