Introduction Heart Failure (HF) readmissions is a burden to the patient, family and healthcare system. The PARADIGM-HF trial demonstrated that patients on maintenance doses of sacubitril/valsartan 97/103 mg twice daily experienced a reduction in cardiovascular mortality and heart failure hospitalizations compared with enalapril. The Veterans Affairs (VA) Pharmacy Benefit Management (PBM) criteria for use recommends that patients follow-up with a provider within two to four weeks of therapy initiation for serum potassium, renal function, and blood pressure monitoring, and to ensure dose titration to the target maintenance dose. The objective of this medication use evaluation was to evaluate the prescribing and monitoring of patients on sacubitril/valsartan at a Veterans Affairs facility. Methods A retrospective chart review was conducted of heart failure patients who were initiated on sacubitril/valsartan at a Veterans Affairs facility. Patients with a prior authorization drug request (PADR) and who had an active prescription order for sacubitril/valsartan between September 2016 through January 2018 were included. Data collected were patient adherence to provider follow up, timing of patient follow up appointments, and laboratory monitoring, and the patient's adherence to medication (using the medication possession ratio). All data were analyzed using descriptive statistics. Results Initially, thirty-five PADR requests were identified. Sixteen were approved and included in the medication use evaluation. After drug initiation, approximately 75% (n=12) of patients on sacubitril/valsartan are being sub optimally monitored while on therapy. Of the 25% of patients reevaluated within two to four weeks, hypotension limited further dose titration in all these patients. Two patients achieved target maintenance dose 97/103 mg twice daily. Approximately 69% (n=11) of patients were determined to be adherent to sacubitril/valsartan. Conclusions Patients on sacubitril/valsartan are being sub optimally monitored while on therapy. It is essential that patients are titrated to the goal sacubitril/valsartan dose of 97/103 mg twice daily to optimize clinical outcomes. As shown in the PARADIGM trial, it is essential that patients are titrated to the goal sacubitril/valsartan dose of 97/103 mg twice daily, when possible, to optimize clinical outcomes. The results of this quality improvement project were presented to the P&T Committee (Pharmacy and Therapeutics). Informational “Dear Provider” letters were sent out to remind providers to optimize dosing. Subsequent follow up of the original sixteen patients is currently pending and results of the intervention will be followed up with P&T, and presented at HFSA.