Understanding the Part D spending dynamics of heart failure patients

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By Bruce S. Pyenson, Gabriela Dieguez, Michael Bellanich | 18 August 2015

Part D spending by heart failure (HF) patients is higher than for other patients due to their costly condition and comorbidities. In the benefit design of Part D, the portions of spending attributable to the member, drug manufacturer, Part D plan, and federal government vary dramatically depending on the member’s annual spending. Because of their overall higher drug spending, HF patients are more likely to pass through the initial coverage zone and reach the Part D “donut hole” and Catastrophic spending zones than the average Part D member.

This report was commissioned by Novartis Pharmaceuticals Corporation.

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