Heart Failure
Heart failure is when your heart is no longer effectively pumping enough blood for the body’s needs. It can happen if the heart cannot fill up with enough blood, or if it is too weak to pump properly. More than six million adults in the US have heart failure.
Assistance Information
Dollar cap is shared across assistance types.
Other Insurance — Up to 500% FPL
| Assistance Type | Status | Max Amount |
|---|---|---|
| Copay | At Capacity | $6,500 |
| Medical Expenses | At Capacity | $6,500 |
| Travel Expense | At Capacity | $500 |
Private Insurance — Up to 500% FPL
| Assistance Type | Status | Max Amount |
|---|---|---|
| Copay | At Capacity | $6,500 |
| Medical Expenses | At Capacity | $6,500 |
| Premium | At Capacity | $6,500 |
| Travel Expense | At Capacity | $500 |
Diagnosis Codes
- I09.81 Rheumatic heart failure
- I11.0 Hypertensive heart disease with heart failure
- I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
- I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
- I50 Heart failure
- I50.1 Left ventricular failure, unspecified
- I50.2 Systolic (congestive) heart failure
- I50.20 Unspecified systolic (congestive) heart failure
- I50.21 Acute systolic (congestive) heart failure
- I50.22 Chronic systolic (congestive) heart failure
- I50.23 Acute on chronic systolic (congestive) heart failure
- I50.3 Diastolic (congestive) heart failure
- I50.30 Unspecified diastolic (congestive) heart failure
- I50.31 Acute diastolic (congestive) heart failure
- I50.32 Chronic diastolic (congestive) heart failure
- I50.33 Acute on chronic diastolic (congestive) heart failure
- I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure
- I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
- I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
- I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
- I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
- I50.8 Other heart failure
- I50.81 Right heart failure
- I50.810 Right heart failure, unspecified
- I50.811 Acute right heart failure
- I50.812 Chronic right heart failure
- I50.813 Acute on chronic right heart failure
- I50.814 Right heart failure due to left heart failure
- I50.82 Biventricular heart failure
- I50.83 High output heart failure
- I50.84 End stage heart failure
- I50.89 Other heart failure
- I50.9 Heart failure, unspecified
- I97.13 Postprocedural heart failure
- I97.130 Postprocedural heart failure following cardiac surgery
- I97.131 Postprocedural heart failure following other surgery
- O29.12 Cardiac failure due to anesthesia during pregnancy
Covered Medications
- DOBUTamine HCl
- DOBUTamine-Dextrose
- Milrinone Lactate
- Milrinone Lactate in Dextrose
- Nitroprusside Sodium
- Sodium Nitroprusside
- Nipride RTU
- Nitroprusside Sodium-NaCl
- Bicillin L-A
- Extencilline
- Lentocilin
- Penicillin G Benzathine
- Accupril
- Quinapril HCl
- Altace
- Ramipril
- Isoproterenol HCl
- aMILoride HCl
- Atacand
- Candesartan Cilexetil
- Eplerenone
- Inspra
- Aldactone
- CaroSpir
- Spironolactone
- Empagliflozin
- Jardiance
- Digitek
- Digox
- Digoxin
- Lanoxin Pediatric
- Lanoxin
- GoNitro
- Nitro-Bid
- Nitro-Dur
- Nitro-Time
- Nitroglycerin ER
- Nitroglycerin
- Nitrolingual
- NitroMist
- Nitrostat
- Nitroglycerin in D5W
- Kapspargo Sprinkle
- Metoprolol Succinate ER
- Metoprolol Succinate
- Toprol XL
- Carvedilol
- Coreg
- Carvedilol Phosphate ER
- Coreg CR
- Captopril
- Fosinopril Sodium
- Lisinopril
- Qbrelis
- Zestril
- Mavik
- Trandolapril
- Diovan
- Valsartan
- Bumetanide
- Bumex
- Enbumyst
- Edecrin
- Ethacrynic Acid
- Ethacrynate Sodium
- Sodium Edecrin
- Soaanz
- Torsemide
- Chlorothiazide
- Diuril
- Chlorothiazide Sodium
- Sodium Diuril
- Chlorthalidone
- Hemiclor
- Thalitone
- hydroCHLOROthiazide
- Inzirqo
- Indapamide
- Atorvaliq
- Atorvastatin Calcium
- Lipitor
- Corlanor
- Ivabradine HCl
- Vericiguat
- Verquvo
- Entresto
- Sacubitril-Valsartan
- BiDil
- Isosorb Dinitrate-hydrALAZINE
- Furoscix
- Furosemide
- Lasix ONYU
- Lasix
- aMILoride-hydroCHLOROthiazide
- Aldactazide
- Spironolactone-HCTZ
- Inpefa
- Sotagliflozin
- Enalapril Maleate
- Epaned
- Vasotec
- acetaZOLAMIDE ER
- acetaZOLAMIDE
- acetaZOLAMIDE Sodium
- Dyrenium
- Triamterene
- Finerenone
- Kerendia
- Dapagliflozin
- Farxiga
Resources
American Heart Association
The Mended Hearts, Inc. (MHI)
Heart Failure Society of America (HFSA)
Caregiver Resources
ARCH National Respite Network and Resource Center
National Alliance for Caregiving
Other Patient Assistance Organizations
Heart failure is when your heart is no longer effectively pumping enough blood for the body’s needs. It can happen if the heart cannot fill up with enough blood, or if it is too weak to pump properly. More than six million adults in the US have heart failure.
Assistance Information
Dollar cap is shared across assistance types.
Public Insurance — Up to 500% FPL
| Assistance Type | Status | Max Amount |
|---|---|---|
| Copay | At Capacity | $4,500 |
| Medical Expenses | At Capacity | $4,500 |
| Premium | At Capacity | $4,500 |
| Travel Expense | At Capacity | $500 |
Diagnosis Codes
- I09.81 Rheumatic heart failure
- I11.0 Hypertensive heart disease with heart failure
- I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
- I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
- I50 Heart failure
- I50.1 Left ventricular failure, unspecified
- I50.2 Systolic (congestive) heart failure
- I50.20 Unspecified systolic (congestive) heart failure
- I50.21 Acute systolic (congestive) heart failure
- I50.22 Chronic systolic (congestive) heart failure
- I50.23 Acute on chronic systolic (congestive) heart failure
- I50.3 Diastolic (congestive) heart failure
- I50.30 Unspecified diastolic (congestive) heart failure
- I50.31 Acute diastolic (congestive) heart failure
- I50.32 Chronic diastolic (congestive) heart failure
- I50.33 Acute on chronic diastolic (congestive) heart failure
- I50.4 Combined systolic (congestive) and diastolic (congestive) heart failure
- I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
- I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
- I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
- I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
- I50.8 Other heart failure
- I50.81 Right heart failure
- I50.810 Right heart failure, unspecified
- I50.811 Acute right heart failure
- I50.812 Chronic right heart failure
- I50.813 Acute on chronic right heart failure
- I50.814 Right heart failure due to left heart failure
- I50.82 Biventricular heart failure
- I50.83 High output heart failure
- I50.84 End stage heart failure
- I50.89 Other heart failure
- I50.9 Heart failure, unspecified
- I97.13 Postprocedural heart failure
- I97.130 Postprocedural heart failure following cardiac surgery
- I97.131 Postprocedural heart failure following other surgery
- O29.12 Cardiac failure due to anesthesia during pregnancy
Covered Medications
- DOBUTamine HCl
- DOBUTamine-Dextrose
- Milrinone Lactate
- Milrinone Lactate in Dextrose
- Nitroprusside Sodium
- Sodium Nitroprusside
- Nipride RTU
- Nitroprusside Sodium-NaCl
- Bicillin L-A
- Extencilline
- Lentocilin
- Penicillin G Benzathine
- Accupril
- Quinapril HCl
- Altace
- Ramipril
- Isoproterenol HCl
- aMILoride HCl
- Atacand
- Candesartan Cilexetil
- Eplerenone
- Inspra
- Aldactone
- CaroSpir
- Spironolactone
- Empagliflozin
- Jardiance
- Digitek
- Digox
- Digoxin
- Lanoxin Pediatric
- Lanoxin
- GoNitro
- Nitro-Bid
- Nitro-Dur
- Nitro-Time
- Nitroglycerin ER
- Nitroglycerin
- Nitrolingual
- NitroMist
- Nitrostat
- Nitroglycerin in D5W
- Kapspargo Sprinkle
- Metoprolol Succinate ER
- Metoprolol Succinate
- Toprol XL
- Carvedilol
- Coreg
- Carvedilol Phosphate ER
- Coreg CR
- Captopril
- Fosinopril Sodium
- Lisinopril
- Qbrelis
- Zestril
- Mavik
- Trandolapril
- Diovan
- Valsartan
- Bumetanide
- Bumex
- Enbumyst
- Edecrin
- Ethacrynic Acid
- Ethacrynate Sodium
- Sodium Edecrin
- Soaanz
- Torsemide
- Chlorothiazide
- Diuril
- Chlorothiazide Sodium
- Sodium Diuril
- Chlorthalidone
- Hemiclor
- Thalitone
- hydroCHLOROthiazide
- Inzirqo
- Indapamide
- Atorvaliq
- Atorvastatin Calcium
- Lipitor
- Corlanor
- Ivabradine HCl
- Vericiguat
- Verquvo
- Entresto
- Sacubitril-Valsartan
- BiDil
- Isosorb Dinitrate-hydrALAZINE
- Furoscix
- Furosemide
- Lasix ONYU
- Lasix
- aMILoride-hydroCHLOROthiazide
- Aldactazide
- Spironolactone-HCTZ
- Inpefa
- Sotagliflozin
- Enalapril Maleate
- Epaned
- Vasotec
- acetaZOLAMIDE ER
- acetaZOLAMIDE
- acetaZOLAMIDE Sodium
- Dyrenium
- Triamterene
- Finerenone
- Kerendia
- Dapagliflozin
- Farxiga
Resources
American Heart Association
The Mended Hearts, Inc. (MHI)
Heart Failure Society of America (HFSA)
Caregiver Resources
ARCH National Respite Network and Resource Center
National Alliance for Caregiving
Other Patient Assistance Organizations
