Sacubitril / valsartan (Entresto)

How Medicare covers it

Part D (tablets and sprinkle pellets taken at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Lowers the risk of death from heart problems and of hospital stays for heart failure in adults with chronic (long-term) heart failure, with the clearest benefit in patients whose heart pumps out a below-normal share of blood with each beat (left ventricular ejection fraction below normal). It also treats symptomatic heart failure with left-sided pumping weakness in children 1 year of age and older. It is sold as the brand-name product Entresto.

What it is for, in depth

Entresto is a brand-name combination tablet — sacubitril plus valsartan, a type of drug called an ARNI — for chronic heart failure. In adults the labeled use is to reduce the risk of cardiovascular death and hospitalization for heart failure, with benefits most clearly seen when the heart's ejection fraction is below normal. In children 1 year and older it treats symptomatic heart failure with systemic left ventricular systolic dysfunction. The adult dose starts at 49 mg/51 mg twice a day and is raised every 2 to 4 weeks toward 97 mg/103 mg twice a day. Two safety rules shape its use: a 36-hour gap is required when switching to or from an ACE inhibitor, and it must be stopped as soon as pregnancy is detected because of the boxed warning on fetal harm.

How it works

Entresto combines two drugs. Sacubitril blocks an enzyme called neprilysin, which normally breaks down helpful peptides such as natriuretic peptides; blocking it raises their levels, which helps the heart and blood vessels. Valsartan is an angiotensin receptor blocker (ARB): it blocks the angiotensin II type-1 receptor, stopping angiotensin II from tightening blood vessels, and it also lowers release of aldosterone. Together the two actions ease the strain on a failing heart.

How it is taken

Film-coated tablets of sacubitril/valsartan 24 mg/26 mg, 49 mg/51 mg, and 97 mg/103 mg, taken by mouth twice a day. For adults, the usual starting dose is 49 mg/51 mg twice a day, doubled after 2 to 4 weeks to the target dose of 97 mg/103 mg twice a day, as tolerated. The starting dose is halved for people not already taking an ACE inhibitor or ARB (or taking only a low dose), for severe kidney impairment, and for moderate liver impairment. It also comes as sprinkle pellets in capsules (6 mg/6 mg and 15 mg/16 mg) that are opened and sprinkled on 1 to 2 teaspoons of soft food, mainly for children; the capsules themselves are not swallowed. Never take it within 36 hours of an ACE inhibitor dose.

Common side effects

The side effects that occurred in 5% or more of patients in the main adult trial were low blood pressure (hypotension, 18%), high potassium (hyperkalemia, 12%), cough (9%), dizziness (6%), and kidney failure (5%). Falls and feeling dizzy on standing were also reported more often than with the comparison drug.

Serious warnings

The boxed warning is about harm to an unborn baby (see boxed_warning). Other serious warnings are angioedema — sudden swelling of the face, lips, tongue, or throat that can block the airway and can be fatal; the rate was higher in Black patients (2.4%) than in non-Black patients. Low blood pressure can occur, especially in people who are low on fluid or salt, such as those on high doses of water pills. Kidney function can worsen, at times to kidney failure, and potassium can rise too high; blood tests for kidney function and potassium should be checked, especially in people with kidney problems, diabetes, or a high-potassium diet.

Boxed warning

BOXED WARNING — FETAL TOXICITY: When pregnancy is detected, discontinue Entresto as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Who should be careful

Do not take it if you are allergic to any of its components, if you have had angioedema from an earlier ACE inhibitor or ARB, with an ACE inhibitor, or with aliskiren if you have diabetes. Do not take it during pregnancy, and breastfeeding is not recommended during treatment. Be careful if you have kidney or liver problems (use is not recommended in severe liver impairment, and the starting dose is halved for severe kidney impairment), low blood pressure, high potassium, or narrowed kidney arteries. It should not be used in patients with hereditary angioedema.

Major interactions

Never combine it with an ACE inhibitor — the risk of angioedema is higher, and a 36-hour washout gap is required when switching between the two. Do not use it with another ARB, since Entresto already contains the ARB valsartan. Use with aliskiren is not allowed in people with diabetes and should be avoided in people with kidney impairment. Potassium-sparing water pills (such as spironolactone, triamterene, or amiloride), potassium supplements, and salt substitutes with potassium can push potassium too high. NSAID pain relievers (including COX-2 inhibitors) can worsen kidney function, especially in older, fluid-depleted, or kidney-impaired patients. Lithium levels and lithium toxicity can rise when the two are used together.

Why it is in its tier

Sacubitril-valsartan is most often placed on Tier 3 in 2027 Medicare Part D formularies — the modal tier, used by about 80.47% of listing plans — and every plan in the data lists it (100%). Tier 3 is the preferred brand tier with mid-level copays, which fits Entresto's status as a brand-name product. The CMS Part D dashboard put average program spending for Entresto at $5,055.16 per beneficiary for 2024, a high cost level. That dashboard figure is a program average, not your copay. The tier shown is the most common one; individual plans vary, so check your own plan's formulary.

Sources

• ENTRESTO (SACUBITRIL AND VALSARTAN) TABLET, FILM COATED ENTRESTO (SACUBITRIL AND VALSARTAN) PELLET [NOVARTIS PHARMACEUTICALS CORPORATION] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Valsartan and Sacubitril

What official patient guides say

The combination of valsartan and sacubitril comes as a tablet and as a sprinkle capsule to take by mouth, with the tablets usually taken twice a day with or without food and the sprinkle capsules mixed with food and taken twice a day, at around the same times every day. If you miss a dose, take it as soon as you remember it, but if it is almost time for the next dose, skip the missed dose and do not take a double dose. Keep the medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture, not in the bathroom.

Source: MedlinePlus — Valsartan and Sacubitril

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 11.59231 per unit (ENTRESTO 24 MG-26 MG TABLET) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 5,495 list Sacubitril / valsartan (Entresto) — 100% of plans. Most of those plans put it on Tier 3: 4,422 plans, 80.5% of the plans that list it. Other plans place it on Tier 2 (893 plans), Tier 1 (144 plans) or Tier 4 (36 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 3; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 3; Aetna Medicare Value Plus (PPO) puts it on Tier 3. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.