Entresto (sacubitril/valsartan) is a first-line treatment for heart failure with reduced ejection fraction (HFrEF) and is covered by most insurance plans. As a guideline-recommended therapy, coverage is generally favorable, though prior authorization is common. Entresto was selected for Medicare price negotiation under the Inflation Reduction Act.

Key Facts

Entresto is covered on most commercial and Medicare formularies as a preferred heart failure therapy
Selected for Medicare price negotiation under the IRA, with negotiated pricing effective 2026
Novartis offers a copay card reducing cost to $10/month for eligible commercially insured patients
Prior authorization typically requires documentation of heart failure diagnosis and ejection fraction
Without insurance, Entresto costs approximately $580 to $650 per month
Generic sacubitril/valsartan may enter the market in 2026 to 2027 based on patent timelines

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Frequently Asked Questions

Is there a generic for Entresto?

Generic sacubitril/valsartan products are expected to become available in the 2026 to 2027 timeframe. Several generic manufacturers have filed abbreviated new drug applications (ANDAs). When generics launch, costs should decrease substantially, and insurance coverage should improve with lower tier placements.

Does Medicare cover Entresto?

Yes, Medicare Part D covers Entresto for heart failure. The drug was selected for IRA price negotiation, which should lower costs for Medicare beneficiaries. Combined with the $2,000 annual out-of-pocket cap, Medicare patients' Entresto costs are more manageable than in previous years.

What if my insurance denies Entresto?

If denied, your doctor can submit an appeal with clinical documentation showing your heart failure diagnosis, ejection fraction, and why Entresto is medically necessary. Heart failure guidelines from the AHA/ACC recommend Entresto as first-line therapy for HFrEF, which strengthens your appeal. You can also request an external review if the internal appeal fails.

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