March 2019

Heart Healthy Entresto No Longer Requires Prior Authorization

At Cigna, we're dedicated to finding ways to remove barriers to adherence and make it easier for customers to maintain their heart health. That’s why on November 15, 2018, we removed the prior authorization (PA) requirement for Entresto® (sacubitril/valsartan), across all commercial group formularies.1

Integrated data shows value of Entresto.
Cigna is uniquely positioned to manage medical and pharmacy as a connected benefit to help improve health outcomes and lower total medical cost. To gain insight on the use and clinical value of Entresto, we conducted a real-world evidence study. We evaluated pharmacy and medical claim data for customers receiving coverage for Entresto. The study compared the associated expense of hospitalization claims due to recorded heart failure before and after customers began treatment with Entresto.

Study results showed a reduction in hospitalizations during the period after individuals started using Entresto, as well as a net reduction in total medical cost for the client.2 This evidence, in conjunction with an assessment of the PA on Entresto, (in which we determined that the vast majority of use was consistent with the PA criteria) led to the decision to lift the PA requirement.

Learn more about the study and discover how Entresto can help reduce the risk of death and hospitalization in people with certain types of long-lasting (chronic) heart failure and reduce medical costs associated with heart failure-related hospitalizations. Entresto is usually used with other heart failure therapies, in place of an ACE inhibitor or other ARB therapy.3

  1. Does not include Individual and Family Plan formularies. Entresto is subject to the plan’s pharmacy benefit terms of coverage at the 2nd tier/ preferred brand level on most formularies/plans.
  2. Cigna National Book of Business clinical study 2018.
  3. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. November 2017.