Entyvio (vedolizumab subcutaneous injection – Takeda) — Cigna

Initial criteria

• Patient is age ≥ 18 years; AND
• According to the prescriber, the patient is currently receiving Entyvio intravenous or will receive induction dosing with Entyvio intravenous within 2 months of initiating therapy with Entyvio subcutaneous; AND
• The medication is prescribed by or in consultation with a gastroenterologist.

Reauthorization criteria

• Patient has been established on Entyvio subcutaneous or intravenous for at least 6 months; AND
• Patient meets at least ONE of the following (a or b):
• a) When assessed by at least one objective measure, patient experienced a beneficial clinical response from baseline (e.g., fecal calprotectin, C-reactive protein, endoscopic assessment, and/or reduced corticosteroid dose); OR
• b) Compared with baseline, patient experienced an improvement in at least one symptom (e.g., decreased pain, fatigue, stool frequency, and/or decreased rectal bleeding).

Approval duration

Initial: 6 months; Reauth: 1 year