Prime Therapeutics research a thumbs up for Entresto — with caveats

Entresto (sacubitril-valsartan) didn’t get a lot of love from payers after it was approved in 2015 because of its expense and the crowded armamentarium for heart failure.

But Entresto has since made its way into guidelines for reduced ejection fraction heart failure, sometimes called systolic heart failure. And now research done by pharmacy benefit manager (PBM) Prime Therapeutics may give the combination drug a further boost, although there's some catches.

Patrick Gleason, Pharm.D., the PBM’s assistant vice president of health outcomes, presented findings at the Academy of Managed Care Pharmacy Nexus meeting in October that showed Entresto reduced annual total cost of care for reduced ejection heart failure patients by $10,177, on average, a 22% decrease. The study, a before-and-after Entresto comparison, included 658 commercially insured patients. Their annual pharmacy costs went up by $5,547 after they started taking Entresto, but that was offset by a $15,724 decrease in their medical costs, most of it coming from reduced hospitalizations.

Gleason says the results support removing prior authorization requirements for Entresto. Prime has negotiated a value-based contract for Entresto with the drug’s maker, Novartis, that is based on the total cost of care. That contract was the impetus for Prime removing prior authorization for Entresto, according to a company press release about Gleason’s research.

One possible problem with this research is the use of patients as their own historical controls. Such a design can invite confounding. But more importantly, the 658 patients were adherent patients and so a best-case scenario. When the analysis included 378 nonadherent patients, the total cost of care decreased by 2% instead of 22%. The clear implication is that for health plans and PBMs to realize savings from Entresto, they will have to work at making sure people take the drug as prescribed.