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
Check Your Specific Plan's Formulary
Coverage varies by plan. Use our formulary checker tool to look up your exact copay and restrictions.
Open Formulary CheckerSources and standards behind this page
Drug coverage in the United States is governed by published rules rather than by any one insurer's summary, and the sources below are the primary ones. They are linked so a reader can check a claim without taking this page's word for it.
- FDA Orange Book publishes the therapeutic-equivalence ratings that decide whether a generic may be substituted for a brand-name drug.
- FDA generic drug facts sets out what "generic equivalent" means and what a manufacturer must prove.
- CMS prescription drug coverage defines the rules a Medicare drug plan formulary must follow and how it may change mid-year.
- Medicare.gov drug coverage (Part D) states what a Part D plan is required to offer a member.
- CMS prescription drug appeals documents the coverage-determination and exception process when a drug is denied.
This page describes how coverage and formularies work. It is not medical advice, and a reader's own plan documents and prescriber decide what applies to them.
Frequently Asked Questions
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.
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 annual out-of-pocket cap (set at $2,000 in 2025 and indexed upward each year since), Medicare patients' Entresto costs are more manageable than in previous years.
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.
Related Resources
- Medicare Part D Formulary 2026
- UnitedHealthcare Formulary 2026
- Humana Formulary 2026
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