Does Medicare Cover Entyvio?

In this article...
  • Find out if Medicare covers Entyvio, which has been proven to provide relief and remission for individuals with ulcerative colitis or Crohn's disease.

Entyvio is an intravenous drug therapy that helps reduce inflammation in the gut. Its primary use is to help relieve and treat the symptoms associated with moderate to severe Crohn's disease and ulcerative colitis. There are no known cures for these illnesses, and symptoms can lead to serious discomfort. Keep reading to discover if Medicare can help you cover the costs of Entyvio treatment.

Does Medicare Cover Entyvio?

Medicare Part D doesn't cover Entyvio treatment currently, but it's important to note that it only became FDA-approved in 2014. While it's no longer an experimental medication, it's expensive and challenging to administer. This is because it's an IV infusion that must be administered in a hospital, an infusion center or a clinic at regular intervals. 

A 30-day supply of Entyvio costs almost $4,000, which is a significant expense. Costs can also vary according to your location and pharmacy. While Medicare Part C and Part D are unlikely to cover the costs of Entyvio, you might be able to get alternative drug therapy with these plans. 

Crohn's Disease and Ulcerative Colitis

Ulcerative colitis and Crohn's disease are chronic conditions that affect the gut. They cause inflammation and damage in the digestive tract that lead to unpredictable bowel movements and chronic pain.

There are a number of FDA-approved medications to help manage the symptoms of these conditions, and Entyvio is one of them. Despite it being approved by the FDA, it's not currently included in the National Coverage Determination, and there are currently no Local Coverage Determinations under Medicare.

What Is Entyvio?

Entyvio is the brand name of vedolizumab, a monoclonal antibody administered as an IV infusion in an inpatient or outpatient setting. The procedure takes half an hour, and a health care practitioner gives the initial dose, a second two weeks after and the third six weeks after that. Maintenance doses are required every eight weeks. 

There's good evidence to show that Entyvio can help people with CD or UC, and it's usually given as a last resort when other therapies have proved unsuccessful. 

What Are Entyvio's Side Effects?

There are some side effects associated with Entyvio drug therapy:

  • Headache
  • Joint pain
  • Pain the extremities
  • Cold- and flu-like symptoms

While there are currently no Medicare Part D formularies that include Entyvio treatment, you might be able to get a different drug to help ease your UC or CD symptoms with Medicare coverage. You might also be able to get help from nonprofit organizations or other groups. 

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