What alternatives to Entresto are typically covered by Aetna CVS Health in Florida?

Aetna CVS Health typically covers ACE inhibitors (like lisinopril, enalapril), ARBs (like losartan, valsartan), and beta-blockers as first-line alternatives for heart failure treatment. Starting January 2026, generic sacubitril/valsartan is also covered as the preferred alternative to brand Entresto.

How long does an Entresto formulary exception request take with Aetna?

Standard formulary exception requests typically take 72 hours for a decision. Urgent requests can be processed within 24 hours if your doctor certifies that waiting could seriously jeopardize your health.

What documentation is needed for an Entresto exception request?

You'll need your heart failure diagnosis documentation, current ejection fraction results, records of previous treatments with covered alternatives, documentation of side effects or inadequate response to formulary drugs, and a completed prior authorization form from your cardiologist.

Can I appeal if my Entresto exception request is denied?

Yes, you have multiple appeal options including internal appeals through Aetna CVS Health and external appeals through Florida's independent review process. You typically have 60 days from the denial notice to file an appeal.

By Counterforce Health Team in Entresto (sacubitril/valsartan) — 09 Feb 2026

If Entresto Isn't Approved by Aetna CVS Health in Florida: Formulary Alternatives & Exception Paths

Name: If Entresto Isn't Approved by Aetna CVS Health in Florida: Formulary Alternatives & Exception Paths
Creator: Counterforce Health
Published: 2026-02-09

Answer Box: Your Options When Entresto Isn't Covered

If Aetna CVS Health denies Entresto (sacubitril/valsartan) in Florida, you have three paths: try covered heart failure alternatives (ACE inhibitors, ARBs), request a formulary exception with clinical documentation, or appeal the denial through Florida's external review process. Starting January 2026, Aetna covers generic sacubitril/valsartan as the preferred alternative to brand Entresto. First step today: Contact your cardiologist to review covered alternatives or gather LVEF documentation for an exception request via Aetna's provider portal.

When Alternatives Make Sense
Covered Heart Failure Medications
Pros and Cons Overview
Exception Strategy for Entresto
Switching Logistics
Re-trying for Entresto Later
Appeals Process in Florida
FAQ

When Alternatives Make Sense

Not every heart failure patient needs Entresto immediately. Aetna CVS Health's step therapy requirements often start with proven, lower-cost options before advancing to newer medications like sacubitril/valsartan combinations.

You might consider alternatives first if:

Your LVEF is mildly reduced (40-50%) and you haven't tried optimized ACE inhibitor or ARB therapy
You have contraindications to Entresto (history of angioedema, eGFR <30 mL/min/1.73m²)
Your cardiologist wants to establish baseline response before switching
Cost is a primary concern and your symptoms are stable

Move directly to exception request if:

You've documented ACE inhibitor or ARB intolerance/failure
Your LVEF is ≤40% with persistent symptoms despite optimal medical therapy
You have specific contraindications to first-line alternatives

Note: Starting January 2026, Aetna covers generic sacubitril/valsartan as the preferred alternative to brand Entresto across multiple plans.

Covered Heart Failure Medications

ACE Inhibitors (Tier 1/Generic)

Most commonly covered first-line options:

Lisinopril - Once daily dosing, extensive outcomes data
Enalapril - Twice daily, used in major heart failure trials
Captopril - Three times daily, oldest in class
Benazepril, ramipril - Alternative options for intolerance

ARBs (Angiotensin Receptor Blockers)

For patients who can't tolerate ACE inhibitors:

Valsartan - Component of Entresto, available separately
Losartan - Most studied ARB in heart failure
Candesartan - Good outcomes data in HFrEF

Complementary Heart Failure Therapies

Beta-blockers: Metoprolol succinate, carvedilol, bisoprolol
Aldosterone antagonists: Spironolactone, eplerenone
SGLT2 inhibitors: Empagliflozin, dapagliflozin (growing evidence)

Pros and Cons Overview

Medication Class	Access Advantages	Monitoring Considerations	Effectiveness Notes
ACE Inhibitors	Usually no PA required; low cost	Cough (10-15%); hyperkalemia; renal function	Proven mortality benefit; 36-hour washout needed before Entresto
ARBs	Good ACEi alternative; no cough	Hyperkalemia; renal function	Similar efficacy to ACEi; easier switch to Entresto
Generic sacubitril/valsartan	Covered 2026+; same mechanism	Same as Entresto; BP monitoring	Identical to brand Entresto
Beta-blockers	Widely covered; cardioprotective	Fatigue; bradycardia; avoid abrupt stopping	Essential in HFrEF; use with ACEi/ARB

Access Considerations in Florida

Insurance factors that favor alternatives:

Step therapy requirements satisfied more quickly
Lower copays (often $10-30/month vs. $50-200+ for specialty tiers)
Available at local pharmacies vs. specialty pharmacy requirements

Clinical factors that favor Entresto:

Superior outcomes in PARADIGM-HF trial (20% reduction in CV death/HF hospitalization vs. enalapril)
Fewer medication interactions than some alternatives
Once established, often easier to maintain long-term

Exception Strategy for Entresto

Required Documentation Checklist

Clinical evidence needed for approval:

Recent echocardiogram showing LVEF ≤40% (within 6-12 months)
Heart failure diagnosis with NYHA Class II-IV symptoms
Documentation of ACE inhibitor or ARB trial and failure/intolerance
Recent labs: BNP/NT-proBNP, creatinine, potassium
Cardiology consultation notes

Common failure documentation examples:

ACE inhibitor: persistent cough, angioedema, hyperkalemia >5.2 mEq/L
ARB: inadequate symptom control after 4-8 weeks at optimal dose
Both: worsening renal function, hypotension <90 mmHg systolic

Submission Process

Provider contacts for exceptions:

Specialty medications: 1-866-814-5506 (phone), 1-866-249-6155 (fax)
Non-specialty: 1-800-294-5979 (phone), 1-888-836-0730 (fax)
Mail: Medical Exception to Pharmacy Prior Authorization Unit, 1300 East Campbell Road, Richardson, TX 75081

Timeline expectations:

Standard exceptions: 72 hours if prescriber supports urgency
Expedited (life-threatening): 24 hours
Routine processing: varies (verify with provider portal)

Tip: Mark requests as urgent if heart failure symptoms are worsening or hospitalization risk is high.

Switching Logistics

From ACE Inhibitors to Alternatives

If switching to ARB (no Entresto approval):

No washout needed - start ARB at next scheduled ACE inhibitor dose
Monitor closely for hypotension first 1-2 weeks
Check labs in 1-2 weeks (potassium, creatinine)

If switching to generic sacubitril/valsartan (2026+):

36-hour washout required after last ACE inhibitor dose
Start at appropriate dose based on prior ACE inhibitor strength
Coordinate with CVS Specialty Pharmacy for dispensing

Pharmacy Coordination

For specialty medications (Entresto, generic sacubitril/valsartan):

CVS Specialty Pharmacy: 1-800-237-2767
Home delivery standard (2-3 business days)
CareTeam verification call within 48 hours of approval

For standard alternatives:

Available at any CVS or network pharmacy
90-day supplies often available for maintenance therapy
Automatic refill programs reduce gaps in therapy

Re-trying for Entresto Later

What to Document During Alternative Trials

Keep detailed records of:

Exact medications tried (drug, dose, duration)
Specific reasons for discontinuation or inadequacy
Symptom changes, hospitalizations, or ER visits
Lab abnormalities or side effects
Functional capacity changes (6-minute walk, NYHA class)

Optimal documentation timeline:

4-8 weeks minimum trial of each alternative at maximum tolerated dose
Quarterly assessments with cardiology including LVEF monitoring
Annual medication reviews to reassess Entresto candidacy

When to Resubmit Exception Requests

Strong re-approval scenarios:

New hospitalization for heart failure despite optimal alternative therapy
Worsening LVEF on serial echocardiograms
Progressive functional decline (worsening NYHA class)
New contraindications to current alternatives

At Counterforce Health, we help patients and providers build stronger exception requests by analyzing denial patterns and crafting evidence-based appeals. Our platform identifies exactly what documentation payers need and helps coordinate the clinical evidence that leads to approval.

Appeals Process in Florida

Internal Appeals with Aetna CVS Health

If your exception is denied:

File internal appeal within 180 days of denial notice
Submit additional evidence not included in original request
Request peer-to-peer review if available
Standard timeline: 30 days for determination

Florida External Review Process

After internal denial, you can request binding external review:

How to request:

Florida Department of Financial Services: 1-877-693-5236
Online complaint submission available
Timeline: Within 4 months of final internal denial

External review decisions:

Standard cases: 45 days for binding decision
Expedited cases: 72 hours for urgent medical needs
No cost to patient
Binding on insurer if reviewer approves coverage

From our advocates: "We've seen Entresto denials successfully overturned in Florida external review when patients included both the original cardiology notes showing LVEF ≤40% and documentation of ACE inhibitor cough that prevented optimal dosing. The key was showing the clinical progression clearly."

FAQ

How long does Aetna CVS Health prior authorization take in Florida? Standard PA decisions typically take 72 hours to 14 days. Expedited requests for urgent medical needs are processed within 24-72 hours. Verify current timelines with your provider portal.

What if Entresto is non-formulary on my plan? Request a formulary exception through your provider using the specialty medication contacts above. Include clinical documentation showing medical necessity and prior therapy failures.

Can I get generic sacubitril/valsartan instead of brand Entresto? Starting January 2026, Aetna covers generic sacubitril/valsartan as the preferred alternative to brand Entresto across multiple plans. Check your specific formulary for current coverage.

Does step therapy apply if I failed ACE inhibitors outside Florida? Yes, documented failures from other states count toward step therapy requirements. Ensure your new Florida provider has complete records from previous treatments.

What counts as ACE inhibitor failure for Entresto approval? Common accepted reasons include persistent cough preventing optimal dosing, angioedema, hyperkalemia >5.2 mEq/L, or worsening renal function. Document specific symptoms and timeline.

How do I find my Aetna formulary in Florida? Use the Aetna drug lookup tool or check your plan documents. Formularies can vary by specific plan type within Florida.

Sources & Further Reading

Working with coverage challenges can feel overwhelming, but remember that Counterforce Health and other advocacy resources exist to help you navigate these complex processes. Whether you're trying alternatives first or pursuing an exception for Entresto, having the right documentation and understanding your appeal rights in Florida gives you the best chance of success.

This information is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider about the most appropriate treatment options for your specific condition. For assistance with Florida insurance questions, contact the Florida Department of Financial Services at 1-877-693-5236.

Powered by Counterforce Health—AI that turns drug denials into evidence-based appeals patients and clinicians can submit today.