Comprehensive medication guide to Sacubitril/Valsartan including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
As low as $10/month for commercially insured patients with the Novartis copay savings card; approximately $295/month for Medicare Part D beneficiaries under the IRA negotiated price effective 2026. Tier 3 (non-preferred brand) on most Part D plans without exception.
Estimated Cash Pricing
$45–$255 per 30-day supply for generic sacubitril/valsartan without insurance; as low as $45–$52 with GoodRx or SingleCare at major pharmacies. Brand-name Entresto runs $600–$700 per 30-day supply without insurance.
Medfinder Findability Score
72/100
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Sacubitril/valsartan (brand name: Entresto) is a prescription heart failure medication combining two active ingredients into a unique twice-daily tablet. It is the first and only FDA-approved angiotensin receptor-neprilysin inhibitor (ARNI) in the United States, approved on July 7, 2015. Manufactured by Novartis Pharmaceuticals Corporation, Entresto generated $7.8 billion in global sales in 2024.
Sacubitril/valsartan is FDA-approved to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with chronic heart failure and reduced ejection fraction (HFrEF), and for symptomatic heart failure in pediatric patients aged 1 year and older with systemic left ventricular systolic dysfunction. Generic sacubitril/valsartan was FDA-approved in May 2024 and began reaching pharmacy shelves in July 2025 from multiple manufacturers including Novadoz, Camber, Ascend, and Macleods Pharma.
Approximately 6 million Americans live with heart failure, and current ACC/AHA guidelines recommend sacubitril/valsartan as the preferred ARNI in the guideline-directed medical therapy (GDMT) quadruple therapy regimen for HFrEF, alongside a beta-blocker, mineralocorticoid receptor antagonist, and SGLT2 inhibitor.
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Sacubitril/valsartan works through a unique dual mechanism that no other heart failure drug replicates. Sacubitril is a prodrug converted in the body to its active form, LBQ657, which inhibits neprilysin — an enzyme that breaks down beneficial natriuretic peptides (ANP, BNP) and other vasoactive peptides. By blocking neprilysin, sacubitril allows natriuretic peptides to remain active longer, promoting vasodilation, natriuresis (sodium excretion), diuresis (water excretion), and anti-fibrotic effects on the heart.
Valsartan, the ARB component, blocks the angiotensin II receptor to prevent vasoconstriction and aldosterone release, reducing afterload and sodium retention. The two components are inseparable: sacubitril cannot be used alone because neprilysin inhibition also reduces angiotensin II breakdown, raising angiotensin II levels. Valsartan blocks these elevated angiotensin II receptors, preventing RAAS activation while natriuretic peptides accumulate.
In the landmark PARADIGM-HF trial, sacubitril/valsartan reduced the composite endpoint of cardiovascular death or heart failure hospitalization by 20% compared to enalapril, with cardiovascular mortality reduced by 20% and all-cause mortality reduced by 16%. These results established it as the preferred ARNI over ACE inhibitors in current heart failure guidelines.
24 mg/26 mg — tablet
Starting dose for patients not currently on ACE inhibitor or ARB, or those with low blood pressure
49 mg/51 mg — tablet
Starting dose for patients switching from an ACE inhibitor or ARB
97 mg/103 mg — tablet
Target maintenance dose (twice daily)
6 mg/6 mg — Sprinkle capsule (oral pellets)
Pediatric dosing — sprinkle on food
15 mg/16 mg — Sprinkle capsule (oral pellets)
Pediatric dosing — sprinkle on food
As of 2026, sacubitril/valsartan is not on the FDA Drug Shortage Database. The overall supply outlook has improved significantly with multiple generic manufacturers now producing all three strengths (24/26 mg, 49/51 mg, and 97/103 mg). However, the brand-to-generic transition that began after the May 2024 FDA approval of generics and the July 2025 Novartis patent expiration created a transitional period of real-world availability gaps.
Some patients still encounter difficulty filling prescriptions because individual pharmacies may stock brand or generic but not both, insurance plans may be shifting coverage mid-plan year, or local supply chains are still ramping up. The drug's technically complex co-crystal manufacturing process makes it somewhat more vulnerable to production disruptions than simpler generic drugs.
If your pharmacy is out of stock, medfinder contacts pharmacies near you by phone to find which ones have sacubitril/valsartan available, texting you the results. Pharmacists with good supply chains report that generic sacubitril/valsartan is typically available for next-day ordering. We give sacubitril/valsartan a findability score of 72 out of 100.
Sacubitril/valsartan is not a controlled substance, so any licensed prescriber with prescribing authority can write a prescription. However, because it requires a confirmed diagnosis of heart failure with reduced ejection fraction (LVEF below normal), most initial prescriptions come from cardiac specialists. Insurance prior authorization typically requires documented LVEF, NYHA class, and prior ACE inhibitor or ARB trial history.
Cardiologists — primary prescribers; manage most Entresto prescriptions
Heart failure specialists — subspecialty cardiologists managing advanced or complex HFrEF
Internal medicine / family medicine physicians — can manage stable HFrEF patients and continue prescriptions initiated by cardiology
Nurse practitioners (NPs) and physician assistants (PAs) — particularly those working in cardiology or heart failure clinics
Pediatric cardiologists — for pediatric patients aged 1 year and older with systemic LV systolic dysfunction
Telehealth prescribing is available for established heart failure patients with documented diagnosis and LVEF data. Initial prescribing typically requires an in-person cardiac evaluation for echocardiogram review and baseline lab work (renal function, electrolytes). Many heart failure clinics now offer hybrid care with in-person initiation and telehealth follow-up.
No. Sacubitril/valsartan (Entresto) is not a controlled substance and is not scheduled by the DEA. Any licensed physician, nurse practitioner, or physician assistant with prescribing authority can write a prescription for it — there are no special DEA registration requirements, quantity limits, or prescription restrictions associated with controlled substance scheduling.
While sacubitril/valsartan is not a controlled substance, it does carry important restrictions: it requires a prescription from a licensed provider, carries a boxed warning for fetal toxicity, and cannot be taken within 36 hours of an ACE inhibitor due to angioedema risk. Insurance plans may require prior authorization and step therapy documentation before approving the prescription.
The most frequently reported side effects from clinical trials (PARADIGM-HF, PARAGON-HF) and post-marketing surveillance:
Hypotension (low blood pressure) — most common; risk increases with concurrent diuretic use
Hyperkalemia (elevated potassium) — especially with concurrent MRAs or potassium supplements
Cough — less common than with ACE inhibitors
Dizziness — often related to blood pressure reduction
Renal impairment — monitor creatinine and eGFR at baseline and periodically
Angioedema — life-threatening swelling of face, lips, tongue, or throat; seek emergency care immediately. Contraindicated in patients with prior ACE inhibitor or ARB angioedema history.
Fetal toxicity (Boxed Warning) — can cause serious injury or death to unborn baby. Discontinue immediately if pregnancy detected.
Acute kidney injury — markedly decreased urination, swelling; contact doctor immediately.
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Enalapril (Vasotec)
ACE inhibitor — previous gold standard for HFrEF before Entresto. Highly effective, generic, inexpensive. Cannot be used simultaneously with Entresto; 36-hour washout required.
Dapagliflozin (Farxiga)
SGLT2 inhibitor — now part of standard quadruple GDMT for HFrEF. Complementary mechanism to Entresto; approved for heart failure regardless of diabetes status.
Empagliflozin (Jardiance)
SGLT2 inhibitor — same class as dapagliflozin; approved for heart failure regardless of diabetes. Used alongside Entresto in quadruple therapy.
Spironolactone (Aldactone)
Mineralocorticoid receptor antagonist — blocks aldosterone to reduce fluid retention. Standard part of HFrEF quadruple therapy alongside Entresto. Monitor potassium.
Carvedilol (Coreg)
Beta-blocker — essential HFrEF therapy. Slows heart rate and reduces workload. Used alongside Entresto, not as a replacement.
Prefer Sacubitril/Valsartan? We can find it.
ACE inhibitors (lisinopril, enalapril, ramipril, etc.)
majorContraindicated — dramatically increases angioedema risk due to combined bradykinin accumulation. Mandatory 36-hour washout when switching between Entresto and any ACE inhibitor.
Aliskiren (Tekturna)
majorContraindicated in diabetic patients — increased risk of hypotension, hyperkalemia, and acute kidney injury. Avoid in patients with eGFR < 60 mL/min/1.73m².
Other ARBs (losartan, irbesartan, candesartan)
majorAvoid — Entresto already contains valsartan (ARB). Duplicate RAAS blockade increases hypotension, hyperkalemia, and renal impairment risk.
Potassium-sparing diuretics (spironolactone, eplerenone, triamterene)
moderateMonitor — increases hyperkalemia risk. Commonly used together in HFrEF quadruple therapy; requires regular potassium monitoring.
NSAIDs (ibuprofen, naproxen, COX-2 inhibitors)
moderateCaution — may worsen renal function, especially in elderly, volume-depleted, or CKD patients. Use lowest effective dose for shortest time.
Lithium
moderateMonitor — Entresto increases serum lithium levels, raising toxicity risk. Coordinate between prescribers and monitor lithium levels regularly.
Potassium supplements / salt substitutes
moderateCaution — combined with Entresto can cause dangerous hyperkalemia. Avoid without physician guidance.
Sacubitril/valsartan (Entresto) represents a genuine breakthrough in heart failure therapy. The PARADIGM-HF trial results — 20% reduction in cardiovascular mortality compared to the previous gold-standard enalapril — drove rapid adoption into international guidelines and established ARNI therapy as the preferred renin-angiotensin axis intervention in HFrEF. With generic sacubitril/valsartan now available at a fraction of the brand-name cost, access barriers related to price are significantly reduced.
For patients, the most important things to know are: take it twice daily as prescribed, never stop abruptly without talking to your cardiologist, and never combine it with an ACE inhibitor. For those experiencing fill difficulties, generic sacubitril/valsartan is bioequivalent to brand-name Entresto and is now more broadly available. Cost savings programs — including the Novartis copay card ($10/month for commercially insured), IRA-negotiated Medicare pricing (~$295/month in 2026), and generic discount pricing ($45–$50 with GoodRx) — have made this drug more accessible than ever.
If you are having trouble finding sacubitril/valsartan at your local pharmacy, medfinder can help. medfinder contacts pharmacies near you to identify which ones have your medication in stock and can fill your prescription, texting you the results.
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