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

Provider Briefing: Entresto Availability in 2026

Sacubitril/Valsartan (Entresto) remains a cornerstone of guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction. But the drug's landscape has shifted significantly entering 2026 — with generic entry, Medicare price negotiation, and evolving insurance formularies all affecting how your patients access this medication.

This briefing covers what you need to know as a prescriber to keep your heart failure patients on optimal therapy without interruption.

Timeline: Key Events Affecting Entresto Access

• July 2015: FDA approves Entresto (Sacubitril/Valsartan) for HFrEF based on the PARADIGM-HF trial
• February 2021: FDA expands indication to include heart failure with preserved ejection fraction (HFpEF)
• June 2024: FDA approves first generic Sacubitril/Valsartan products
• July 2025: Entresto core U.S. patent expires; generic manufacturers begin distribution
• January 2026: Medicare negotiated maximum fair price (~$295/month) takes effect under the Inflation Reduction Act

These overlapping changes have created a dynamic availability picture that directly affects clinical practice.

Prescribing Implications

Generic Substitution Is Now Standard

Most pharmacy benefit managers (PBMs) and insurance formularies have begun favoring generic Sacubitril/Valsartan over brand-name Entresto. For most patients, this is a seamless transition — the generic is bioequivalent and available in all three strengths (24/26 mg, 49/51 mg, 97/103 mg).

Clinical consideration: If you're writing prescriptions with "dispense as written" (DAW) for brand-name Entresto, consider updating your prescribing practices to allow generic substitution. Patients with DAW prescriptions may face higher copays and more difficulty finding the medication in stock, as pharmacies increasingly stock the generic.

Formulary and Prior Authorization Changes

As generics have entered the market, some insurance plans have adjusted their prior authorization (PA) requirements:

• Some plans that previously required PA for Entresto have relaxed requirements for generic Sacubitril/Valsartan
• Other plans may now require step therapy through a generic ACE inhibitor or ARB before approving Sacubitril/Valsartan
• Medicare Part D plans are implementing the negotiated pricing structure, which may affect tier placement

Providers should verify current PA requirements when patients report difficulty filling prescriptions, as these are changing frequently in the current environment.

The 36-Hour Washout Rule Remains Critical

The mandatory 36-hour washout period between ACE inhibitor and Sacubitril/Valsartan therapy hasn't changed. With patients potentially switching between different medications during availability disruptions, reinforce this safety requirement with your clinical staff and patients. The risk of angioedema with concurrent or insufficiently spaced ACE inhibitor and ARNI therapy remains significant.

Current Availability Picture

As of early 2026, there is no FDA-listed shortage of Entresto or generic Sacubitril/Valsartan. Supply from multiple generic manufacturers has broadly improved availability compared to years past.

However, localized stock-outs continue to occur, particularly:

• At high-volume chain pharmacies in urban areas
• During the first week of the month (when most prescriptions are filled)
• For specific strengths — the 97/103 mg maintenance dose may be harder to find than the 24/26 mg or 49/51 mg starting doses

When patients report difficulty finding the medication, the issue is more often pharmacy-level inventory management than true supply shortage.

Cost and Access in 2026

The financial landscape for Sacubitril/Valsartan has improved substantially:

• Generic cash price: $45–$255/month depending on pharmacy and discount program
• Medicare negotiated price: ~$295/month maximum fair price (before patient cost-sharing)
• Medicare out-of-pocket cap: $2,000/year limit on Part D spending (effective 2025) provides additional protection
• Novartis Co-Pay Card: Still available for commercially insured patients; as low as $10/month (annual limit $4,100)
• Patient assistance programs: Novartis has begun phasing out its Patient Assistance Foundation program for Entresto as generics become available, directing qualifying patients to generic alternatives

For patients who remain on brand-name Entresto and face high costs, a provider-focused savings guide is available with detailed cost-reduction strategies.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder offers a provider-facing tool that helps clinical staff quickly identify pharmacies with Sacubitril/Valsartan in stock. This can be integrated into your discharge and prescribing workflow to proactively address availability before patients leave the office or hospital.

Patient Education Materials

Consider directing patients to the following resources:

• How to find Entresto in stock near you — practical tips for patients
• How to save money on Entresto — comprehensive savings guide
• Entresto side effects — what to expect and when to call
• Entresto drug interactions — important safety information for patients

Alternative Therapy Guidance

For patients who cannot access Sacubitril/Valsartan, current ACC/AHA/HFSA guidelines support the following substitutions within the RAAS inhibitor pillar of GDMT:

• ACE inhibitor (e.g., Enalapril, Lisinopril, Ramipril) — most evidence in HFrEF; observe 36-hour washout
• ARB (e.g., Valsartan, Losartan, Candesartan) — for ACE inhibitor-intolerant patients

Ensure the other three pillars of GDMT remain optimized: beta blocker (Carvedilol, Metoprolol Succinate, or Bisoprolol), mineralocorticoid receptor antagonist (Spironolactone or Eplerenone), and SGLT2 inhibitor (Dapagliflozin or Empagliflozin).

Looking Ahead

The Sacubitril/Valsartan market is expected to continue stabilizing through 2026 as:

• Additional generic manufacturers reach full production capacity
• PBMs and formularies finalize their generic-preferred strategies
• Medicare negotiated pricing becomes standard across Part D plans
• Supply chains adjust to the new multi-source manufacturing environment

For providers managing large heart failure populations, the key action items are: update prescriptions to allow generic substitution, verify current PA requirements proactively, and integrate pharmacy stock-checking tools like Medfinder into clinical workflows.

Final Thoughts

The shift to generic Sacubitril/Valsartan availability and Medicare price negotiation represents a meaningful improvement in patient access and affordability. However, the transition period requires vigilance to ensure your patients don't fall through the cracks.

Stay informed, proactively address prescription filling barriers, and leverage tools like Medfinder for Providers to help your patients maintain uninterrupted access to guideline-directed heart failure therapy.

For a practical step-by-step guide on supporting patients with Entresto access, see our companion article: How to help your patients find Entresto in stock.