Expensive new heart medications: When are they worth it?

Newly approved drugs for heart failure and high cholesterol come with raised expectations and, in some cases, alarmingly high prices. They certainly aren’t right for everyone, but if they’re a good fit for you, the cost may be worthwhile.

Heart disease is the leading cause of death for men and women in the United States, and it’s expensive, accounting for one in every six dollars spent on health care in the country, according to the Centers for Disease Control and Prevention (CDC). Drugs are a big contributor to these costs, and there are four newcomers of note on the market this year— two for heart failure and two for high cholesterol. With daily patient costs reaching $40 in the case of one of the cholesterol drugs, understanding just who these drugs are meant for will help you decide if the ends justify the means.

2 New Heart Failure Medications
Heart failure occurs when the heart can’t pump enough blood to the cells in the body. It sounds scary, and can be, but it’s also manageable with medication. The two new drugs— Corlanor from Amgen and Entresto from Novartis— are the first new chronic heart failure treatments to enter the market in years.

Who are they for?
Corlanor (ivabradine) works by slowing the heart rate, which has been shown to help patients with heart failure. It is intended for heart failure patients who have a resting heart rate of 70 beats per minute or more, even when taking traditional drugs for heart rate control. Although 70 bpm is normal in healthy adults, lower is better for heart failure patients. It is also for those unable to take traditional drugs known as beta blockers, which work by blocking the hormone epinephrine to reduce heart rate.

“In heart failure patients, it is known that the higher the heart rate, the worse the outcome,” says Dr. Robert Kloner, director of the Cardiovascular Research Institute at Huntington Medical Research Institutes in Pasadena, Calif. Kloner adds that in clinical trials, Corlanor reduced hospitalization in patients with heart failure.

Entresto is a combination drug, including the medicines sacubitril and valsartan, an angiotensin II receptor blocker, which makes it easier for your heart to pump blood by relaxing your blood vessels. This drug has been heralded as a promising alternative to existing drugs in the same class, as a large clinical trial found it reduced hospitalization and the rate of cardiovascular death in certain patients.

“Entresto was shown to be better than enalapril (a standard angiostensin receptor blocker) for reducing these adverse outcomes,” Kloner says. Because of this, doctors may begin prescribing the new drug in place of others in that class.

How much do they cost?
Corlanor and Entresto each cost about $375 a month, or about $12.50 a day, according to online drug pricing sites.

Two New Cholesterol Medications
High cholesterol can lead to heart disease, and traditional cholesterol medicines, such as statins, are prescribed for people with high cholesterol and additional risk factors. The new cholesterol medications— Praluent from Sanofi and Repatha from Amgen— are subcutaneous drugs. This means they must be injected.

Who are they for?
Praluent (alirocumab) and Repatha (evolocumab) are in a new class of cholesterol medications known as PCSK9 inhibitors. These drugs inactivate the PCSK9 protein found in the liver. This, in turn, allows a greater amount of LDL, or “bad” cholesterol, to be metabolized and removed from the body. Neither will be used for the general masses of people with high cholesterol. Rather, a select group— those people who have tried statins with little effect, and those for whom statins cause intolerable side effects— are the target patient population.

“There are individuals with genetic disorders who struggle with unacceptably high levels of cholesterol and are likely to benefit from the newer agents,” says Dr. Anna Bortnick, cardiologist and assistant professor at the Albert Einstein College of Medicine. These patients have high cholesterol despite the use of statins. Praluent and Repatha may also be useful in patients who are “truly statin intolerant,” according to Bortnick.

How much do they cost?
Both are specialty drugs and are very expensive.

Praluent costs about $1,120 every 28 days, or $40 per day.

Repatha costs about $1,084 for biweekly injections, or $39 per day.

Need them? How to afford them
All four of these new drugs are brand names and no generic will be available for years, so they’re costly. Getting them for less than retail price will largely depend on whether your insurer is covering them and your ability to get discounts through the manufacturer.

If you’re insured, log on to your insurer’s website and check the formulary for the drug you’re interested in. If it’s not listed, call the number on the back of your insurance card and ask a representative directly, both whether the drug is covered and what your out-of-pocket responsibilities will be.

If you’re uninsured or subject to a copayment, Amgen is offering a Corlanor Savings Card and a Repatha Copay Card to help reduce costs. For Entresto, Novartis offers a $10 copay card for insured patients as well as a free trial offer. Insured Praluent patients may be eligible for a MyPRALUENT Copay Card, and qualify to receive their medicine for free for the first six months.

Also, all drugmakers have assistance programs for low-income people so that qualifying patients can receive their medicine at little to no cost. Ask your doctor for details.