sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto]
sacubitril
RxCUI: 1656356
What the CMS Formulary Data Shows for sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto]
Per the CMS 2026 Part D formulary file, sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] (RxNorm concept RXCUI 1656356, generic name sacubitril) appears on 74 distinct formulary files spanning 337 Medicare Part D plan offerings - 6.7% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.6.
Real-world access to sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 4.1% require step therapy. 97.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 663,587 Part D beneficiaries filled sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] in 2023, with total plan-and-beneficiary spending of $3,430,441,590 and an average per-beneficiary annual cost of $5,169.54. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] today.
Coverage Details
- Formularies covering
- 74
- Plans covering
- 337
- Coverage rate
- 6.7%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 4.1% of formularies
- Quantity limits
- 97.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 663,587
- Total spending
- $3,430,441,590
- Avg per beneficiary
- $5,169.54
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | DENVER HEALTH MEDICAL PLAN, INC. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | ALLCARE HEALTH PLAN, INC. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE | T1 | No | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $0 | AR |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
| Tribute Select (HMO-POS I-SNP) | ARKANSAS SUPERIOR SELECT, INC. | T1 | No | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | ATRIO HEALTH PLANS | T1 | No | $10.50 | OR |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $58.80 | NY |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T2 | No | $0 | CA |
| DualConnect (HMO D-SNP) | SANTA CLARA COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T2 | No | $0 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T2 | No | $51.60 | NY |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| MCS Classicare RxMax (HMO) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare Platino Ideal (HMO D-SNP) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare Efectivo (HMO) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare Essential (HMO-POS) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare Platino Progreso (HMO D-SNP) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare Primero (HMO C-SNP) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare Firme (HMO) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
| MCS Classicare En Tu Hogar (HMO) | MCS ADVANTAGE, INC. | T3 | No | $0 | PR |
Frequently Asked Questions
Is sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] covered by Medicare Part D?
Yes, sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] is covered by 337 Medicare Part D plans (6.7% of all Part D formularies).
What tier is sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] on Medicare Part D plans?
sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 6.
Does sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] require prior authorization?
0% of Part D formularies require prior authorization for sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto]. Step therapy: 4.1%. Quantity limits: 97.3%.
How much does Medicare spend on sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto]?
In 2023, total Medicare Part D spending on sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto] was $3,430,441,590, covering 663,587 beneficiaries. The average spend per beneficiary was $5,169.54.
Read our methodology - how this data is sourced, computed, and verified.