Entyvio Medicare Coverage

Entyvio is a monoclonal antibody with gut selective anti-inflammatory effects to treat and manage symptoms of moderate-to-severe UC or CD. It is an IV infusion given in a hospital, clinic, or infusion center over 30 minutes, with 3 starting doses at 0, 2, and 6 weeks, followed by maintenance dosing every 8 weeks.

The most common side effects of this medication include headache, joint and extremity pain, cold and flu. Serious side effects with this medication can include hypersensitivity or infusion-related reactions, infections and liver injury.

Entyvio has been proven to help achieve relief and remission in people with UC or CD who have been unsuccessful on other therapies.

How much does Entyvio cost with Medicare?

If Medicare Part B covers Entyvio treatments for you because you meet the qualifying conditions, you’ll typically pay 0% to 20% of the Medicare-approved amount for the Entyvio prescription price, after you meet your Part B deductible.

In 2024, the Medicare Part B deductible is $240 per year. Once you pay this amount, you’ll pay the remaining copay costs Medicare Part B doesn’t cover.

Does Medicare cover Trulicity?

Medicare Part B covers injectable and infused drugs administered by a medical provider for qualified beneficiaries.

You don’t need a Medicare Advantage plan or a Medicare Part D prescription drug plan to get Entyvio coverage.¹

If you have either type of private drug plan, you’re enrolled in Medicare Part B, and you qualify for Medicare coverage of Entyvio, your Part B benefits will cover Entyvio.

Some Medicare Advantage plans and Medicare Part D plans cover other prescription drugs that aren’t administered in a doctor’s office or by a medical professional.

• Part D plans or Medicare Advantage plans that cover drugs include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2024 Medicare Advantage plans include prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover prescription drugs. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Additional information

Ulcerative Colitis and Crohn’s Disease are characterized by ongoing inflammation in the digestive tract and are associated with severe abdominal pain and diarrhea.

If left untreated or improperly managed, complications could arise such as bowel obstruction, ulcers, malnutrition and other serious health problems.

Entyvio is a medication with proven benefits, showing evidence of long-term remission and long-term safety in patients with UC or CD. Entyvio is mostly used in adults with moderate-to-severe disease after failure or intolerance to other therapies.

Entyvio has demonstrated significantly better remission rates than other therapies. It can, however increase risk of developing serious or fatal infections and increase risk of liver injury.

People interested in starting Entyvio must be up to date with their immunizations before starting this treatment. Clinical benefit of treatment with Entyvio will be assessed at week 14 and stopped if response to therapy is inadequate.

Entyvio should not be used with immunosuppressants or TNF inhibitors.

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.