Does Medicare cover Entresto?
Heart failure happens when your heart can’t pump enough blood to your organs to function properly. Anybody can experience heart failure, but prevalence among people aged 65 and up is higher. For older adults, heart failure is one of the most common reasons for hospitalization.
The good news is there are prescriptions available to treat heart failure. Medicare Part D (prescription drug coverage) is responsible for covering these medications, and Entresto, one of the most popular options, is covered! Depending on your Part D coverage, you may have some out-of-pocket costs, but a prescription drug plan ensures that it won’t be too expensive.
Key takeaways:
100% of Medicare drug plans cover Entresto, but you may still owe something out of pocket.
Medicare Part D plans have varying costs, including premiums, deductibles, copayments, and coinsurance. You'll have to check your drug plan's summary of benefits to understand your costs for specific drugs.
While every drug plan is different, you can expect to pay between $10-$11 for Entresto if you haven’t yet met your deductible. Once you reach your deductible, your copayment or coinsurance will likely be between $0 and $12.
The Inflation Reduction Act enabled Medicare to negotiate pricing for some prescription drugs on behalf of Medicare beneficiaries. Entresto is one of the first ten drugs that Medicare is negotiating prices for.
What is Entresto?
Entresto is a prescription medication that treats chronic heart failure and other related conditions, like congestive heart failure (CHF). The drug is available in both powder and tablet forms, and doctors typically recommend taking it twice a day. Your dosage will depend on your health condition.
Entresto lowers your risk of hospitalization and severe complications from chronic heart failure. It has two active ingredients: sacubitril and valsartan. Sacubitril also treats high blood pressure by reducing sodium levels. Doctors also prescribe Entresto for people who need to manage blood pressure. Valsartan helps to improve your blood flow and makes it easier for your heart to pump blood to your organs.
Does Medicare cover Entresto?
Yes, 100% of Medicare drug plans cover Entresto. Even so, you may have out-of-pocket costs associated with your Part D. These costs can include:
The monthly premium for your drug plan
An annual deductible, which can’t exceed $545 in 2024 and could be as low as $0
Copayments or coinsurance for covered drugs (once you reach your deductible)
What your specific out-of-pocket costs are will vary depending on your drug plan.
Soon, you may pay even less for Entresto and some of the other drugs you need. The Inflation Reduction Act enabled Medicare to negotiate pricing for some prescription drugs on behalf of Medicare beneficiaries. Entresto is one of the first ten drugs that Medicare is negotiating prices for.
Does Medicare Part D cover Entresto?
Here’s a breakdown of what you can generally expect to pay for Entresto with Medicare Part D. Remember, your specific drug plan will ultimately determine your costs for Entresto.
If you have not yet met your deductible for a drug plan, you’ll pay between $10-$11 for Entresto.
If you’ve met your deductible, your copayment or coinsurance will be $0-$12.
People with chronic heart failure may be using additional medications to treat their health conditions. While Entresto is covered by Medicare, your Part D plan’s formulary is the best place to check coverage for other drugs.
Finding the right plan for drug coverage
Finding the right drug plan for your needs involves careful consideration of your healthcare and financial needs. For people with chronic heart problems, paying extra attention to what medications you need covered is essential.
Comparing drug plan coverage can feel overwhelming, especially if you need coverage for multiple prescriptions. You don’t have to do it alone! Our licensed Medicare Advisors will take note of your prescription needs and quickly compare plans to find the lowest cost option for you. Call us at 855-900-2427 today or schedule a time to speak with us soon to get free, personalized advice.