Entresto may be covered by a Medicare Part D plan or a Medicare Advantage plan that includes drug coverage. There is no single coverage rule or price that applies to every plan. Each plan has a formulary, which is its list of covered drugs.
How Part D coverage works
Check the plan’s current formulary for both the brand name Entresto and its active ingredients, sacubitril and valsartan. A plan may place the drug on a particular cost-sharing tier. It may also use prior authorization, quantity limits, or step therapy. These rules can change at the start of a new plan year and in certain permitted situations during the year.
Original Medicare Parts A and B do not generally cover prescriptions that a person fills at a retail or mail-order pharmacy. Part B covers a limited group of drugs given in certain medical settings. Entresto used at home is generally handled through Medicare drug coverage rather than Part B.
Costs and coverage requests
The amount paid depends on the plan, pharmacy, drug tier, supply length, and the person’s current Part D spending stage. The price can also differ between preferred and nonpreferred network pharmacies. A plan’s online formulary and pharmacy directory should be checked together.
If the plan does not cover the drug, or applies a rule that cannot be met, the enrollee or prescriber may request a coverage determination or formulary exception. The prescriber generally must provide a supporting statement explaining why the requested drug is medically necessary. Approval is not guaranteed.
What to do next
- Use the exact drug name, dose, quantity, and pharmacy when checking coverage.
- Ask the plan whether prior authorization, step therapy, or a quantity limit applies.
- Ask the pharmacy for the plan price before filling the prescription.
- If coverage is denied, read the denial notice and discuss the plan’s exception process with the prescriber.
- Review Medicare’s guidance on drug formularies and plan coverage rules.
Sources
Coverage and costs can change each calendar year. Check current Medicare rules and current plan documents before receiving care. A provider’s estimate is not a Medicare coverage decision. Final payment depends on the claim and the applicable coverage requirements.
Last reviewed: August 2026. Medicare rules and plan benefits can change.