Does Medicaid cover Entyvio?

• In general, state Medicaid plans do not cover the cost of Entyvio, but preferred alternative treatments are usually available. State Medicaid programs may provide coverage for Entyvio but it can vary based on your state formulary (the list of preferred covered drugs may change over time).
• Contact Medicaid in your state to determine if Entyvio is a preferred drug under your Medicaid plan, and what the alternatives are if it is not covered. What you pay largely depends on if it is a preferred drug, your income level, and your overall plan benefit.
• Be sure to speak with your doctor about medications costs before treatment and let them know that you have Medicaid.

Entyvio (vedolizumab) is used in adults with moderate to severe ulcerative colitis (UC) or moderate to severe Crohn's disease. Entyvio was first approved in May 2014 and is manufactured by Takeda Pharmaceuticals. It is available as an intravenous infusion given into a vein and as a self-administered subcutaneous injection given under the skin from a pen injector.

Enyvio Medicaid Example

Medicaid is a U.S. health insurance program that provides medical assistance for low-income individuals and families. It is jointly run by the federal government and individual U.S. states. All States provide coverage for certain outpatient prescription drugs to eligible Medicaid enrollees.

• As one example, in the state of North Carolina, Enytvio (vedolizumab), an immunomodulator, is classified as a “non-preferred” drug on the state formulary list for Medicaid.
• Instead, North Carolina Medicaid lists Humira (adalimumab) and infliximab as preferred drug options to treat ulcerative colitis or Crohn’s disease.
• Drugs are usually selected by a clinical Medicaid committee as “preferred” based on effectiveness, safety, and costs. The drugs on a "preferred" drug formulary list will differ between states and can change over time.
• In the state of North Carolina, Medicaid copays for prescriptions tend to cost between $0 and $4 per prescription. A copay is the fee you pay when you get your prescription. Copays and cost-sharing can very between states.

To learn more about Medicaid in your state visit Medicaid.gov.

Related questions

• How much does Entyvio cost per month?
• Is Entyvio an immunosuppressant or a biologic?
• How long does it take Entyvio to start working?

Entyvio Prior Authorization

Entyvio is a biologic medication and may require a “prior authorization” from your health plan if your doctor wants to prescribe this medicine.

A “prior authorization” request is paperwork filled out by your doctor and sent to your insurance company. It usually explains your medical condition, what treatments you’ve tried in the past and their effects, and why you need this therapy now. Your doctor's office can work with the insurance plan to complete the prior authorization request.

In some cases, the health plan may deny coverage for Entyvio when submitted through a prior authorization request. If this is the case, speak to your healthcare provider, who may be able to prescribe a different medication or may help you appeal the denial to gain coverage.

If you have trouble paying for Entyvio or gaining access to this medicine, you can also call Takeda Pharmaceuticals at 1-844-ENTYVIO (1-844-368-9846), Monday to Friday, from 8am to 8pm ET (except holidays). A representative can explain your benefits and may be able to help you find financial assistance, if needed.

You may want to sign up for EntyvioConnect, a patient support program that an provide answers about co-pay support, nurse support, and management of your condition.

This is not all the information you need to know about Entyvio (vedolizumab) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.