Entyvio® Intravenous (vedolizumab)

Entyvio (vedolizumab) IV is covered only for adults (≥18) with FDA‑approved moderately to severely active Crohn’s disease or ulcerative colitis—including specified scenarios such as fistulizing disease, post‑ileocolonic resection, and pouchitis—and non‑FDA indications are excluded (mesalamine products do not count as systemic therapy). Coverage requires gastroenterologist prescription/consultation, documentation of prior therapies per indication (e.g., trial of a biologic or conventional systemic agent or specified clinical circumstances), adherence to dosing (300 mg IV at Weeks 0, 2, 6 then every 8 weeks), 12‑month approval periods, and reauthorization only after ≥6 months on therapy with documented objective or symptomatic improvement.

"Moderately to severely active ulcerative colitis in adults (FDA-approved indication)."

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