Does Medicare Part D cover Entresto?
Coverage, cost, and 2026 details for Entresto (sacubitril/valsartan) under Medicare Part D.
Quick answer: Yes, Entresto is generally covered by Medicare Part D plans, typically on Tier 3 (preferred brand). Coverage details, copays, and restrictions vary by plan, so compare plans available in your area to find the best coverage for your medications.
What is Entresto?
Entresto (sacubitril/valsartan) is a twice-daily oral medication for chronic heart failure. It's been shown in clinical trials to reduce the risk of cardiovascular death and hospitalization for heart failure compared to older treatments. Entresto is one of the 10 Medicare-negotiated drugs.
Is Entresto covered by Medicare Part D?
Entresto is covered by most Medicare Part D plans on Tier 3 (preferred brand) or Tier 4. The Medicare negotiated price reduces the list price by 53% starting January 2026. Many plans require prior authorization, often confirming a heart failure diagnosis.
Typical formulary tier
Entresto is most often listed on Tier 3 (preferred brand) of Part D formularies. The exact tier — and the copay — depends on the specific plan you're enrolled in.
How much does Entresto cost with Medicare Part D?
Without insurance, Entresto costs around $625 per month before negotiation at retail pharmacies. With Medicare Part D coverage, you typically pay Lower in 2026 due to negotiation; typically $30 to $300 per month before the $2,100 cap.
Your actual cost depends on:
- Your plan's deductible — up to $615 in 2026
- The tier Entresto is on in your plan's formulary
- Whether you've reached the $2,100 annual out-of-pocket cap
- Whether you qualify for Extra Help (Low-Income Subsidy)
- Whether you've enrolled in the Medicare Prescription Payment Plan (M3P), which spreads costs across the year
2026 Medicare-negotiated price
Entresto is one of the 10 drugs whose prices were negotiated by Medicare under the Inflation Reduction Act. Starting January 1, 2026, the negotiated price reduces the Medicare list price by 53%.
This negotiated price is what Medicare pays to the manufacturer. Your specific copay depends on your plan's tier structure and where you are in the Part D coverage phases. The negotiation is expected to flow through to lower costs for many enrollees, especially as plans adjust their formularies and tiers for 2026.
See all 10 negotiated drugs and 2026 prices →
How to lower your Entresto costs
1. Compare Part D plans for your specific drugs
The same drug can cost dramatically different amounts on different plans. During the Annual Enrollment Period (October 15 – December 7), use the Medicare.gov Plan Finder to compare what Entresto would cost across every plan available in your ZIP code.
2. Check if you qualify for Extra Help
If your income is below approximately $23,475 (single) or $31,725 (married couple) in 2026, you likely qualify for Extra Help, which dramatically reduces what you pay for Entresto and all your medications. Learn about Extra Help →
3. Use the Medicare Prescription Payment Plan (M3P)
M3P doesn't lower your total cost, but it spreads your annual out-of-pocket costs into monthly installments — which can help if Entresto causes a big upfront pharmacy bill. Learn about M3P →
4. Look into Patient Assistance Programs
Novartis may offer a Patient Assistance Program for people with limited income who don't qualify for Extra Help. These programs can provide free or deeply discounted medication directly from the manufacturer. Learn more about manufacturer programs →
5. Ask about alternatives
Talk to your doctor about whether a different medication — including a generic version or a similar drug in the same class — would work for you.
Alternatives to Entresto
Other medications used for heart failure include:
- ACE inhibitors like lisinopril (generic)
- ARBs like losartan or valsartan (generic)
- Beta blockers (often used together with Entresto)
- SGLT2 inhibitors like Jardiance for heart failure
Always discuss any medication change with your prescribing doctor.
Key facts about Entresto on Medicare
- 53% Medicare price reduction starting January 2026
- Standard of care for many heart failure patients
- No generic available yet
Frequently asked questions about Entresto on Medicare
Does Medicare cover Entresto?
Yes, Entresto is generally covered by Medicare Part D plans, most often on Tier 3 (preferred brand). Coverage and costs vary between plans, so compare plans available in your area. Some plans require prior authorization.
How much does Entresto cost on Medicare Part D?
Costs typically range from Lower in 2026 due to negotiation; typically $30 to $300 per month before the $2,100 cap. Your actual cost depends on your plan's deductible, the tier Entresto is on, and whether you've reached the $2,100 annual out-of-pocket cap.
Is there a generic version of Entresto?
No, there is no generic version of Entresto currently available. Patent expirations and FDA approvals will eventually allow generics, but the timing varies. Talk to your doctor about other medications in the same class that may have generic options.
What if my Part D plan doesn't cover this drug?
You have several options: (1) Switch to a different Part D plan during Annual Enrollment that covers Entresto, (2) Request a formulary exception from your current plan with your prescriber's support, (3) Ask your doctor about a covered alternative medication, or (4) Look into the manufacturer's Patient Assistance Program if you have limited income.
Did Medicare negotiate the price of Entresto?
Yes. Entresto is one of the 10 drugs whose prices were negotiated by Medicare under the Inflation Reduction Act. Starting January 1, 2026, the negotiated price reduces the Medicare list price by 53%.
Compare your Part D options
Coverage and costs for this drug vary significantly between plans. Compare your options:
You can also visit Medicare.gov or call 1-800-MEDICARE