Your Patients Need Entresto — Here's How to Help Them Get It

You've optimized your patient's heart failure regimen and Sacubitril/Valsartan (Entresto) is a critical part of their guideline-directed medical therapy. But then the pharmacy calls: they don't have it in stock. Or worse — your patient simply goes without, and you don't find out until their next visit.

This guide provides practical, actionable steps you can take as a provider to help your patients maintain consistent access to Sacubitril/Valsartan in the current market environment.

Current Availability: What You Need to Know

As of early 2026, there is no FDA-listed shortage of Entresto or generic Sacubitril/Valsartan. The availability picture has broadly improved with the entry of multiple generic manufacturers following the July 2025 patent expiration.

However, localized stock-outs persist. Common scenarios include:

• Chain pharmacies in high-volume areas running out of the 97/103 mg strength
• Pharmacies caught between brand and generic inventory during the formulary transition
• End-of-month rushes depleting pharmacy stock when most patients fill prescriptions simultaneously
• Insurance-driven pharmacy switches where the new pharmacy doesn't anticipate the patient's medications

For a comprehensive overview of the supply situation, see our provider briefing on the Entresto shortage in 2026.

Why Patients Can't Find Their Medication

Understanding the root causes helps you counsel patients and implement solutions:

Brand vs. Generic Confusion

Patients may not realize that generic Sacubitril/Valsartan is the same medication as Entresto. If a pharmacy is out of the brand but has the generic, patients may leave empty-handed because they don't recognize the drug. Educating patients at the point of prescribing — "this may be filled as generic Sacubitril/Valsartan, and that's the same medication" — prevents this problem.

Prescription Restrictions

Prescriptions marked "dispense as written" (DAW) or specifying brand-name Entresto prevent pharmacists from substituting the generic. As pharmacies increasingly stock generic Sacubitril/Valsartan over brand Entresto, DAW prescriptions become harder to fill. Review and update prescriptions to allow generic substitution unless there's a specific clinical reason not to.

Insurance and Prior Authorization Barriers

Formulary changes are happening rapidly in 2026. Patients may encounter new prior authorization requirements, step therapy edits, or tier changes they weren't expecting. Your staff can proactively verify coverage before the patient arrives at the pharmacy by checking with the PBM or using electronic prior authorization (ePA) tools.

What Providers Can Do: 5 Actionable Steps

Step 1: Allow Generic Substitution on All Sacubitril/Valsartan Prescriptions

Unless there's a documented clinical necessity for brand-name Entresto, write prescriptions that allow generic substitution. This gives pharmacists the flexibility to fill with whichever version — brand or generic — they have in stock. It also typically lowers the patient's out-of-pocket cost.

Step 2: Integrate Pharmacy Stock-Checking into Your Workflow

Medfinder for Providers allows your clinical staff to check which pharmacies near your patient have Sacubitril/Valsartan in stock before writing the prescription. This is especially valuable for:

• Hospital discharge prescriptions (where filling delays can lead to readmissions)
• New starts on Sacubitril/Valsartan (where the patient hasn't established a pharmacy relationship for this medication)
• Patients reporting repeated stock-outs at their current pharmacy

Integrating a quick stock check into your prescribing workflow — even spending 30 seconds on Medfinder — can prevent days of patient frustration and medication gaps.

Step 3: Proactively Address Prior Authorization

Don't wait for a pharmacy rejection. When starting a patient on Sacubitril/Valsartan or when they report insurance changes:

• Verify PA requirements with the patient's plan before prescribing
• Submit ePA concurrently with the prescription
• Document the clinical rationale (LVEF, NYHA class, prior ACE inhibitor/ARB use) in the PA submission
• Have your staff follow up within 48 hours if approval hasn't been received

Step 4: Educate Patients About the Generic

At every prescribing touchpoint, tell patients:

• Generic Sacubitril/Valsartan is the same medication as Entresto
• It's FDA-approved and bioequivalent
• It costs significantly less ($45–$255/month vs. $600–$700/month for brand)
• If a pharmacy says they don't have "Entresto," patients should ask specifically about "Sacubitril/Valsartan"

Step 5: Have a Bridge Plan Ready

For patients who face extended delays filling Sacubitril/Valsartan, have a documented bridge protocol:

• First-line bridge: Valsartan 80-160 mg twice daily (the ARB component of Entresto, no washout required when switching from Sacubitril/Valsartan)
• Alternative bridge: Enalapril 10-20 mg twice daily or another evidence-based ACE inhibitor (requires 36-hour washout from Sacubitril/Valsartan)
• Document the plan: Note in the chart that this is a temporary bridge pending Sacubitril/Valsartan availability, with a plan to transition back

For a full discussion of alternative medications, see alternatives to Entresto.

Alternative Therapy Considerations

If a patient needs a true long-term alternative to Sacubitril/Valsartan (not a temporary bridge), consider the following within the RAAS inhibitor pillar of GDMT:

• ACE inhibitors: Enalapril (most evidence), Lisinopril, or Ramipril — cost-effective and well-studied in HFrEF, though inferior to ARNI therapy per PARADIGM-HF
• ARBs: Valsartan, Losartan, or Candesartan — for patients intolerant of ACE inhibitors (cough, angioedema)

Regardless of the RAAS inhibitor chosen, ensure the other three GDMT pillars are optimized: evidence-based beta blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor. For eligible patients, plan to transition back to Sacubitril/Valsartan when access improves.

Workflow Tips for Your Practice

• Add a pharmacy verification step to your heart failure clinic visit template — check that the patient's pharmacy stocks their current medications before they leave
• Use 90-day prescriptions where insurance allows — fewer fills means fewer stock-out encounters
• Flag patients on Sacubitril/Valsartan in your EHR for proactive outreach when supply disruptions are reported
• Build a list of reliable pharmacies in your area that consistently stock Sacubitril/Valsartan — share this with patients
• Designate a medication access coordinator (if resources allow) to handle PA submissions, stock inquiries, and savings program enrollment for your heart failure population

Final Thoughts

Medication access shouldn't be a barrier to optimal heart failure therapy. By proactively addressing availability and cost issues, updating prescribing practices for the generic era, and leveraging tools like Medfinder for Providers, you can help ensure your patients maintain uninterrupted access to this critical therapy.

For the broader clinical picture, see our companion article: Entresto shortage: What providers and prescribers need to know in 2026. For patient-facing resources you can share, visit how to find Entresto in stock near you.