While there are the basic ways in reducing costs for Entresto that are common, maybe the best way for a medicare recipient to lessen the expense is to apply for manufacturer assistance programs while waiting for a generic version to come on line. Like for many medications, there are low income government subsidy programs that are available for Entresto, but like many of these programs that are operated by the government, they can often be slow and cumbersome. Norvatis, the company that manufactures Entresto does offer patient assistance programs that are not so bogged down by red-tape and can offer a viable alternative to government programs. In addition, there is some evidence that there will be generics of this medication that will soon hit the market. So while you are waiting for the generic alternatives, those on Medicare may want to look into manufacturer discounts for Entresto as their best way of reducing costs.
1. Entresto is historically expensive because it was noted to be one of the pillars that reduced heart failure readmissions but more importantly dramatically improved heart function. It has also now been recommended as guideline directed therapy for anyone with Heart Failure with a low ejection fraction A few factors may be insurance, co-pay, out of pocket deductible. 2. Medicare does cover Entresto however, accurate documentation must be provided. I have multiple patients on Entresto but the patient story that sticks out to me is regarding a middle age patient of mine with heart failure from unknown causes. His heart function was low (~ 17% - normal is 60-65%.) We started him on entresto however, his insurance quickly became an issue with coverage. With sending the prescription to Canada he was able to receive the medication and subsequently improve his heart function to 60%. He continues to receive his Canadian Rx and does extremely well. Entresto samples can also help with coverage. We have been able to appeal some insurance companies once we demonstrate the significant improvement in heart function and patient's symptoms.