Entresto Shortage: What Providers and Prescribers Need to Know in 2026

Sacubitril/valsartan (Entresto) is now the cornerstone of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction. As prescribing volumes rise and the drug navigates a complex brand-to-generic transition, clinicians are increasingly fielding calls from patients who cannot fill their prescriptions. This 2026 update is designed to give prescribers and care teams a clear picture of what's happening and how to support affected patients.

Current Supply Status: No Formal Shortage, but Real-World Gaps Exist

As of 2026, sacubitril/valsartan is not listed on the FDA Drug Shortage Database. However, the brand-to-generic transition that began with FDA approval of generic sacubitril/valsartan in May 2024 and culminated in broad generic availability after the July 2025 Novartis patent expiration has created meaningful disruption.

The practical effects your patients may be experiencing include:

Pharmacy-level stocking gaps (brand available, no generic — or vice versa)

Insurance rejections when the plan has shifted to requiring generic dispensing

Prior authorization delays at pharmacies newly added to the drug's coverage criteria

Regional variation — some markets have good generic supply, others lagging

Why Sacubitril/Valsartan Is Vulnerable to Supply Disruptions

The unique co-crystal molecular architecture of sacubitril/valsartan — in which the two active pharmaceutical ingredients are co-crystallized in a precise 1:1 supramolecular complex — makes manufacturing more demanding than conventional fixed-dose combinations. Bioequivalence requirements for generic manufacturers add additional technical complexity and can slow initial production scale-up. As multiple generic manufacturers (Novadoz, Camber, Ascend, Macleods) mature their processes throughout 2026, supply stability is expected to improve.

Clinical Considerations: Managing Patients During Supply Gaps

When a patient reports being unable to fill their sacubitril/valsartan prescription, consider the following clinical pathway:

Confirm whether brand vs. generic is driving the problem. If the patient is on a brand-specific prescription, consider switching to DAW-0 (dispense as written = off) so pharmacies can substitute the generic. Generic sacubitril/valsartan is FDA-approved as bioequivalent in all three strengths.

Check insurance step therapy status. Many plans require step therapy (documented failure of ACE inhibitor or ARB). If prior authorization is pending or denied, expedited PA appeals are possible when you can document LVEF <40% and prior therapy failure or intolerance.

For short gaps: maintain the rest of quadruple therapy. Ensure the patient continues their beta-blocker, MRA, and SGLT2 inhibitor during any gap in ARNI therapy. Do not stop all four drugs.

For longer gaps (>2 weeks): consider bridging with ACE inhibitor or ARB. Remember the mandatory 36-hour washout period before restarting sacubitril/valsartan after any ACE inhibitor use. Carefully document the switch in the chart.

Provide samples when possible. Novartis provides a copay savings card for commercially insured patients (as low as $10/month, up to $4,100/year) that can resolve affordability barriers while you await prior auth decisions.

Insurance Navigation: Key Points for Prescribers in 2026

Documentation that strengthens prior authorization appeals for sacubitril/valsartan:

LVEF measurement (echocardiogram or nuclear study) showing reduced ejection fraction (<40%)

NYHA functional class classification (II, III, or IV)

Documentation of prior ACE inhibitor or ARB trial, with reason for failure or intolerance

Letter of medical necessity explaining why sacubitril/valsartan is preferred over alternatives

Patient Financial Assistance Resources

Novartis Copay Savings Card: For commercially insured patients — as low as $10/month (not valid for Medicare/Medicaid). Annual combined limit of $4,100.

PAN Foundation: Grants of up to $2,400/year when funding is available. Eligibility based on income and insurance status.

Novartis Patient Assistance Program: For uninsured or underinsured patients who meet income criteria — may provide Entresto at no cost.

Medicare negotiated price: Approximately $295/month for Part D beneficiaries starting in 2026, with the $2,000 annual OOP cap.

How medfinder Can Support Your Patients

medfinder is a service that contacts pharmacies on behalf of patients to locate which ones have sacubitril/valsartan in stock and can fill the prescription. For practices managing large heart failure panels, recommending medfinder to patients experiencing fill difficulties can save your care team significant time. See our provider guide to helping patients find Entresto in stock for more detail.