Does anyone understand negotiated prices Entresto?

[billgrantham]

I read in many places that Entresto (among other drugs) must be included in the formularies of Medicare Part D providers, that there is a negotiated maximum out of pocket cost for Entresto, and that there is a cap of $2100 for out of pocket expenses for Part D covered drugs in 2026.

No plans that I can find in northeast Florida include Entresto in their formularies

I have no idea what Entresto is going to cost

If I use some kind of drug discount plan I have no sure way of knowing how much Entresto will cost, or if that cost will be included in the $2100 limit.

Where can I get answers to these questions?

[GailL1]

@billgrantham 

Come back to add:  look it up under it’s chemical name - sacubitril / valsartan

and I just used a Jacksonville, FL zipcode and there were several plans that covered it - 

Start your search here on Medicare . gov - use both the brand and chemical name of Entresto plus any other drugs you might take 

Medicare.gov - Find a Drug Plan - Part D 

But then check it’s inclusion on the actual insurer’s site as a double check.

It is covered on (at least) this plan in FL (what part of FL, IDK) but I will assume that it is available in your area. Probably on other plan formularies - I just don’t know what is available to you in your area. 

AARP® Medicare Rx Saver from UHC (PDP)- here is the formulary:

AARP® Medicare Rx Saver from UHC (PDP)- Complete Drug List (Formulary) 2026 

see page 59

Entresto is a cardio vascular agent - that’s it’s classification and it is available as:

Drug name	Brand / Generic	Tier	Coverage rules / limits on use
Entresto (Oral Capsule Sprinkle)	Brand	3	QL
Entresto (Oral Tablet)	Brand	3	QL

Yes, Entresto ( sacubitril/valsartan ) was among the drugs that were negotiated for a new price in 2024 - effective 01/2026 on this drug

CMS.gov - Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability... 

Drug	Company	Use	Neg. 30 day Price 2026	List Price 30-day 2023	Discount
Entresto	Novartis Pharms Corp	Heart Failure	$ 295	$ 628	53%

Your price should be $ 295 for a 30-day supply but note there is also a QL on this formulary from AARP UHC Rx.  

You know how this works with your 2026 deductible and out of pocket max?  

Do you already have a Plan in place for 2026?

However, I also read that Entresto will no longer be part of the Medicare Drug Price Neg Program beginning in 01/2027 because it is highly expected to be replaced by a generic or bio similar drug in 2027 or 2028.  However, if a lower price is accomplished during 2025 on the brand then Medicare beneficiaries will get this in January 2027 and it will remain until a generic or biosimilar has become effective. 

[TRL1111]

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@billgrantham wrote:

No plans that I can find in northeast Florida include Entresto in their formularies

I have no idea what Entresto is going to cost

---

Entresto now has a generic available.  Have you tried using that in your search for Part D plans on medicare.gov?  You don't even have to know the name--when I entered "Entresto" as a drug on my list, I got a pop-up window allowing me to enter the generic instead.

I added both the name brand and the generic to my list and ran a search, and no plans in the Jacksonville zip code I used had the name brand on the formulary, but did have the generic.  

As for the negotiated price, I have no idea how any of that works, but I do know it's only for the name brand.  Entresto was put on that list before the generic became available in pharmacies a few months ago.  

The negotiated price for name-brand Entresto I saw is $3,500/year.  But on the Medicare.gov plan finder, the generic would cost $800/year (including paying the $615 deductible) with a $0 premium Wellcare plan.    

It would be even cheaper through GoodRx or CostPlus, but any time you buy a drug without having your insurance involved, whatever you pay does not count toward the $2,100 out-of-pocket maximum.  Only drugs the insurance company covers count toward that (and the drug doesn't have to be on the formulary--if a drug isn't on the formulary but the insurance company grants an exception and covers it, it does count toward the out-of-pocket maximum).  

All that said, the open enrollment period during which you can change your Part D prescription drug plan ended in December.  Unless I'm misunderstanding your situation, you have to keep your current Part D plan for the rest of 2025, and can't change it until open enrollment at the end of the year.  In which case you only have to find out what it costs under the plan you have.  Once you know that, you can decide whether going outside your insurance to one of the many discount prescription companies is worth it, considering that nothing you pay to them will go toward the $2,100 out-of-pocket maximum.

[nctarheel]

Well, everybody's situation is different so I thought I'd throw my 2 cents in with my experience with ENTRESTO. I started taking it last year. Until I reached the $2000 max, I was paying $40 per month for the branded ENTRESTO through my Medicare Advantage Plan. Once I reached the max, I paid ZERO for the rest of the year. Toward the end of the year, I was informed that, startingt 1/1/26, ENTRESTO was going to require advance approval by the insurance, was also going to go to a a higher tier on the formulary, and the advice was to use the generic which had received FDA approval mid-2025. I have now switched to the generic which is $10 a month in my plan. The name is what @gail1 noted above.