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Entyvio SC (vedolizumab) — Highmark

Crohn’s disease (CD)

Initial criteria

  • For UC: age ≥18 years; diagnosis of moderately to severely active UC; prescribed by or in consultation with a gastroenterologist; and either (i) has received at least two doses of Entyvio IV at least 6 weeks before initiating Entyvio SC or is currently undergoing Entyvio IV induction OR (ii) therapeutic failure or intolerance to at least two step 1 or 2a plan-preferred agents for UC
  • For CD: age ≥18 years; diagnosis of moderately to severely active CD; prescribed by or in consultation with a gastroenterologist; and either (i) has received at least two doses of Entyvio IV at least 6 weeks before initiating Entyvio SC or is currently undergoing Entyvio IV induction OR (ii) therapeutic failure or intolerance to at least two step 1 or 2a plan-preferred agents for CD

Reauthorization criteria

  • Member has demonstrated disease stability or a beneficial response to therapy