- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Implementing MRAs for Heart Failure Treatment in the Clinic
Panelists discuss how payers typically require step therapy with SGLT2 inhibitors before approving nonsteroidal MRAs due to cost considerations, while acknowledging the need for head-to-head trials to determine incremental benefits, though early clinical experience suggests good tolerability and the potential for combination therapy initiation rather than sequential treatment approaches.
EP: 1.Economic Burden of Heart Failure Care
EP: 2.Heart Failure Prevalence and Screening
EP: 3.Quality Metrics in Heart Failure
EP: 4.Heart Failure Stages and Impact of Delayed Diagnosis
EP: 5.Collaboration in Heart Failure Treatment
EP: 6.Guideline-Directed Medical Therapies in Heart Failure
EP: 7.β-Blockers for Treatment of Heart Failure
EP: 8.Role of Diuretics in Heart Failure Management
EP: 9.Treatment of Heart Failure With ARNI Therapy
EP: 10.SGLT2 Inhibitors for Treatment of Heart Failure
EP: 11.GLP-1 for Treatment of Heart Failure
EP: 12.Role of MRAs in Heart Failure Treatment
EP: 13.Steroidal vs Nonsteroidal MRAs in Heart Failure
EP: 14.Implementing MRAs for Heart Failure Treatment in the Clinic
Implementation of mineralocorticoid receptor antagonist therapy faces significant barriers despite robust evidence supporting their use in eligible patients with heart failure. Primary care providers often express discomfort with monitoring requirements and concerns about transient creatinine increases and hyperkalemia risks, leading to substantial underutilization. Educational initiatives focusing on appropriate monitoring protocols and understanding the protective nature of transient renal function changes may help address these implementation barriers.
Economic considerations significantly impact treatment decisions, particularly regarding nonsteroidal mineralocorticoid receptor antagonists (MRAs) with annual costs around $8,000 compared with generic alternatives. Payer strategies typically require step-therapy approaches, often mandating SGLT2 inhibitor trials before approving nonsteroidal MRA coverage. The fundamental question remains unanswered: What is the incremental benefit of adding branded nonsteroidal MRAs vs generic steroidal MRAs to existing SGLT2 inhibitor therapy, and does this incremental benefit justify the substantial cost differential?
Early clinical experience with nonsteroidal MRAs in heart failure has been limited due to recent approval, though experience in diabetic kidney disease suggests manageable access barriers typical of branded medications. The need for head-to-head comparative effectiveness studies becomes critical, as cross-trial comparisons are fraught with limitations due to different trial eras, populations, and conduct issues. Large real-world evidence studies using administrative databases may provide the most practical approach to determining relative effectiveness and optimal implementation strategies for these agents in clinical practice.
Brensocatib Improves Outcomes in Non-Cystic Fibrosis Bronchiectasis With or Without Comorbid COPD
November 8th 2025Brensocatib improves lung structure and reduces exacerbations in non-cystic fibrosis bronchiectasis with or without COPD, according to posters presented at this year's CHEST meeting.
Read More
Preventing Tomorrow’s High-Cost Claims: The Rising-Risk Patient Opportunity in Medicaid
November 6th 2025For Medicaid care management, focusing on rising-risk patients is more effective than targeting high-cost claimants, whose spending tends to decrease over time due to regression to the mean.
Read More
