For example, diabetes is present in over 40% of all patients with HF, and polypharmacy for diabetes treat- ment is also growing rapidly (143). Cost Reduction Measures: A variety of cost reduction measures should be considered in patients with HF (Table 12). Whenever possible, generic equivalents for GDMT should be considered. Pricing for common generic HF drugs (digoxin, carvedilol, and lisinopril) varies J Maddox et al. widely, even within a limited geographic area (144). This variability in pricing could potentially have negative im- plications for adherence, encouraging patients to shop around for the best price, increasing time and travel costs, and leading patients to obtain drugs at multiple pharmacies. The use of multiple pharmacies prevents the ef ciencies of having a single pharmacist overseeing all of a patient s medications, identifying potential drug in- teractions, performing medication synchronization, and assessing adherence, as well as providing disease man- agement programs and ensuring that vaccinations are current. As such, patients and clinicians should be encouraged to work with pharmacists, social workers, and/or patient navigators to help identify copay assis- tance programs and request price matching, when possible, should another pharmacy be found to have the medication at a lower cost. In addition, price-checker tools (e.g., GoodRx) can be used to assist patients in locating the retailers with the lowest cost medications. Medication Access Measures: Newer HFrEF therapies are often expensive, with higher monthly costs and copays, and frequently more time and effort are required to obtain them. For example, prior authorization from payers is often required before these medications will be covered, which can serve as a signi cant barrier to GDMT. 