# Impact of Restrictive Drug Coverage Policies on Heart Failure Care

> **NIH NIH K23** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2024 · $198,936

## Abstract

PROJECT SUMMARY
 Despite proven benefits, many patients with heart failure with reduced ejection fraction (HFrEF) are not
prescribed life-saving, guideline-recommended medications. This gap in prescribing occurs in up to 75% of
eligible patients, leading to an estimated 68,000 preventable deaths per year nationwide. Moreover, patients
often do not consistently adhere to these life-saving medications up to 60% of the time. A major reason for
these gaps in prescribing and adherence may due to be restrictive coverage policies, such as cost-sharing
(patients pay out of pocket through copayment or co-insurance), and prior authorization (providers required to
justify use of a medication before it is covered). These policies can have harmful effects when applied to life-
saving therapies. For example, high out-of-pocket costs can result in reduced medication adherence, or may
worsen inequities by differentially impacting vulnerable populations. Moreover, physicians are often unaware of
these policies’ existence or magnitude, and often do not discuss cost with their patients, despite the majority of
patients wanting their providers to initiate this conversation.
 We propose to utilize a large, integrated database combining publicly available insurance formulary
information, electronic health record (EHR) data, pharmacy data, and neighborhood-level census information.
In Aim 1, we will use this database to quantify the effects of restrictive drug coverage policies for guideline-
recommended HFrEF regimens on provider prescribing, patient adherence, and clinical outcomes. In Aim 2,
we will develop models to ascertain whether certain vulnerable subgroups of patients with HFrEF are at higher
risk of negative impacts of these policies. Finally, in Aim 3, we will use implementation science methodologies
to develop and pilot-test an EHR-embedded intervention that will identify patients at risk for coverage-related
barriers, and promote discussions between physicians and patients on cost-related barriers and alternatives.
 This proposal addresses the NHLBI strategic vision by investigating differences among populations,
optimizing implementation research, and leveraging opportunities in data science. Moreover, the proposed
research and training plan will advance Dr. Mukhopadhyay as an independent investigator in cardiovascular
health services research. Specifically, this proposal will allow her to develop proficiency in quasi-experimental
methods, master skills required for integrated population database analysis, acquire content expertise in health
equity research, and cultivate competency in implementation science methods. Dr. Mukhopadhyay’s
interdisciplinary mentorship team unites established investigators with expertise in large population database
analysis, advanced quasi-experimental methods, health equity research, implementation science, EHR-based
research, and cardiovascular medicine. This team will guide Dr. Mukhopadhyay towards her goal of becoming
an...

## Key facts

- **NIH application ID:** 10984164
- **Project number:** 1K23HL171636-01A1
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** Amrita Mukhopadhyay
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $198,936
- **Award type:** 1
- **Project period:** 2024-08-05 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10984164

## Citation

> US National Institutes of Health, RePORTER application 10984164, Impact of Restrictive Drug Coverage Policies on Heart Failure Care (1K23HL171636-01A1). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10984164. Licensed CC0.

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