Prescription Fill Trends for Heart Failure Therapies Indicate Continued Access to Medications During the COVID-19 Pandemic

Despite concerns over the COVID-19 pandemic’s potential impact on access to medications to treat chronic conditions, GoodRx finds that prescription fills for generic heart failure drugs remained steady last year, while fills for newer therapies soared, indicating that patients were able to maintain access to critical medications.

As COVID-19 circulated in the U.S., many healthcare professionals were concerned about chronic disease management due to disruptions in routine medical care and access to prescription medications. Patients with heart failure, in particular, are not only at increased risk of severe COVID-19, but typically manage their condition with one or more combinations of drugs. 

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), drug classes used to treat heart failure, were also subjected to safety concerns related to their use in COVID-19 patients. 

This confusion and uncertainty led us to ask: How did fills for medications commonly used for heart failure fare during the COVID-19 pandemic?

New data from the GoodRx Research Team, in collaboration with researchers from Harvard University and published in the Journal of Cardiac Failure, shows that prescription fills of some of the most established generic medications used in heart failure care were maintained, despite initial concerns. In addition, 2020 saw a steady increase in fills for newer brand therapies, suggesting that patients were able to access the latest advances in medical therapies, even during a public health crisis. 

Fills for generic heart failure therapies

Treatment for heart failure can involve one or a combination of different generic therapies, including:

• Angiotensin-converting enzyme (ACE) inhibitors (lisinopril)

• Beta blockers (carvedilol, metoprolol)

• Angiotensin receptor blockers (ARB) (losartan)

• Diuretics (eplerenone, spironolactone)

Our research suggests that prescription fills for generic drugs used in heart care were maintained. In fact, fills for losartan, lisinopril, carvedilol, and metoprolol all peaked in the weeks of March 2020 and showed relatively consistent patterns for the rest of the year, when compared to a reference set of drugs. Fills of spironolactone and eplerenone showed modest trends towards increased relative use during 2020.

Fills for brand heart failure therapies

Our data also show that newer brand-name therapies (Farxiga, Jardiance, and Entresto) had a steep increase from expected trends, with increasing use throughout 2020. The marked increase may show that patients with heart failure or other cardiometabolic illnesses were able to access the latest advances in medical therapies, even during a public health crisis. 

Several reasons may have contributed to the increased use of newer therapies, even during the COVID-19 pandemic: 

• One such theory is the use of mail order pharmacies that could have facilitated continued access even during lockdown phases. 

• In addition, healthcare professionals may have restructured heart failure care using virtual pathways, without the need for in-person visits. 

• Finally, increasing awareness around best practices in heart failure care and emerging supportive clinical trial evidence may have also contributed to increased use.

Summing it all up

Overall, prescription fills of most established generic medications used in heart failure care were stable, while use of newer therapies (Farxiga, Jardiance, and Entresto) steeply increased during the pandemic. The data shows maintained access to evidence-based medications for heart failure despite concerns.

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Co-contributors: Jeroen van Meijgaard, PhD

Methodology

Using a sample of U.S. prescription fills, evidence-based heart failure medication fills (in 2-week intervals) in 2020 were indexed to comparable timeframes in 2019. Note, fills for carvedilol ER were combined with carvedilol and fills for metoprolol ER were combined with metoprolol. We normalized these year-over-year changes in heart failure medical therapies relative to those observed with a stable basket of drugs. We define the stable basket of drugs as a reference set of 859 drugs used in general medical practice that excludes seasonal drugs (e.g., oseltamivir). Data are presented as percent deviation from the expected year-over-year trends seen with this stable basket of drugs.

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Written by:

Diane Li

Diane Li is an analyst and writer on the Research Team at GoodRx. In her day-to-day work, she is responsible for using data to disentangle healthcare trends for data stories and reporting.

Edited by:

Tori Marsh, MPH

Tori Marsh is GoodRx’s resident expert on prescription drug pricing, prescribing trends, and drug savings. She oversees the GoodRx drug database, ensuring that all drug information is accurate and up to date.

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