How much does Entresto cost with Medicare in New Jersey?

Entresto combines sacubitril with valsartan; it is an angiotensin receptor neprilysin inhibitor (ARNI) prescribed for chronic heart failure. It had the highest gross cost per fill of the heart medicines on these pages, $621.93 per 30-day fill in New Jersey in 2024, for 23,386 Part D members.

Entresto under Medicare Part D: price, generic approval and how use is shifting

Entresto	Amount
New Jersey Part D members who filled Entresto (2024)	23,386
New Jersey gross cost per 30-day fill (2024)	$621.93
New Jersey patient share per 30-day fill (2024)	$40.32
Medicare negotiated price, 30 days (2026 only)	$295
First generic approvals (FDA)	May 28, 2024
National brand claims, average per quarter of 2025	910,928
National brand claims, first quarter of 2026	122,111
Most common tier on renewing Part D plans for 2027 (national)	Tier 1 (4,029 of 4,748 plans)

Source: CMS Medicare Quarterly Part D Spending by Drug.

The generic is already changing the numbers

FDA approved the first generics of Entresto on May 28, 2024, from Alembic, Laurus Labs and Crystal Pharmaceutical, for lowering the risk of cardiovascular death and heart failure hospitalization in adults with chronic heart failure.

National CMS claims show brand Entresto use falling fast. Part D recorded 3,643,711 brand claims across 2025, about 910,928 a quarter, and only 122,111 in the first quarter of 2026. CMS determined in October 2025 that Entresto leaves the negotiation program effective January 1, 2027.

A worked year at the 2026 price

With the full $615 deductible and 25% coinsurance, January and February cost $295 each, March costs $92.50, and April through December cost $73.75 each, for $1,346.25 in 2026. That stays below the $2,100 cap on its own, but heart failure patients often take several medicines, and every covered Part D dollar counts toward the same cap.

If the January bill worries you, the Medicare Prescription Payment Plan would turn that first $295 into a bill of about $24.58, then about $51.40 in February, rising through the year as balances spread over fewer months.

Questions to ask about 2027

From January 1, 2027 the $295 negotiated price no longer applies, and your plan sets coverage for brand Entresto and generic sacubitril and valsartan. Ask three things: is the generic on the 2027 list, which tier is it on, and does the brand need a prior authorization or carry a higher tier. Also check your pharmacy is in network, since preferred pharmacies can price the same tier differently.

Lower-income help

Extra Help covers the drug deductible and limits brand copays to $14.40 and generic copays to $5.80 for 2027. A couple qualifies with up to $32,460 of income and $36,100 of resources in 2026. Medicare.gov also suggests asking the manufacturer whether it runs a patient assistance program.

Valsartan alone is not the same medicine

Valsartan by itself has long been sold as a generic for blood pressure, and some people ask whether it can stand in for Entresto. It cannot: the combination with sacubitril is what your cardiologist prescribed, and only your prescriber should change it. What you can do is ask for the generic of the exact combination, sacubitril and valsartan, in your current strength.

For scale, New Jersey enrollees spent $7,588,099 of their own money on Entresto during 2024, averaging $324.47 each, under the older rules. In 2024 the ceiling worked differently: once true out-of-pocket costs, which also counted manufacturer discounts, reached $8,000, enrollees entered catastrophic coverage and paid $0 for covered drugs for the rest of the year. The flat $2,000 yearly out-of-pocket cap began in 2025 (CMS CY 2025 Rate Announcement, Part D parameters table), and it is $2,100 in 2026 and $2,400 in 2027.

Leaving the hospital, and New Jersey help

Heart failure treatment often starts or changes during a hospital stay. Before you are discharged, ask the hospital pharmacist two questions: will the first fill be brand or generic, and is that version on my plan list?

Plan lists already lean generic: counting any version of sacubitril and valsartan, 4,029 of 4,748 renewing Part D plans nationwide place it on tier 1 for 2027, per CMS formulary files. If you qualify for New Jersey's PAAD program and choose Medicare Advantage, PAAD contributes up to the regional benchmark amount toward the drug part of your plan premium, and your copay is $5 for a covered generic (NJ Division of Aging Services).

Related questions

Sources

1. CMS Medicare Part D Prescribers by Geography and Drug, 2024 (New Jersey) Centers for Medicare & Medicaid Services
2. CMS fact sheet: negotiated prices for initial price applicability year 2026 Centers for Medicare & Medicaid Services
3. CMS: Selected drugs and negotiated prices Centers for Medicare & Medicaid Services
4. CMS Medicare Quarterly Part D Spending by Drug Centers for Medicare & Medicaid Services
5. Medicare.gov: How much does Medicare drug coverage cost? Centers for Medicare & Medicaid Services
6. FDA: 2024 First Generic Drug Approvals U.S. Food and Drug Administration
7. FDA Roundup: May 31, 2024 U.S. Food and Drug Administration
8. CMS Announcement of CY 2025 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies Centers for Medicare & Medicaid Services
9. Medicare.gov: Medicare Prescription Payment Plan, before using this payment option Centers for Medicare & Medicaid Services
10. Medicare.gov: Help with drug costs (Extra Help) Centers for Medicare & Medicaid Services
11. CMS Monthly Prescription Drug Plan Formulary and Pharmacy Network Information (CY2026 and CY2027 basic drugs formulary), with the CMS 2027 plan crosswalk Centers for Medicare & Medicaid Services
12. New Jersey Division of Aging Services: Pharmaceutical Assistance to the Aged and Disabled (PAAD) New Jersey Department of Human Services, Division of Aging Services

Please note: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.Garden State Medicare Solutions is not connected with or endorsed by the United States government or the federal Medicare program. Medicare has neither endorsed nor reviewed this information.