Entyvio® (Vedolizumab) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers IV vedolizumab (Entyvio) for adults with moderately-to-severely active Crohn’s disease or ulcerative colitis, certain immune checkpoint inhibitor–related GI toxicities (authorization up to 3 doses), and steroid‑refractory acute GI aGVHD (up to 4 doses), and excludes use in combination with specified targeted immunomodulators or natalizumab. Coverage requires FDA‑labeled dosing, documentation of diagnosis and prior failure/contraindication/intolerance to at least one conventional therapy for initial CD/UC (positive clinical response and reauthorization limited to 12‑month intervals), plus specific documentation for ICI toxicities (e.g., positive lactoferrin/calprotectin for persistent mild colitis or prior infliximab failure unless immune‑related hepatitis) and adherence to member benefit plan/state/federal mandates.

"Crohn's disease when all of the following criteria are met:"