Entresto Medicare Prescription Coverage

In this article...
  • Entresto is a prescription medication that's often recommended for individuals with chronic heart failure, and Medicare may help cover its costs. Learn more.

Heart failure is a serious and sometimes chronic medical condition that affects approximately 6.2 million adults in the United States each year. In people with heart failure, the heart continues to beat, but it cannot pump enough blood to properly maintain the body's other organs. Medical conditions that may increase an individual's risk of developing heart failure include a history of coronary artery disease, valvular heart disease, obesity and diabetes. Heart failure can be treated and managed by making dietary changes, limiting excess fluid intake, using a defibrillator or pacemaker and taking medications such as Entresto. 

Does Medicare Cover Entresto?

Entresto is covered 100% by both Medicare Advantage plans and Medicare Part D plans. Specific coverage options can vary based on factors such as plan availability and geographical location, and copay and deductible costs are determined by an individual's specific coverage stage. For beneficiaries in the deductible stage, all prescription costs must usually be paid out of pocket until the deductibles are met. When a Medicare recipient completes the deductible stage, they're typically required to pay a copayment or coinsurance percentage for all prescriptions. 

At full cost, the price of Entresto ranges between $42 and $676.59. When paying a coinsurance percentage or copay, Medicare recipients should expect to pay between $1 and $11 per prescription.

How Does Entresto Work?

Entresto contains two medications - sacubitril, a blood pressure medication, and valsartan, an angiotensin receptor blocker that helps prevent narrowing of the blood vessels. Entresto is prescribed to adults with chronic heart failure, and its unique combination of medications works together to help lower the risk of hospitalization and death as an individual's heart failure symptoms worsen. Entresto is available in tablet and powder form, and it's typically taken on a twice-daily basis. When taken as directed, Entresto may help reduce strain on failing heart muscles and improve the heart's ability to properly pump blood. 

Is Entresto Used as a Blood Pressure Medication?

While Entresto is commonly prescribed to treat different types of heart failure, it is also sometimes recommended for individuals with high blood pressure due to its sacubitril (blood pressure medicine) content. However, Entresto may cause blood pressure to drop too low in certain people, so it's essential for individuals using the medication to treat high blood pressure to discuss all potential risks and side effects with their primary care physicians.

Can Entresto Help People Live Longer?

While specific results can vary depending on the overall age, health and diagnoses of individuals taking Entresto, research has shown that using Entresto instead of ACE inhibitor medication may help prolong life by 1 to 2 years when taken as directed. Additional studies have shown that Ernesto may also help prevent over 28,000 deaths due to heart failure in the United States each year. 

Does Entresto Cause Any Adverse Effects?

Some common side effects of Entresto include light-headedness and extreme exhaustion or tiredness and high potassium levels in the body, which can cause muscle weakness and a slow heart rate. People taking Entresto may also experience signs of kidney problems, such as painful or reduced urination and swollen feet and ankles. 

Which Drugs Interact With Entresto?

Certain ACE inhibitor and ARB medications may increase the risk of higher potassium levels in the blood when taken with Entresto, leading to low blood pressure and angioedema (swelling beneath the skin). Entresto may also interact with aspirin, potassium chloride, ibuprofen, insulin and methadone. This is only a partial list of medications that may cause adverse reactions when taken with Entresto, so it's always a good idea to consult with a medical professional regarding all potential interactions and dosage recommendations.

What Are the Stages of Heart Failure?

The four stages of heart failure are Stage A, Stage B, Stage C and Stage D:

  • Stage A: Referred to as pre-heart failure, Stage A heart failure indicates an individual is at high risk for developing heart failure. People with conditions such as high blood pressure, coronary artery disease, alcoholism and diabetes are sometimes considered high risk or Stage A, and the progression to heart failure can often be prevented with lifestyle changes and medications. 
  • Stage B: Stage B heart failure is still in the pre-heart failure category, but at this point, the heart may start to show signs of structural problems and an inability to pump blood as it should. At this stage, dietary and lifestyle changes are recommended, and surgical procedures may be necessary to replace heart valves and clean out artery blockages. 
  • Stage C: Stage C heart failure refers to weakening of the left ventricle, which can cause a host of uncomfortable symptoms such as shortness of breath and edema. Diuretic medications may be prescribed at this point, and surgery may also be necessary. 
  • Stage D: Stage D heart failure means that the heart has significant structural damage. Certain treatments may not be helpful at this point, and individuals with Stage D heart failure are often hospitalized for extended lengths of time. Treatment options for this stage include heart transplant surgery and continuous medication infusions. 
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