Medicare AdvantagePrior AuthMedium impact
Entresto® (sacubitril-valsartan) (New)
Humana·Cardiology, Internal Medicine, Family Medicine +2 more·Medicare Advantage
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage now requires prior authorization for Entresto (sacubitril-valsartan) tablets and oral pellets used for heart failure treatment. Members must have a diagnosis of heart failure and have tried, had contraindications to, or been intolerant of generic Entresto.
Action Required
By January 1, 2026: Billing and clinical teams must implement prior authorization requests for all Entresto prescriptions for Humana Medicare Advantage members. Update pharmacy and medical billing systems to flag Entresto orders for prior auth review. Ensure documentation includes heart failure diagnosis and previous treatment history with generic Entresto. Failure to obtain prior authorization may result in claim denials.