First-line treatment of chronic heart failure (CHF) usually involves an angiotensin-converting enzyme (ACE) inhibitor, oral beta blocker, and oral diuretic. Second- or third-line treatments is often needed to better manage the disease. Physicians have numerous drug classes to choose from, most of which have many drug options. The CHF market is heavily genericized, as such physicians are less constrained by pricing pressures. The CHF Treatment Algorithm offers insight into prescribing patterns following the increase in generic drug availability. That said, there are a few branded agents that jostle for patient share in this crowded sector. Small patient shares for such a prevalent indication can translate into significant commercial positions.