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. In 2017, the ACC and a coalition of 16 medical or- ganizations called for reform of the prior authorization process and utilization management requirements that increase clinical workload and limit patient access to care (see: https://www.aacap.org/App_Themes/AACAP/docs/ homepage/2017/PA_Reform_Principles.pdf) (145). Managing approvals for medications may be time- consuming; tips for managing such processes are out- lined in Table 13. It is important to consider the cost-effectiveness of any new therapy to justify out-of-pocket costs. Cost- effectiveness analyses of sacubitril/valsartan and ivabra- dine showed an incremental cost-effectiveness ratio that compares favorably to other accepted CV therapies when they were rst adopted or approved (146 148). Pharma- cists can help navigate insurance coverage and patient assistance programs to make sure that patients have ac- cess to the appropriate medications. Standard requests through patient assistance programs allow for 90-day supplies with 3 re lls to provide coverage for 1 year. However, income veri cation and reordering procedures are among the most challenging aspects of patient assis- tance programs for patients and clinicians (149). Many pharmaceutical companies accept signed letters from clinicians indicating that the patient has no known in- come. This can be used in place of of cial income docu- mentation, although this option is not clearly apparent on many of the patient assistance program websites. Like- wise, patients and clinicians need to be cognizant of reordering procedures, which becomes especially impor- tant if doses are changed re lls/reorders are not always sent and, unfortunately, re lls/reorders cannot be requested before the 60-day post-approval date. 