DeJong C, et al. - In view of the fact that more than 80% of deaths from heart failure happen in individuals older than 65 years, researchers investigated if high cost sharing or a lack of coverage could represent obstacles to the adoption of sacubitril/valsartan [an angiotensin receptor–neprilysin inhibitor (ARNI)] under Medicare Part D. Among new drugs, the first one to confer mortality benefit for heart failure with reduced ejection fraction (HFrEF) in more than a decade is sacubitril/valsartan. This drug was approved by US Food and Drug Administration in 2015 and was recommended by a class I American Heart Association/American College of Cardiology/Heart Failure Society of America guideline in 2016 because it caused 20% reduction in cardiovascular death vs enalapril in the Prospective Comparison of ARNI With ACEI (Angiotensin-Converting Enzyme Inhibitors) to Determine Impact on Global Mortality and Morbidity in Heart Failure (PARADIGM-HF) trial. However, sluggish clinical adoption is still an issue. As of 2016, less than 3% of patients with HFrEF received the drug.