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Entresto is a brand of sacubitril / valsartan. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 2,507 of 5,492 Medicare Part D and Medicare Advantage drug plans (45.6%) list Entresto on their formulary, across 110 of 286 formularies. The most common placement is tier 3 (2,298 plans, 91.7% of those covering it). 91 of the covering plans require prior authorization (3.6%), 0 step therapy and 1,789 a quantity limit.
177 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $30, 52 of them $0; 2,330 charge coinsurance instead — median 20% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
Entresto has a Medicare negotiated price (maximum fair price) of $295 for a 30-day supply, which applies. The negotiated price lowers what the plan pays; the member's copay or coinsurance still follows the plan's tier.
2026: 5,496 of 5,496 plans covered it (100%); 2027: 2,507 of 5,492 (45.6%).
Of 4,367 plans offered in both years, 0 added it to the formulary and 2,543 dropped it.
Among plans covering it both years, 112 moved it to a higher tier and 25 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 37 |
| Tier 2 | 38 |
| Tier 3 | 2,298 |
| Tier 4 | 134 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 66 of 323 | 20.4% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,548 of 3,200 | 48.4% | 5.9% |
| Special needs plans (SNP) | 893 of 1,969 | 45.4% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 728 of 728 | Tier 3 | 0 |
| Aetna Medicare | 631 of 631 | Tier 3 | 0 |
| Wellcare | 0 of 268 | No tier listed | 0 |
| HealthSpring | 226 of 226 | Tier 3 | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 0 of 83 | No tier listed | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 4 | 80 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 3 | 0 |
| Wellpoint | 63 of 63 | Tier 3 | 0 |
| Priority Health Medicare | 40 of 40 | Tier 3 | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 36 of 36 | Tier 4 | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 29 of 29 | Tier 3 | 0 |
| Medica | 27 of 27 | Tier 3 | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 3 | 0 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 3 | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 69 of 114 | 60.5% |
| Alaska | 2 of 9 | 22.2% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 66 of 147 | 44.9% |
| Arkansas | 44 of 85 | 51.8% |
| California | 76 of 397 | 19.1% |
| Colorado | 46 of 106 | 43.4% |
| Connecticut | 32 of 54 | 59.3% |
| Delaware | 20 of 43 | 46.5% |
| District of Columbia | 3 of 12 | 25% |
| Florida | 246 of 545 | 45.1% |
| Georgia | 61 of 149 | 40.9% |
| Guam | 0 of 1 | 0% |
| Hawaii | 25 of 50 | 50% |
| Idaho | 12 of 45 | 26.7% |
| Illinois | 70 of 132 | 53% |
| Indiana | 72 of 138 | 52.2% |
| Iowa | 23 of 64 | 35.9% |
| Kansas | 37 of 84 | 44% |
| Kentucky | 46 of 121 | 38% |
| Louisiana | 50 of 125 | 40% |
| Maine | 19 of 52 | 36.5% |
| Maryland | 22 of 49 | 44.9% |
| Massachusetts | 57 of 89 | 64% |
| Michigan | 124 of 182 | 68.1% |
| Minnesota | 28 of 63 | 44.4% |
| Mississippi | 45 of 104 | 43.3% |
| Missouri | 90 of 170 | 52.9% |
| Montana | 3 of 27 | 11.1% |
| Nebraska | 20 of 51 | 39.2% |
| Nevada | 38 of 100 | 38% |
| New Hampshire | 7 of 25 | 28% |
| New Jersey | 29 of 73 | 39.7% |
| New Mexico | 19 of 68 | 27.9% |
| New York | 115 of 215 | 53.5% |
| North Carolina | 74 of 176 | 42% |
| North Dakota | 10 of 26 | 38.5% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 99 of 171 | 57.9% |
| Oklahoma | 24 of 81 | 29.6% |
| Oregon | 31 of 92 | 33.7% |
| Pennsylvania | 179 of 323 | 55.4% |
| Puerto Rico | 43 of 64 | 67.2% |
| Rhode Island | 8 of 29 | 27.6% |
| South Carolina | 35 of 89 | 39.3% |
| South Dakota | 16 of 30 | 53.3% |
| Tennessee | 81 of 156 | 51.9% |
| Texas | 190 of 407 | 46.7% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 18 of 53 | 34% |
| Vermont | 3 of 14 | 21.4% |
| Virginia | 51 of 144 | 35.4% |
| Washington | 38 of 114 | 33.3% |
| West Virginia | 30 of 69 | 43.5% |
| Wisconsin | 23 of 96 | 24% |
| Wyoming | 3 of 13 | 23.1% |
Medicare Part D paid for 6,531,140 30-day fills of Entresto in 2024 for about 795,090 enrollees, at an average total cost of $613.44 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Entresto and the rest of a client's list on every plan in their county.
Estimate Entresto costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.