Entyvio® Medicare Coverage

Entyvio®
Chemical name: Vedolizumab

Typical dosage: 300mg

Typical type: IV infusion1

Entyvio® is a prescription medication used to treat moderate to severe Ulcerative Colitis (UC) or Crohn’s Disease (CD) in adults. This medication is administered as an IV injection and is available in both generic and brand formulations.

Entyvio is a monoclonal antibody with gut selective anti-inflammatory effects to treat and manage symptoms of moderate-to-severe UC or CD. It is an IV infusion given in a hospital, clinic, or infusion center over 30 minutes, with 3 starting doses at 0, 2, and 6 weeks, followed by maintenance dosing every 8 weeks.

The most common side effects of this medication include headache, joint and extremity pain, cold and flu. Serious side effects with this medication can include hypersensitivity or infusion-related reactions, infections and liver injury.

Entyvio has been proven to help achieve relief and remission in people with UC or CD who have been unsuccessful on other therapies.

Does Medicare cover Entyvio?

No. Medicare Advantage plans and Medicare Part D plans do not typically cover Entyvio.1

You may be able to find Medicare Advantage plans or Part D plans that cover other drugs that help treat UC or CD.

  • Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage beneficiaries (88 percent) are enrolled in MA-PDs.2

  • Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability.

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Average costs for Entyvio with Medicare drug coverage1

Because Medicare Advantage plans and Medicare Part D plans do not typically cover Entyvio, you will likely be responsible for all costs for this drug if you have one of these types of Medicare coverage.

Additional information

Ulcerative Colitis and Crohn’s Disease are characterized by ongoing inflammation in the digestive tract and are associated with severe abdominal pain and diarrhea.

If left untreated or improperly managed, complications could arise such as bowel obstruction, ulcers, malnutrition and other serious health problems.

Entyvio is a medication with proven benefits, showing evidence of long-term remission and long-term safety in patients with UC or CD. Entyvio is mostly used in adults with moderate-to-severe disease after failure or intolerance to other therapies.

Entyvio has demonstrated significantly better remission rates than other therapies. It can, however increase risk of developing serious or fatal infections and increase risk of liver injury.

People interested in starting Entyvio must be up to date with their immunizations before starting this treatment. Clinical benefit of treatment with Entyvio will be assessed at week 14 and stopped if response to therapy is inadequate.

Entyvio should not be used with immunosuppressants or TNF inhibitors.

 

 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

 

Written by Hayden Gharibyar, Pharm.D.

Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.

1 GoodRx. Entyvio. Retrieved May 2019, from www.goodrx.com/entyvio.

2 Jacobson, Gretchen; et al. A Dozen Facts About Medicare Advantage. (Nov. 13, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage.

MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.