Entyvio — Medical Mutual
Acute Graft Versus Host Disease (aGVHD)
Initial criteria
- Patient age ≥ 18 years
- Patient has received an allogeneic hematopoietic stem cell transplant
- Used for steroid-refractory acute GVHD
- Used in combination with systemic corticosteroids as additional therapy following no response to first-line therapies
- Site of care medical necessity is met
Reauthorization criteria
- Approve for an additional 6 months of therapy if the patient has responded (e.g., clinician assessments such as NIH Skin Score, Upper GI Response Score, NIH Lung Symptom Score, or patient-reported symptoms such as Lee Symptom Scale), as determined by the prescribing physician
Approval duration
14 weeks initial, 6 months reauth