Integrated analysis confirms decision to remove Entresto® from UM

Unique cost of care study on sacubitril-valsartan (sac-val) shows significant medical cost savings for adherent users; also, advanced analytics adds insights to impact UM for all users 

Heart failure is the leading cause of death in the U.S. Sac-val is proven to decrease hospitalization and reduce death due to heart failure with reduced ejection fraction (HFrEF), also known as systolic heart failure. 

As a knowledge management company, Prime wanted to study real world integrated benefits data on use of sac-val for adherent members, as well as all sac-val utilizing members. 

This study looked at more than 1,000 members newly initiating sac-val. For an adherent members taking sac-val, after just one year: 

• Medical costs decreased 38%
• Hospital costs decreased 69%
• Emergency room costs decreased 44% 
• Total cost of care decreased 22% 

When looking at the entire cohort (including adherent and nonadherent members), the cohort still showed a small total decrease in cost of care (2%). Prime’s recommendation to its health plan clients is to offer sac-val on an open formulary. Eliminating the prior authorization fast-tracks member access. This can save lives and health care costs.

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