Why Is Entresto So Expensive and How Can Patients Save Money?

Why Is Entresto So Expensive and How Can Patients Save Money?

Entresto (sacubitril/valsartan) is a widely prescribed medication for heart failure, but its high cost leaves many patients searching for more affordable options. With brand-name pricing often exceeding several hundred dollars per month, many wonder why Entresto is so expensive and whether there are ways to reduce the cost.

This article explores why Entresto is priced so high, when a generic version may become available, and potential cost-saving options for patients who rely on it.

Why Is Entresto So Expensive?

Entresto remains expensive because it is a brand-name medication protected by patents. Novartis, the manufacturer, holds exclusive rights to produce and sell Entresto, preventing generic competition in most countries.

Factors Affecting Entresto’s Cost

  • Patent Protection: Entresto is protected under multiple patents, delaying the release of generic versions. Some of these patents extend until at least 2025, while others may keep generic alternatives off the market even longer. Patents allow pharmaceutical companies to recoup research and development costs, ensuring they have a financial incentive to continue developing new medications.
  • New Drug Innovation: Entresto is a combination of two medications—sacubitril (a neprilysin inhibitor) and valsartan (an angiotensin receptor blocker). The combination was a breakthrough in heart failure treatment, allowing Novartis to set a high price based on its effectiveness in reducing hospitalizations and improving survival rates. Many brand-name medications with novel mechanisms tend to be expensive because they offer significant clinical benefits over older treatments.
  • Limited Generic Competition: Since Entresto is still under patent, no generic alternatives are currently available in the U.S., keeping prices high. Without competition, Novartis can maintain premium pricing, particularly since Entresto has been incorporated into many heart failure treatment guidelines.
  • Market Demand: Because Entresto has been proven to improve heart failure outcomes and reduce the risk of hospitalizations, demand remains high, allowing Novartis to continue charging a premium price. As heart failure is a chronic and progressive condition, patients often require long-term treatment, contributing to sustained high demand.
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When Will a Generic Version of Entresto Be Available?

A generic version of Entresto is expected to be available after 2025, depending on patent disputes and regulatory approvals. Some pharmaceutical companies have challenged Novartis’ patents, but even if legal battles clear the way for generics, it may take additional time before they become widely available.

Even after the initial release of a generic version, the cost savings may not be immediate. Some generics enter the market with only a slight discount at first, as competing manufacturers ramp up production. Over time, as more generic manufacturers receive FDA approval, prices may decrease more significantly.

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How Can Patients Save Money on Entresto?

While waiting for a generic version, patients can explore several ways to reduce the cost of Entresto and make treatment more affordable.

1. Manufacturer Savings Programs

Novartis offers a co-pay savings card for eligible patients, reducing out-of-pocket costs for those with commercial insurance. This program can significantly lower the cost for those who qualify. However, patients with Medicare, Medicaid, or other government-funded insurance programs may not be eligible for these savings.

  • Patients should check the official Novartis Entresto Savings Program to see if they qualify.
  • Some pharmaceutical savings programs require annual re-enrollment, so patients should track their eligibility to avoid unexpected costs.
  • These savings programs do not last indefinitely, so alternative savings strategies should also be considered.

2. Prescription Assistance Programs

For patients who do not qualify for manufacturer discounts, prescription assistance programs (PAPs) may be available through nonprofit organizations and charitable foundations.

  • Organizations like the PAN Foundation and RxAssist sometimes offer financial aid for eligible patients struggling with high medication costs.
  • Some programs require income-based eligibility, so patients should check the criteria before applying.
  • Other programs may provide temporary relief, covering costs for a set period.

3. Buying in Larger Quantities

Some pharmacies offer discounts on 90-day supplies rather than refilling prescriptions monthly.

  • If your insurance allows it, ordering in bulk can sometimes lower the overall cost per pill.
  • Patients who choose mail-order pharmacies through their insurance provider may also find cost reductions.
  • Long-term prescriptions can help reduce the frequency of refills, lowering costs associated with pharmacy dispensing fees.

4. Insurance Coverage Review

Insurance coverage for Entresto varies between different plans.

  • Some insurance companies place Entresto in higher-cost tiers, meaning patients pay more out of pocket.
  • Checking with an insurance provider about formulary changes or alternative coverage options may help reduce costs.
  • Some patients may need to request a prior authorization or a formulary exception to get better insurance coverage for Entresto.

5. Exploring Alternative Medications

For some patients, switching to an alternative heart failure medication may be a way to reduce costs. While Entresto is one of the most effective treatments for heart failure, other medications like:

  • Valsartan (an angiotensin receptor blocker)
  • Lisinopril (an ACE inhibitor)
  • Carvedilol (a beta-blocker)

may be options for those who cannot afford Entresto. However, these medications work differently, and patients should consult their doctor before making any changes to their treatment plan.

Is Entresto Worth the Cost?

Despite its high price, Entresto has been shown to:

  • Reduce heart failure hospitalizations
  • Improve heart function and quality of life
  • Extend life expectancy in many patients

Clinical trials have demonstrated that Entresto is more effective than traditional ACE inhibitors like enalapril. For many, the benefits outweigh the costs, making it a preferred option for heart failure management.

However, for those struggling with affordability, discussing cost-saving options with a doctor or pharmacist is essential to avoid treatment interruptions.

Final Thoughts

Entresto remains an expensive medication due to patent protections, market demand, and its effectiveness in treating heart failure. A generic version may not be available until after 2025, but patients can explore savings programs, alternative medications, and insurance strategies to reduce costs in the meantime.

For those who rely on Entresto, taking proactive steps to find financial assistance or alternative treatments can help ensure continued access to this important medication.

Reference:

ENTRESTO® supports your eligible heart failure patients with options to help them start and stay on treatment as prescribed