Vedolizumab

This policy covers intravenous (IV) vedolizumab for treatment of inflammatory bowel disease, specifically adults (≥18 years) with moderate to severely active ulcerative colitis or Crohn’s disease, when dose, frequency, and duration align with FDA labeling or recognized authoritative references. Coverage is limited to IV administration (subcutaneous/self‑administered formulations are managed under pharmacy benefits), off‑label uses require high‑quality peer‑reviewed or compendia support, concurrent use with natalizumab or TNF blockers is prohibited, and all coverage is subject to the member’s benefit plan/contract limitations.

"Therapies that are proven effective for the relevant diagnosis or procedure are eligible for coverage."

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