Medicare Part D usually covers Entresto. However, the exact cost of Entresto can vary. In 2022, according to the most recent data, the annual out-of-pocket cost for Entresto for people with Medicare was $357.
Sacubitril-valsartan (Entresto) is the first medication with Food and Drug Administration (FDA) approval in a class of drugs called angiotensin receptor neprilysin inhibitors (ARNIs). It is only available as a brand-name drug. No cheaper generic alternative is available.
Entresto helps manage chronic heart failure by reducing the effort necessary for the heart to pump blood around the body.
This article explains how much a person with Medicare Part D typically pays for Entresto.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
According to the Centers for Medicare & Medicaid Services (CMS), beneficiaries paid $357 out of pocket for Entresto in the 2022 calendar year. This would be just below $30 per month.
This may have increased since, but newer data are not currently available. Entresto’s manufacturer, Novartis, maintained in August 2023 that Medicare beneficiaries pay no more than $50 monthly for an Entresto prescription.
However, it is important to note that the actual cost of Entresto can depend on factors such as:
- the individual plan’s formulary
- which drug benefit phase a person is in and whether they have reached catastrophic coverage
- which pharmacy a person uses
- whether an individual qualifies for the Extra Help program
Learn more about the costs of Entresto.
Medicare Part D covers Entresto. Many privately administered Medicare Advantage plans also include prescription drug benefits in their coverage.
In addition to the out-of-pocket costs for Entresto, a person will need to pay Part D costs if they enroll alongside Original Medicare (parts A and B). Costs of Medicare Advantage can vary depending on the specific plan.
Medicare Part D coverage in 2024 moves through four different stages that affect what a beneficiary pays:
- Beneficiaries will need to meet a deductible each year. In 2024, the highest deductible allowed for Medicare Part D is $545.
- After a person meets their deductible, they must pay coinsurance or copayment for each prescription. This can vary throughout the year. For example, a manufacturer may increase the price of a drug.
- After a person and the plan spend $5,030, the individual is then liable for a maximum of 25% of prescription drug and dispensing fee costs until their out-of-pocket spending reaches $8,000. This is known as the coverage gap. The manufacturer pays 70% of a drug’s price, and the plan pays 5%.
- After reaching $8,000 in out-of-pocket spending, an individual pays nothing for their prescription medications until the plan restarts in the next calendar year.
In 2025, a beneficiary will spend no more than $2,000 out of pocket for medications under Medicare Part D, down from $8,000 in 2024.
Learn more about Medicare Part D costs.
Entresto is a tier 3 medication under Part D, meaning that Medicare considers it a nonpreferred, brand-name prescription medication for which beneficiaries pay a higher copayment.
A doctor can request an exception by writing to the insurer, which may secure a lower copay or coinsurance for Entresto if no alternative is suitable.
For many medications, people can take a generic, unbranded version instead, which costs much less. However, Ernesto only has the brand-name version available.
Learn more about Medicare drug lists.
The list price, or the cost for which the manufacturer sells the drug, per month is currently $688.01, according to the manufacturer’s website.
Without insurance coverage, paying the list price for Entresto would cost more than $8,000 per year.
However, Entresto’s pricing can depend on several factors, including:
- the price decided by the dispensing pharmacy
- whether a person uses any savings programs
- a beneficiary’s required dosages, as
different dosages can have different prices
Several different programs are available to help with the costs of Entresto, including:
- Entresto Enspire: Individuals without insurance may qualify for the Entresto Enspire program, which provides Entresto for a $10 copay in some instances. It also offers a free 30-day trial and manufacturer assistance program. People can contact 888-368-7378 or visit the Entresto site for an eligibility assessment.
- Medication support websites: Sites such as Medicine Assistance Tool and NeedyMeds can connect users with drug assistance programs and savings cards.
- Medicare Extra Help: This supports drug costs for people with limited resources.
A person may automatically qualify for Medicare Extra help if they:
- get full Medicaid coverage
- already receive help paying their Part B premiums
- receive supplemental security income (SSI) from Social Security. Other people may need to apply.
Extra Help reduces the copay and coinsurance per drug, and pays for the premium and deductible for a drug plan. Individuals can contact 1-800-MEDICARE (1-800-633-4227) to learn more about Extra Help and whether they qualify.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part D pays for Entresto as a tier 3 medication, which may be subject to higher copayments or coinsurance than drugs in lower tiers. Medicare Advantage plans with drug coverage will also cover Entresto.
Out-of-pocket costs may vary depending on factors such as the individual’s dosage and pharmacy pricing.
Support for Entresto costs may be available through the Entresto Enspire program, sites such as NeedyMeds and Medicine Assistance Tool, and Medicare Extra Help.