Does Medicare Cover ENTYVIO?

In this article...
  • If you were prescribed ENTYVIO, you may be wondering if your Medicare plan or supplemental policies cover it. Find out more about this drug and whether Medicare covers it now.

ENTYVIO is also known by the chemical name vedolizumab and is typically administered via an IV infusion in a clinic or hospital. Administration takes around 30 minutes and is generally done at 2 and 6 weeks following your initial dose. After 6 weeks, maintenance doses are usually given every 2 months or 8 weeks.

Both brand name and generic options are available, but access often depends on where you receive your treatment.

If you've been prescribed ENTYVIO, you're probably wondering if Medicare covers it. 

Does Medicare Cover ENTYVIO?

ENTYVIO isn't covered by either Medicare Part D or the drug benefit of your Medicare Advantage plan because it's a drug that is typically injected by a healthcare provider in an office setting. This means that it may be covered under Medicare Part B or your outpatient Medicare Advantage benefits. 

Discuss your coverage and whether your provider can bill Medicare for this treatment. If you haven't met your Part B deductible, you will have to pay it before coverage kicks in. As of 2022, the deductible is $233. After you meet the deductible, you may be responsible for 20% coinsurance for all charges Medicare approves; if you have supplemental insurance, it may pick up some or all of that coinsurance amount.

What Is ENTYVIO Used To Treat?

ENTYVIO is used to treat moderate to severe Crohn's Disease (CD) and Ulcerative Colitis (UC) in adults. It's a last resort for people who haven't been able to manage their symptoms using other medical therapies and medications. While usually very successful in treating UD and UC, ENTYVIO can be expensive and comes with several severe potential side effects. 

Potential Side Effects

Potential side effects of using ENTYVIO IV infusions include:

  • Headaches
  • Joint pain
  • Pain in the extremities
  • Cold and flu
  • Hypersensitivity
  • Allergic reactions 
  • Infusion-related reactions
  • Infections
  • Liver injury
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