What Does Entresto Cost in 2026? IRA Price, Generic Timing, and All Savings Options

Entresto (sacubitril/valsartan) is the first drug in a class called angiotensin receptor-neprilysin inhibitors (ARNIs). It is approved to reduce the risk of cardiovascular death and hospitalization in adults with chronic heart failure with reduced ejection fraction (HFrEF), typically New York Heart Association (NYHA) functional class II through IV. In 2021, the FDA also expanded approval to heart failure with mildly reduced or preserved ejection fraction in some patient groups. Entresto is manufactured by Novartis and has been one of the most prescribed brand-name drugs in the heart failure category since its 2015 approval.

The Inflation Reduction Act of 2022, signed on August 16, 2022, authorized CMS to directly negotiate drug prices with manufacturers for the first time in Medicare's history. Entresto was one of the first 10 drugs selected for Round 1 price negotiation. The negotiated Maximum Fair Price of $295 per month took effect January 1, 2026, representing a 53% drop from the pre-negotiation list price of approximately $628 per month. All Medicare Part D plans, including Medicare Advantage prescription drug plans (MA-PD), are required by federal law to apply this price at the pharmacy. For Medicare patients on Jardiance or Eliquis, those drugs also received IRA price reductions effective January 2026.

The generic question is resolved for most patients as of mid-2025. The FDA approved the first generic sacubitril/valsartan tablets in May 2024, but patent expirations and legal resolutions delayed commercial availability until July 2025. Multiple manufacturers, including Novadoz, Camber, Ascend, and Macleods, now produce sacubitril/valsartan in all three dosage strengths (24/26 mg, 49/51 mg, and 97/103 mg). With a GoodRx discount card, generic sacubitril/valsartan costs as low as $45 to $52 per 30-day supply at CVS and major chains. Brand-name Entresto Sprinkle capsules remain brand-only, but tablet-form patients have a low-cost generic alternative. Patients with low income can also check Medicaid income limits to see if they qualify for near-zero copays.

What Entresto Costs by Point of Pay (2026)

The price you pay depends almost entirely on WHERE you pay. The same entresto can cost many times more at a hospital than at your local pharmacy:

Why Hospitals Charge So Much

Entresto is an oral medication, not an injectable, so hospitals bill it differently than drugs like insulin or infused biologics. When a patient is admitted for heart failure, the hospital provides oral medications as part of the facility service. These appear on the itemized bill as discrete line items with a facility-level markup that can be 3x to 8x the pharmacy acquisition cost. A 30-day supply worth $60 to $90 at acquisition may generate a $500 to $1,100 inpatient charge when spread across a multi-day heart failure admission.

The hospital markup on oral medications is sometimes harder to dispute than on injectables, because hospitals argue the administration overhead applies even for a pill handed to a patient by a nurse. However, if Entresto appears on your bill at a price far above the pharmacy retail rate, you have standing to request an itemized bill review and compare the line-item cost to what the same drug costs at an outside pharmacy. Patients who qualify for Extra Help (the Medicare Low Income Subsidy) pay a much lower copay for prescription drugs including heart failure medications after a hospital discharge.

For patients transitioning from a heart failure hospitalization to outpatient care, the cost structure changes entirely. Outpatient Entresto is billed through Medicare Part D at the IRA-negotiated $295 maximum, or through a private plan at whatever tier the plan assigns. Given that generic sacubitril/valsartan is now available at $45 to $80 per month, most patients have a significantly cheaper alternative to the brand. Ask your cardiologist or discharge pharmacist whether the generic is appropriate for your dosing regimen before switching.

Patient Assistance Programs

Novartis offers two distinct programs depending on your insurance status. Commercially insured patients can access the copay savings card to cap their monthly cost at $10. Uninsured or underinsured patients who meet income criteria may receive free Entresto through the Novartis Patient Assistance Foundation (NPAF). The PAN Foundation also provides supplemental grants for heart failure patients who need additional help:

Medicare Part D

Entresto is covered under Medicare Part D (outpatient prescription drug benefit), not Part B. As an oral tablet taken at home, it does not receive a Medicare ASP payment rate or a HCPCS J-code. As of January 1, 2026, Entresto carries an IRA-negotiated Maximum Fair Price of $295 per month for Medicare Part D enrollees. This is not a monthly cap in the same sense as the $35 insulin cap. It is a negotiated ceiling price that all Part D plans must honor at the pharmacy counter. Your actual monthly out-of-pocket amount depends on your plan's cost-sharing structure and how much you have spent toward the 2026 annual Part D OOP cap of $2,100.

Medicare Part D enrollees who also qualify for Extra Help (the Low Income Subsidy) pay significantly less. The 2026 full Extra Help copay for brand-name drugs on a preferred tier is $12.15 per prescription. Part D enrollees who have not yet reached the $2,100 annual OOP cap pay their plan's cost-sharing percentage up to the MFP ceiling of $295. Once the $2,100 cap is reached, Medicare covers 100% of drug costs for the rest of the plan year. Patients considering switching from brand-name Entresto to generic sacubitril/valsartan should note that generic pricing on Part D plans may be lower than the brand MFP, depending on formulary tier assignment. Ask your pharmacist to compare the specific plan-level cost for both the brand and generic before filling.

Common Entresto Billing Errors

Entresto billing errors are most common during and after a heart failure hospitalization. The drug may appear on the inpatient bill, the discharge bill, and your first outpatient fill, creating duplicate or overlapping charges. Check for these specific issues:

• Charged for brand-name Entresto when the hospital dispensed generic sacubitril/valsartan (which carries a different NDC number but may be billed under the brand name)
• Inpatient facility rate applied to pills taken during a same-day observation status or outpatient visit (observation patients are not true inpatients and their drug billing rules differ)
• Duplicate billing: Entresto appears on both the inpatient facility claim and a separate outpatient pharmacy claim for the same time period after discharge
• Plan does not apply the IRA Maximum Fair Price of $295 at the pharmacy counter for Medicare Part D enrollees, charging a higher formulary tier rate instead
• Copay card applied to a Medicare or Medicaid claim, which is prohibited by federal anti-kickback statute and can result in claim rejection or fraud referral

Frequently Asked Questions