Key Takeaways
- Medicare Part A should cover Entresto when administered during an inpatient hospital stay.
- Medicare Part D prescription drug plans can provide coverage for Entresto, but costs will depend on the plan’s deductible and where it falls on the plan provider’s formulary (drug list).
- Medicare Advantage (Part C) plans with prescription drug coverage will cover Entresto in the same way as Original Medicare and Part D, but costs vary depending on the specific plan’s premiums, deductibles, and network.
Entresto is a brand-name prescription medication containing sacubitril and valsartan. The
According to the U.S. Office of Health Policy, beneficiaries paid an average of $357 out-of-pocket for Entresto in 2022. This was the overall average for the year, not per month.
Beneficiaries who received a low-income subsidy paid an average of $25. Beneficiaries who did not receive a low-income subsidy paid an average of $569.
As part of the Inflation Reduction Act of 2022, Medicare can negotiate the cost of some medications, and Entresto was selected as one of the drugs to be cost-negotiated for 2026. This will hopefully mean that, starting in 2026, costs will not exceed $295 for a 30-day supply.
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Medicare Part A covers inpatient hospital care you may need at a general hospital, rehabilitation center, or other approved facility. This includes administering Entresto and other necessary medications during an inpatient stay.
If you don’t meet the criteria for premium-free Part A, in 2025 you’ll pay $285 or $518 each month. Here are the other basic costs for an inpatient hospital stay in 2025:
- $1,676 deductible for each benefit period
- $0 coinsurance for days 1 to 60 of treatment after you pay your deductible
- $419 coinsurance per day for days 61 to 90 of treatment
- $838 coinsurance per day for days 91 to 150 of treatment, while using your 60 lifetime reserve days
- 100% of the treatment costs for days 151 and over
Medicare Advantage (Part C) is a bundled alternative to Original Medicare, but it must offer the same inpatient and outpatient benefits. Private insurance companies administer these plans.
Many Medicare Advantage plans also include Part D prescription drug coverage.
Each plan sets its own cost and coverage amounts. The premiums, deductibles, copayments, and coinsurance amounts you’ll pay will depend on your chosen plan.
With Medicare Advantage plans, staying in network — which means getting care from a list of approved healthcare professionals and facilities, including pharmacies — generally costs less than going out of network.
Once you reach the plan’s out-of-pocket maximum, Medicare Advantage plans will typically cover 100% of eligible costs for the rest of the calendar year.
If you are not enrolled in a Medicare Advantage plan that includes drug coverage, you can purchase a stand-alone prescription drug plan to use alongside Original Medicare. As with Medicare Advantage, private insurance companies administer Part D plans, and each plan sets its own costs and coverage amounts.
After you pay your plan’s deductible — up to $590 in 2025 ($615 in 2026) — you will pay a 25% coinsurance toward the cost of your prescription medications until you reach a total of $2,000 in out-of-pocket expenses. This amount will increase to $2,100 in 2026.
After this, catastrophic coverage kicks in and you won’t pay anything for Entresto and other covered prescriptions for the rest of the calendar year.
Part D plans typically have a drug list called a formulary in which insurers categorize drugs into different tiers. More affordable medications are often on lower tiers.
Entresto is usually considered a tier 3 medication, although some insurance plans include it under tier 2. It ultimately depends on whether your plan considers Entresto a preferred or nonpreferred brand-name medication. However, as generic versions are now available, there may be more affordable options available.
You may be eligible for financial assistance for Part D costs through Medicare’s Extra Help program.
Original Medicare Part A and Medicare Advantage plans cover Entresto during an inpatient stay.
If you are prescribed Entresto to take home, you will need coverage for take-home prescription medications, which usually comes from Medicare Part D prescription drug plans.
Medicare Advantage plans often include Part D coverage, and if you have Original Medicare, you can purchase a stand-alone Part D prescription drug plan. Both plans may cover Entresto.