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Does Medicaid cover Entyvio?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Aug 5, 2021.

Official answer

by Drugs.com
  • 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).
  • 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, 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.

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.

  • For 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) as the preferred drug option 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.
  • In the state of North Carolina, copays for prescriptions tend to cost between $0 and $10 per prescription.

Entyvio is a biologic medication and cannot be picked up at your pharmacy. Enytvio may require a “prior authorization” from your plan if your doctor wants to prescribe this medicine.

A “prior authorization” request is paperwork filled out by your doctor. It usually explain 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.

If you have trouble paying for Entyvio or gaining access to this medicine, you can 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.

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

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