Cardiovascular disease (CVD) accounted for over 17.6 million deaths in 2016 and is expected to exceed 23.6 million by 2030. 1,2 Between 2014 and 2016, the direct and indirect costs associated with this burdensome disease reached $351.2 billion. CVD is a disease of concern, given the associated clinical and financial hardships. In October 2019, the Institute for Clinical and Economic Review (ICER) released a final evidence report on the effectiveness and value of 2 additive therapies used to reduce the risk of major adverse cardiovascular events (MACE): rivaroxaban and icosapent ethyl. Rivaroxaban, a direct-acting oral anticoagulant, has been approved as adjunct to aspirin to reduce the risk of MACE in patients with chronic coronary artery disease (CAD) or peripheral artery disease (PAD). 3 These indications are supported by the COMPASS trial, which showed that the combination of rivaroxaban and aspirin reduced the rate of MACE compared with aspirin alone. 4 Icosapent ethyl, an ethyl ester of eicosapentaenoic acid, was approved to reduce the risk of MACE among patients on statin therapy with elevated triglycerides and established CVD or at high risk for CVD. 5 The indication is supported by the REDUCE-IT trial, which showed icosapent ethyl reduced composite outcomes (cardiovascular death, myocardial infarction (MI), stroke, coronary revascularization, or unstable angina) versus placebo. 6 Rivaroxaban's COMPASS trial is representative of a Medicare population with CVD, with 75% of patients aged ≥ 65 years and taking multiple medications (e.g., angiotensin-converting enzyme inhibitors, beta blockers, and statins). 4 The reduction in the primary outcome yielded a number needed to treat of 76. Conversely, COMPASS found a 1.2% absolute increased risk in major bleeding, and a number needed to harm of 83 was reported. However, there was no significant difference in the rate of severe bleeding events. ICER reports with high certainty that rivaroxaban and aspirin "provides a small-to-substantial net health benefit in patients with CAD, PAD, or both