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ARNI (heart failure)

Sacubitril/valsartan prescribing across the NHS.

Sacubitril/valsartan is the heart-failure drug that rebuilt its market: £164m at list price on 1.9m items in the year to April 2026, from a standing start a decade ago. It is also one of the next major loss-of-exclusivity events in England, which makes this page a before-picture worth keeping.

Scorecard, last 12 months
Items
1.9m
dispensed in the last 12 months
Spend
£164.2m
at NIC, last 12 months
Year on year
+18.6% +18.6%
vs the 12 months before
Latest month
May 2026
most recent NHSBSA release
Key facts · plain English

The NHS in England dispensed 1,929,155 prescription items of Sacubitril/valsartan in the 12 months to May 2026, across primary care and hospitals.

Spending on Sacubitril/valsartan over those 12 months was £164.2m at net ingredient cost, the list price of what was dispensed before any discounts.

Items were up 18.6% on the previous 12 months.

100% of Sacubitril/valsartan volume moved through primary care and 0% through hospital pharmacies.

Sacubitril/valsartan ranks #3 of 16 chemical substances in Angiotensin-II receptor antagonists (BNF 2.5.5.2), by items dispensed.

Among Integrated Care Boards, NHS North East and North Cumbria ICB dispensed the highest volume of Sacubitril/valsartan.

Source: NHS Business Services Authority open data (English Prescribing Data and SCMD), OGL v3.0. Items count prescriptions dispensed, not patients treated.

National trend · since 2020
Sacubitril/valsartan, England: monthly items and spend
Items per month (teal) and spend, £ (orange)
items £ 2020-11 2023-08 2026-05
Source: NHSBSA English Prescribing Data (OGL v3.0).
MonthItemsSpend (NIC)
May 2026 166,794 £14.1m
April 2026 168,010 £14.3m
March 2026 169,636 £14.4m
February 2026 153,861 £13.0m
January 2026 165,239 £14.1m
December 2025 171,026 £14.6m
November 2025 153,628 £13.0m
October 2025 164,031 £14.0m
September 2025 158,087 £13.5m
August 2025 150,549 £12.8m
July 2025 159,921 £13.7m
June 2025 148,373 £12.7m

The same series as the chart, most recent month first. The full monthly history, as CSV, sits behind Apply.

Cost per item · price erosion
Sacubitril/valsartan, England: cost per item
Actual cost per item, primary care (£)
£86.81 £80.66 2020-11 2023-08 2026-05
Source: NHSBSA English Prescribing Data (OGL v3.0).
Market share

7.2% of its class.

Sacubitril/valsartan ranks #3 of 16 chemical substances in Angiotensin-II receptor antagonists (BNF 2.5.5.2), by items dispensed in May 2026. The full class league, who's gaining, and the month-by-month share movement sit behind Apply.

See the full class picture →

Seasonality
Average items by calendar month, indexed to the year (100 = average)
120 100 80 JFMAMJJASOND

Average items by calendar month across the full history, indexed to the annual mean.

Where it's prescribed · England

Sacubitril/valsartan across all 36 ICBs.

Every Integrated Care Board in England, shaded by how much sacubitril/valsartan its GPs dispense per head of population. Hover an ICB to name it. The ranked figures for all 36 ICBs, and the drill-down to practice level, are in the full report.

NHS Cheshire and Merseyside ICBNHS Staffordshire and Stoke-on-Trent ICBNHS Shropshire, Telford and Wrekin ICBNHS Lincolnshire ICBNHS Leicester, Leicestershire and Rutland ICBNHS Coventry and Warwickshire ICBNHS Herefordshire and Worcestershire ICBNHS North East London ICBNHS South East London ICBNHS South West London ICBNHS Kent and Medway ICBNHS Cornwall and the Isles of Scilly ICBNHS Devon ICBNHS Somerset ICBNHS Bristol, North Somerset and South Gloucestershire ICBNHS Bath and North East Somerset, Swindon and Wiltshire ICBNHS Dorset ICBNHS Gloucestershire ICBNHS Lancashire and South Cumbria ICBNHS North East and North Cumbria ICBNHS Humber and North Yorkshire ICBNHS West Yorkshire ICBNHS Birmingham and Solihull ICBNHS Greater Manchester ICBNHS Derby and Derbyshire ICBNHS Northamptonshire ICBNHS Nottingham and Nottinghamshire ICBNHS South Yorkshire ICBNHS Black Country ICBNHS Central East ICBNHS Essex ICBNHS Hampshire and Isle of Wight ICBNHS Norfolk and Suffolk ICBNHS Surrey and Sussex ICBNHS Thames Valley ICBNHS West and North London ICB
Items per 1,000 registered patients, 12 months
FewerMore

Darker shading marks where Sacubitril/valsartan is dispensed most per head of population. Exact figures for every ICB, and the drill-down to practice level, are in the full report.

Data: NHSBSA English Prescribing Data (OGL v3.0). Boundaries: ONS Open Geography portal, ICBs April 2026, contains OS data © Crown copyright and database right 2026.

Zoomed out to the 7 NHS regions.

The same 12 months rolled up to NHS England's seven regions, ranked by intensity.

North WestMidlandsMidlandsMidlandsMidlandsMidlandsMidlandsLondonLondonLondonSouth EastSouth WestSouth WestSouth WestSouth WestSouth WestSouth WestSouth WestNorth WestNorth East and YorkshireNorth East and YorkshireNorth East and YorkshireMidlandsNorth WestMidlandsMidlandsMidlandsNorth East and YorkshireMidlandsEast of EnglandEast of EnglandSouth EastEast of EnglandSouth EastSouth EastLondon
Items per 1,000 registered patients, 12 months
North East and Yorkshire
Midlands
East of England
South West
London
North West
South East
Data: NHSBSA English Prescribing Data (OGL v3.0). Regions: ONS Open Geography portal, NHS England regions April 2026. Contains OS data © Crown copyright and database right 2026.
Top 3 previews

The teaser view.

Three rows each. The full 36-ICB view, every prescribing organisation, every strength and the hospital picture sit below the fold, behind Apply.

Top ICBs by volume
  1. 1 NHS North East and North Cumbria ICB 180k
  2. 2 NHS West and North London ICB 133k
  3. 3 NHS Central East ICB 93k
  4. + 33 more. Unlock the full 36-ICB table. Unlock →
Fastest-growing ICBs (YoY)
  1. 1 NHS North East London ICB +37.2%
  2. 2 NHS South West London ICB +30.1%
  3. 3 NHS South East London ICB +26.5%
  4. + 33 more. Unlock every ICB, ranked. Unlock →
Top formulations
  1. 1 Sacubitril 24mg / Valsartan 26mg tablets 31%
  2. 2 Sacubitril 97mg / Valsartan 103mg tablets 24%
  3. 3 Sacubitril 49mg / Valsartan 51mg tablets 22%
  4. + 3 more. Unlock every strength and pack. Unlock →
Primary vs secondary care
Primary 100% Hospital 0%

Split of items across NHSBSA primary care and SCMD hospital dispensing.

Deprivation · IMD 2019

Prescribing by deprivation.

Items per 1,000 registered patients by IMD decile — 1 = most deprived, 10 = least
15.1 0 12345678910

Items per 1,000 registered patients by deprivation decile (1 = most deprived), practice deprivation weighted by where each practice's patients live. Read the shape rather than the absolute level: the most and least deprived deciles cover far fewer practices, and age structure drives much of the gradient.

Beyond England

The devolved nations.

NationItems · 12 monthsData to
England 1.9m May 2026
Northern Ireland 95k May 2026
Scotland 155k April 2026
Wales 182k April 2026

Each nation publishes its own community prescribing data, with different coding and list rules, so read these per-nation rather than as an exact UK total. Sources: NHSBSA (England), Public Health Scotland.

Honesty strip

What open data won't tell you about sacubitril/valsartan.

Spend is list price; the confidential access arrangements that accompanied its NHS adoption are not in open data, and neither is the split between new starts and switches.

Read exactly what the data covers →

Common questions

Asked and answered.

Is sacubitril/valsartan prescribing rising or falling in the NHS?

Rising. England dispensed 1,929,155 items of Sacubitril/valsartan in the 12 months to May 2026, up 18.6% on the previous 12 months. Items count prescriptions dispensed, not patients treated, so the change can reflect dose and duration shifts as well as patient numbers.

How much does the NHS spend on sacubitril/valsartan?

£164.2m at net ingredient cost in the 12 months to May 2026. Net ingredient cost is the list price of the medicine before discounts and rebates; the NHS's final bill, especially for hospital medicines, is usually lower.

Where in England is sacubitril/valsartan prescribed most?

By raw volume, NHS North East and North Cumbria ICB dispensed the most sacubitril/valsartan in the last 12 months. Raw volume favours the biggest populations; the map on this page shades every ICB by items per head to correct for that.

How up to date is this data?

This page runs to May 2026, the most recent NHSBSA release. Prescribing data publishes roughly six to eight weeks in arrears, and DoseTrend refreshes within 48 hours of each monthly release.

Locked · Applicants only

The full breakdown.

Every ICB, every prescribing organisation, every strength, the hospital view, and the monthly briefing PDF. Sample rows shown below with the numbers obscured.

Locked · Applicants only

See the full picture for Sacubitril/valsartan.

All 36 ICBs, prescribing organisations, formulation splits and the hospital view. £1,500 a month per molecule, price published, applications reviewed by a human within one working day.

No card details to apply. About one applicant in ten gets told the open data can't answer their question, before paying anything.

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