Entresto. Would appreciate any discussion, pros, cons.

@abob
It is not Medicare where the issue is. It is the pharmacy not understanding that DRE equipment and insulin used specifically for that DRE is under part B medical. My wife has a G-7 and automatic insulin pump that she injects insulin into the pump and it automatically releases insulin into her body. That was put under DRE and part B by Medicare. Medicare would pay the 80% and then my insurance company BCBS will pick up the 20%. I should pay nothing.

Our issue is with CVS. They try to charge it to Part D which Medicare won't pay as comes under DRE. They try to charge it to BCBS. We ran into an issue with BCBS not recognizing the bill address from CVS as they use a bill paying service not their pharmacy location. So BCBS says the bill's address is not in network and won't pay.

I tried to get CVS to use another address, no luck. Tried to get BCBS to accept the bill payers address as it was still CVS pharmacy charge, but they use a billing company, no luck.

Contacted CVS, no luck. Contacted BCBS supervisor, no luck. So, we just pay the insulin costs charged to us by BCBS prescription which runs us $60.00 co-pay for 90 day supply.

Try getting the company to decrease the payment per month - which is very helpful.
It takes 4-6 months to see any improvement and then you may wind up with an increased dosage and need more time for the Entresto to work. Hopefully, it will kick in. Watching the low sodium diet and trying to lose weight - slowly - can also help your Entresto work better, along with increasing your EF. It is recommended to have defibrillator implanted with an EF of 35 or less. However, give the Entresto time to work, along with weight loss and diet. Hopefully, the EF improves before deciding if a procedure is needed. Entresto would still need to be taken - the defibrillator is preventative in case there are arrythmias with are dangerous. Good luck.

Very confusing. Seems to be conflicting/unclear G7 as DME info from CMS vs DEXACOM?

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CMS booklet:
https://www.medicare.gov/publications/11022-medicare-coverage-of-diabetes-supplies-services-and-prevention-programs.pdf
MONITOR & PUMP - PART B DME:
“The Dexcom G7 continuous glucose monitor (CGM) and automatic insulin pumps are generally covered by Medicare Part B as durable medical equipment (DME). Medicare Part B covers these items when prescribed by a doctor for managing diabetes.”
INSULIN - DRUG CAP:
$35 (or less) for a one-month supply of insulin if you use an insulin pump that’s covered under Medicare’s durable medical equipment benefit. The Part B deductible doesn’t apply.

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DEXACOM website:
https://www.dexcom.com/en-us/faqs/medicare
If you use the receiver (classified as DME) to display glucose data, Medicare covers CGM system supplies and accessories. There is no Medicare coverage if the receiver isn’t classified as DME. However, you can use the app (on your smartphone, smartwatch, tablet, etc) as well as the receiver.
Here are some examples of how you can use a smart device and receiver under Medicare:
Use both a receiver and a smartphone throughout the day
Use a receiver some days and a smartphone on other days

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GOOD LUCK:
Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.

Hi,
I started taking that combination drug Enstresto about 18 months ago after I saw an ad for it. My ejection factor was down to 35 %. my EP doctor agreed and have not had side effects that I'm aware if. I've had trouble with many of the others. In the last echo it appears to have increased to 37 %, so may have helped a bit. I'm also on Digoxin to try reducing my HR which is most times higher then my BP, but if I take the dose of 250 Mg I get side effects of that, so stay at 125 mg. Afib about 90% of the time. 2 cardio-versions and two ablations the last was a CRT and hasn't worked. So now they want to try an AV node removal. I already have the pacemaker/ICD.
Thanks for any comments, I am an 84 yr. male, also have a porcine mitral valve replacement that is 15 years old, yikes, huh.

A much less expensive alternative to Jardiance is either Ozempic or Bexagliflozin. Both of these alternatives cost less than $140 per month. I buy the Bexagliflozin (Brenzavvy) directly from Mark Cuban's CostPlus drug company.

I could not breath or even stay awake. I went to a small town Doctor. He prescribed 24mg entresto , 1 tab daily, in Jan. 2023. It was a life changer. I got my life back.
On Nov28,2024 , 10:30am. I don't know what happened. We were in a crawl space under the house 35 feet from opening. My wife said I clenched my fist, my jaw froze, terror in my gaze but I couldn't speak. She scrambled out to get nitro pills. She is fast. Pushed nitro under my tongue. Immediately my fist and jaw relaxed. She said don't talk, start crawling, we gotta get u outta here.
She said I stopped froze up again within 10 ft. This happened 3 more times. She kept punching on me hitting me slapping my face whatever she had to do to keep me in motion . I just wanted to stop and sleep. She got me out of hole and I sat up crossed my legs. She said that's when my jaw clenched my eyes stared blanky, my face went grey and neck blue. She pushed me over onto my back straighted my legs out and began( her version of CPR). Witnesses said she pounded on my chest screaming my name , tilted my head held my nose blew into my mouth. Pushed my chest few times breathed my mouth again. Shaking me violently and screaming my name. She used both fists pounding on my chest, slapping my face shaking my head. Another nitro pill blow in my mouth hit me in belly. Finally I gasp. Rolled over and breathed on my own . Paramedics arrived tried to argue seizure cause BP was 148/90 . I sat in the ER for 4 hours before being admitted. Whatever the stuff is that the heart releases during a heart attack was spiked at 5,236. Regular number is like 25. The only thing hospital did was apply nicotine patches to my arm( I have not smoked in 20 years) I was weak and tired. I woke up when they changed patches. Made them remove it. My wife saw another patch next morning . Suddenly my speech slurred, within minutes I could not form a sentence. It was terrifying. My wife kept me calm while alerting my care staff of my current condition. Hour later Dr. Came in to test my cognitive ability. It took me a minute to answer each question. I had to think to myself what the answer was then speak it. How old my wife was . What her name was. Answers were not immediate and verbally slowed. Dr. Said I was fine. BS . Anyway, released me on 4 th day. Prescribed me 7 different rx. Told me to stop the entresto.
I only filled the baby aspirin rx and continued taking 24mg entresto and went back to normal life. It is a miracle drug. It worked for me so I chose to continue taking it. Threw new Rx away.
8/2/25. 9 months after heart attack I over did it. Pushed myself to hard in the 110 degree heat. Started getting short of breath again . Like in the beginning 3 years ago. That is where I am now. Should I start taking 2 entresto24 a day at 12 hour interval??? Or should I ask Dr. For 49mg?

Talk to your doctor! I love Entresto but it is a powerful medication. Take your post to your doctor as a conversation starter.

Entresto comes in 3 dosage levels and the idea is to take the lowest dose pill and see if there are side effects. If no side effects one should go to the next higher dose level which is still taken twice each day.

The two drugs in Entresto should be taken with Metoprolol Succinate for full effect on the heart. I take Entresto 49-51 MG 2x day sacubitril and valsartan twice during the day and also take the Metoprolol in 50mg dose. Actually taking a fourth medication which is the 81mg aspirin.

No single medication is going to be enough if one has a failing heart.

We use the pharmacy at Costco which saves us money and they are much more responsive to any issues we may have.

Hiya I’m Dave. I’m on entresto 24/26 1/2tab bid & metoprolol 25mg also 1/2tab bid. I have CHF dilated cardiomyopathy with an EF of 20-25%. Cardiologist likes my BP in the 90/50 range. Had an ICD implant in 01/23. I’ve slowed down quite a bit but I generally feel good and don’t have any episodes.