For US Health Care Professionals

ENTRESTO Coverage

Comprehensive information on health plan coverage, prior authorization requirements, and PA forms. Helping your patients get access to ENTRESTO® is as easy as 1, 2, 3.

This site is intended for US health care office staff.

Find Your Patient's Coverage Information for ENTRESTO

Select a state and multiple plan types to view a list of plans.

STATE


PLAN TYPES


SELECT A PLAN

A list of plans will appear once you have selected a state and plan types.

    The coverage and prior authorization (PA) requirements listed here are representations by Zitter Health Insights of the actual criteria developed and approved by managed care organizations and are not controlled by Novartis Pharmaceuticals Corporation (NPC). Coverage information is subject to change by the relevant plan. NPC has not independently verified the requirements of each plan and assumes no responsibility for this content. NPC cannot guarantee payment of any claim. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. It is the sole responsibility of the health care provider to select the proper code and ensure the accuracy of all claims used in seeking reimbursement.

    Please note: In this tool, qualified health plans available through health insurance marketplaces are considered commercial plans.

    Reference: Data on file. Zitter Health Insights. Policy & Access Tracking Tool. Novartis Pharmaceuticals Corp. East Hanover, NJ.

    Review Coverage Details for ENTRESTO

    Learn about the coverage information and PA requirements for the plan you selected.

    [Plan name dynamically populated]

    COVERAGE

    State:    
    Type of Plan:    
    Name of Payer:    
    State:   Name of Payer:  
    Type of Plan:   PA Required:  
    Formulary Tier:   Number of Formulary Tiers:  
    Step Therapy Required:   Step Therapy Placement:  
    Quantity Limits:  
    PA Requirements  
    NYHA Class Requirements  
    LVEF Requirements  
    Specialist Approval Required?  
    Concomitant Therapy Requirements  
    Proof of Effectiveness Required?  
    Lab Requirements  
    Dose Limits  
    Length of Initial Authorization  

    LVEF, left ventricular ejection fraction; NYHA, New York Heart Association.

    NOT COVERED

    The coverage and prior authorization (PA) requirements listed here are representations by Zitter Health Insights of the actual criteria developed and approved by managed care organizations and are not controlled by Novartis Pharmaceuticals Corporation (NPC). Coverage information is subject to change by the relevant plan. NPC has not independently verified the requirements of each plan and assumes no responsibility for this content. NPC cannot guarantee payment of any claim. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. It is the sole responsibility of the health care provider to select the proper code and ensure the accuracy of all claims used in seeking reimbursement.

    Please note: In this tool, qualified health plans available through health insurance marketplaces are considered commercial plans.

    Reference: Data on file. Zitter Health Insights. Policy & Access Tracking Tool. Novartis Pharmaceuticals Corp. East Hanover, NJ.

    Access the Plan-specific PA Form for ENTRESTO

    Click on the link to access the plan’s PA form. If you have questions about submitting the form, call ENTRESTO® Central at 1-888-ENTRESTO.

    Access PA FormMore PA Information

    No PA form is available at this time.

    Access the Plan-specific PA Form for ENTRESTO

    No PA required.

    Resources Are Available to Help Patients Access ENTRESTO

    Click on the link to access the plan-specific information to request coverage for ENTRESTO.

    Find Plan Coverage Information


    1-888-ENTRESTO

    Support for Appeal Coverage Denials

    • Need information on filing an appeal if a patient does not have coverage for ENTRESTO?
      Call 1-888-ENTRESTO Monday through Friday
      (excluding holidays), 9:00 AM to 8:00 PM ET
    • Wide range of patient support services available
    • Enroll your patients today

    Provides Support for PA Submissions

    • Have questions about insurance coverage and reimbursement? CALL 1-888-ENTRESTO Monday through Friday (excluding holidays),
      9:00 AM to 8:00 PM ET
    • Wide range of patient support services available
    • Enroll your patients today

    1-888-ENTRESTO

    Support for Appeal Coverage Denials

    • Need information on filing an appeal if a patient does not have coverage for ENTRESTO? Call 1-888-ENTRESTO Monday through Friday (excluding holidays),
      9:00 AM to 8:00 PM ET
    • Wide range of patient support services
    • Enroll your patients today