How much does Entresto cost with Medicare in Colorado?

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, $613.55 per 30-day fill in Colorado in 2024, for 6,257 Part D members. CDC PLACES estimates that 4.7% of Adams County adults have coronary heart disease.

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

Entresto	Amount
Colorado Part D members who filled Entresto (2024)	6,257
Colorado gross cost per 30-day fill (2024)	$613.55
Colorado patient share per 30-day fill (2024)	$50.32
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

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, Colorado enrollees spent $2,469,773 of their own money on Entresto during 2024, averaging $394.72 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 with a new Entresto prescription

Heart failure treatment often starts or changes during a hospital stay. If you are discharged from Intermountain Health Platte Valley Hospital in Brighton, HCA HealthOne Mountain Ridge in Thornton or another Medicare-certified hospital nearby, ask the discharge pharmacist two questions before you go home: will the first fill be brand or generic, and is that version on my plan list?

Related questions

Sources

1. CMS Medicare Part D Prescribers by Geography and Drug, 2024 (Colorado) 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. CDC PLACES: Local Data for Better Health, County Data (2025 release) Centers for Disease Control and Prevention
12. CMS Hospital General Information (Provider Data Catalog), Colorado Centers for Medicare & Medicaid Services

Please note: We do not offer every plan available in your area. Currently we represent 10 organizations which offer 106 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.Headwaters Health and Wealth is not connected with or endorsed by the United States government or the federal Medicare program. Medicare has neither endorsed nor reviewed this information.