Medicare Negotiation for Heart Failure Drugs Could Save $5.83 Billion | ACC 2025
A new analysis presented at the ACC 2025 meeting also finds that the new prices for heart failure drugs negotiated through Medicare will reduce hospitalizations.
More Medicare Part D patients will have access to heart failure medications as a result of the new prices negotiated by CMS through the Inflation Reduction Act, and the number of hospitalizations for heart failure will be reduced by 37,000 annually, according to a poster presented at the American College of Cardiology Annual Scientific Session and Expo.
Benson Gunther, D.O.
“Heart failure treatment is expensive,” lead investigator Benson Gunther, D.O., a resident at Abrazo Internal Medicine Residency in Glendale, Ariz., told Managed Healthcare Executive. “Many of the drugs to treat heart failure are brand name only, and they can cost several hundred dollars per month. Heart failure hospitalizations are expensive. They cost patients and the healthcare system significant amounts of money every year.”
In fact, healthcare costs related to heart failure in the United States are projected to reach $70 billion by 2030, according to a paper published last year in Progress in Cardiovascular Diseases.
In the poster presented at ACC 225, researchers — led by Gunther — wanted to determine the impact of Medicare’s price negotiation program on healthcare costs for heart failure.
Ten brand-name drugs were selected for the first round of price negotiations, with new prices beginning January 2026. Three of these are used in heart failure treatment: Jardiance (empagliflozin), Farxiga (dapagliflozin) and Entresto (sacubitril/valsartan). All three drugs are approved for heart failure, and Jardiance and Farxiga are also approved to treat chronic kidney disease. Generics for these medications are not expected to be available until between 2028 and 2034.
Gunther’s research wanted to assess the new prices negotiated by CMS specifically for the three drugs to treat heart failure. They wanted to determine if the new prices would save money for patients, expand access and reduce costs for the healthcare system. They looked at annual drug costs.
Related: HHS Releases Prices for Medicare Negotiated Drugs
In August 2024, the Department of Health and Human Services released the prices for the first 10 drugs that have been negotiated for Medicare Part D. The new prices will go into effect beginning Jan. 1, 2026. About 9 million people with Medicare use at least one of the first 10 drugs selected for negotiation, and these beneficiaries are expected to save an estimated savings of $1.5 billion in out-of-pocket costs in 2026, according to CMS officials.
CMS had estimated that if the new prices had been in effect in 2023, Medicare would have saved 66% on the cost of Boehringer Ingelheim’s Jardiance, 68% for AstraZeneca’s Farxiga and 53% for Novartis’ Entresto
Gunther’s team looked at drug cost data from calendar year 2022 obtained from HHS, as well as the number of Medicare enrollees taking the three drugs. They calculated cost savings comparing 2023 wholesale monthly costs with the prices that will take effect in 2026.
They also included indirect costs estimated using a multivariate analysis based on the anticipated number of beneficiaries not taking these medications because of affordability issues. They also correlated how expanded uptake would prevent additional heart failure-related hospitalization.
Gunther’s team found that the net cost savings would be $5.83 billion, with the majority of the savings from reduced monthly prescription costs at the pharmacy. Researchers also found that 11% of the savings would come from reducing hospitalizations related to heart failure.
“One aim of this [the IRA’s price negotiation] legislation is to expand drug access to patients who are not taking drugs due to affordability,” Gunther said. “Several billion dollars will be saved every year in drug costs. This will save money for the healthcare system and patients directly.”
Researchers said, however, this analysis looked at total costs and did not calculate out-of-pocket costs for beneficiaries because of the variability between healthcare plans and benefits.
Related: Questions Remain about Whether Negotiated Drug Prices will Save Money
Industry leaders whether beneficiaries will see savings is hard to know. What people pay at the pharmacy counter is complicated, and it’s not possible to consider the effects of the drug pricing program on beneficiaries in isolation.
