Is Entresto Covered by Insurance or Medicare? What to Do If It's Too Expensive

Is Entresto Covered by Insurance or Medicare? What to Do If It’s Too Expensive

Entresto (sacubitril/valsartan) is a life-saving heart failure medication, but its price can make it difficult for many patients to afford. Whether you’re covered by Medicare, private insurance, or paying out of pocket, it’s important to understand your options and how to access Entresto at a more affordable cost.

This guide covers insurance coverage basics, savings programs, and alternative ways to reduce your cost, especially if you’re struggling to get this important medication covered.

Medicare Coverage for Entresto

Medicare Part D plans do cover Entresto, but the out-of-pocket cost varies depending on your plan and the tier Entresto is placed in. Some plans cover Entresto under a preferred brand tier, while others may require prior authorization or step therapy.

Even with Medicare coverage, patients can face copays ranging from $100 to over $400 per month, especially during the coverage gap (donut hole).

If you’re unsure about coverage, you can:

  • Review your Medicare Part D plan’s formulary
  • Use Medicare’s plan finder tool
  • Ask your pharmacist to check your copay under your current plan

Private Insurance and Entresto

Private or employer-based insurance plans may also cover Entresto, but again, benefits vary:

  • Some plans place Entresto in a higher tier, leading to higher copays.
  • Prior authorizations may be required, where your doctor must confirm medical necessity.
  • Patients may also be required to try other medications (like ACE inhibitors or ARBs) before approval.

Check your policy or call your insurance company to confirm coverage specifics.

Entresto Co-Pay Cards and Assistance Programs

If you have commercial insurance, Novartis (the manufacturer of Entresto) offers a co-pay savings card that can reduce your cost to as low as $10 per month.

However, this card is not available to patients with Medicare, Medicaid, or other government healthcare programs, due to federal regulations.

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What If You’re Paying Out of Pocket?

If you’re uninsured, underinsured, or have a high deductible plan, the retail cost of Entresto in the U.S. can be unaffordable, often $500 or more per month.

One cost-saving strategy is ordering Entresto from Canada, where the price is significantly lower. For example:

  • Entresto 24/26 mg (30 tablets) starts at $146.95 when ordered through a Canadian prescription referral service like Over the Border Meds.

This option may be helpful for patients who are paying entirely out of pocket or have limited pharmacy benefits.

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Tips for Making Entresto More Affordable

Even if you’re insured, you can try the following strategies to lower your cost:

  • Ask your doctor about alternatives:
    If Entresto isn’t covered, some patients may be prescribed an ARB (like valsartan) combined with other heart failure therapies. While not as effective as Entresto, they may be more affordable.
  • Look for pharmacy discount programs:
    Some pharmacies participate in savings programs (like GoodRx or Inside Rx) that can reduce the cost, even if you’re not using insurance.
  • Consider a 90-day supply:
    If your plan allows it, getting a larger supply may reduce your monthly cost and provide convenience.
  • Use a Canadian prescription referral service:
    This is especially useful for cash-paying patients. Medications are shipped directly to your U.S. address with a valid prescription.

FAQ: Entresto, Insurance, and Costs

Is Entresto covered by Medicare?
Yes, Entresto is typically covered under Medicare Part D plans, but the cost can be high depending on the plan and tier. Some patients may face prior authorization requirements.

How much does Entresto cost without insurance?
In the U.S., a one-month supply of Entresto can cost over $500 without insurance. Prices vary depending on the strength and pharmacy.

Is there a coupon for Entresto?
Yes, Novartis offers a savings card that may reduce your copay to $10 per month, but only for patients with private insurance, not those on Medicare or Medicaid.

Can I buy Entresto from Canada?
Yes, patients in the U.S. can order Entresto from Canada using a valid prescription. Services like Over the Border Meds offer Entresto starting at $146.95 for 30 tablets of 24/26 mg.

Is there a generic version of Entresto?
As of now, there is no FDA-approved generic for Entresto in the U.S. or Canada. The brand remains under patent protection.

Disclaimer: This article is for informational purposes only and not medical advice. Consult a licensed healthcare provider before starting or changing medications. Use reputable, licensed pharmacies to ensure safety.