Addressing Financial Toxicity in Heart Failure with Viet Le, DMSc, PA-C

Financial toxicity is a major concern in the healthcare industry, impacting patients’ ability to obtain and adhere to their prescribed medications. Guideline-directed medical therapy (GDMT) is the foundation of heart failure (HF) care, decreasing hospitalizations, lowering mortality, and improving quality of life overall. However, HF-related expenses have risen in recent years, and research has attributed suboptimal adherence to medications to their cost.1

Average out-of-pocket spending for HF is also substantially higher than for other cardiac comorbidities, due in part to its nature as a chronic disease characterized by multiple comorbidities with their own treatment costs. It is also heavily associated with hospitalizations, which may be expensive on their own, and can lead to compromised physical function.1

To this end, Viet Le, DMSc, PA-C, associate professor of research and a preventative cardiology PA at Intermountain Health, gave a presentation on addressing and potentially circumventing financial toxicity at the Heart Failure Society of America Annual Scientific Meeting 2025 in Minneapolis, MN. The editorial team at HCPLive sat down with Dr. Le beforehand to discuss his perspective on the state of the HF field and his advice to clinicians aiming to address this barrier.

In his presentation, Le urges clinicians to take action through pre-charting patients prior to visits, which he notes will allow clinicians the time they need to determine which patients may or may not be on GDMT.2

“If you know that, then you know what you’re going to consider prescribing on a shared decision-making basis with the patient,” Le told HCPLive. “That means you know what therapies are brand, they are not genetic, and they may or may not be approved, and you know which patients are Medicare, Medicaid, federal, or commercial, and that gives you a sense to be able to reach out to your pharmacist on the team and start the prior authorization process.”

Le also discussed the value of having specialized, expert pharmacists on a clinical team, suggesting clinicians offload much of the time-consuming work of prior authorization, letters of appeal or exception, and so on. Additionally, having a dedicated pharmacist or pharmacy technicians can allow for test claim running and getting key coverage document signatures while the patient is still physically present in the clinic, reducing the need for repeat visits.2

Le’s presentation also highlights the importance of utilizing co-pay cards and vouchers for medications. Co-pay cards are particularly useful given their annual coverage “caps” ranging from $1000 to $4000. This bring co-pay to $0-$25 for 3 30-day or 1 90-day fill, after which point co-pay is back to “usual.” Le points out that this can save patients the $1000-$4000 a year.2

Additionally, Le highlights 30-day vouchers, although their relatively higher monthly co-pay makes ensuring their 3 major conditions are fulfilled critical before patients make their decision. Vouchers primarily apply to medications which may have upfront side effects and require titration, as well as those which could require teaching for administration and monitoring of symptom benefits before full prescription.2

“I don’t like that I have to use copay cards or vouchers, but I will use them, and I often use them just to get patients to feel comfortable with the therapies,” Le said. “That way, they’ll have a better idea whether or not this is something they truly can’t afford, and of the return on investment.”

Editor's Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon.

References

1. 1: Sukumar S, Wasfy JH, Januzzi JL, Peppercorn J, Chino F, Warraich HJ. Financial Toxicity of Medical Management of Heart Failure: JACC Review Topic of the Week. J Am Coll Cardiol. 2023;81(20):2043-2055. doi:10.1016/j.jacc.2023.03.402

2. 2: Le V. Cost of Novel Heart Failure Therapies: Is the Juice Worth the Squeeze. Presented at the Heart Failure Society of America Annual Scientific Meeting 2025. Minneapolis, MN. September 26-29, 2025.