Does Medica Health Plans require prior authorization for Entresto?
Medica Health Plans does not require prior authorization for Entresto on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
- This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| sacubitril 24 MG / valsartan 26 MG Oral Tablet [Entresto]1656346 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
| sacubitril 49 MG / valsartan 51 MG Oral Tablet [Entresto]1656351 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
| sacubitril 97 MG / valsartan 103 MG Oral Tablet [Entresto]1656356 | 0 / 17 | 0 | 0 | 0 | Not on formulary |
| sacubitril 15 MG / valsartan 16 MG Oral Pellet [Entresto]2679797 | 17 / 17 | 0 | 0 | 17 | No prior authorization |
| sacubitril 6 MG / valsartan 6 MG Oral Pellet [Entresto]2679802 | 17 / 17 | 0 | 0 | 17 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — sacubitril 15 MG / valsartan 16 MG Oral Pellet [Entresto]
Entresto has 5 products in the corpus; this table is for sacubitril 15 MG / valsartan 16 MG Oral Pellet [Entresto], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Medica Advantage Dual (PPO D-SNP) | H8889-016 | 3 | No | No | Yes |
| Medica Advantage Preferred (PPO) | H8889-011 | 3 | No | No | Yes |
| Medica Advantage Preferred (PPO) | H8889-013 | 3 | No | No | Yes |
| Medica Advantage Select (PPO) | H8889-012 | 3 | No | No | Yes |
| Medica Advantage Select (PPO) | H8889-015 | 3 | No | No | Yes |
| Medica Advantage Select (PPO) | H8889-018 | 3 | No | No | Yes |
| Medica Advantage Solution H6154-001 (HMO-POS) | H6154-001 | 3 | No | No | Yes |
| Medica Advantage Solution H8889-001 (PPO) | H8889-001 | 3 | No | No | Yes |
| Medica Advantage Solution H8889-002 (PPO) | H8889-002 | 3 | No | No | Yes |
| Medica Advantage Solution H8889-003 (PPO) | H8889-003 | 3 | No | No | Yes |
| Medica Advantage Solution H8889-004 (PPO) | H8889-004 | 3 | No | No | Yes |
| Medica Advantage Solution H8889-005 (PPO) | H8889-005 | 3 | No | No | Yes |
| Medica Advantage Solution H8889-008 (PPO) | H8889-008 | 3 | No | No | Yes |
| Medica Advantage Value (PPO) | H8889-010 | 3 | No | No | Yes |
| Medica Advantage Value (PPO) | H8889-014 | 3 | No | No | Yes |
| Medica Advantage Value (PPO) | H8889-017 | 3 | No | No | Yes |
| Medica DUAL Solution (HMO D-SNP) | H2458-002 | 3 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Entresto at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.