Entyvio (vedolizumab) subcutaneous — United Healthcare
moderately to severely active ulcerative colitis
Initial criteria
- Diagnosis of moderately to severely active ulcerative colitis
- Patient is not receiving Entyvio in combination with a targeted immunomodulator [e.g., adalimumab, Omvoh (mirikizumab-mrkz), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), Tremfya (guselkumab), Xeljanz/Xeljanz XR (tofacitinib), Ustekinumab, Zeposia (ozanimod)]
Reauthorization criteria
- Documentation of positive clinical response to Entyvio therapy
- Patient is not receiving Entyvio in combination with a targeted immunomodulator [e.g., adalimumab, Omvoh (mirikizumab-mrkz), Rinvoq (upadacitinib), Simponi (golimumab), Skyrizi (risankizumab), Tremfya (guselkumab), Xeljanz/Xeljanz XR (tofacitinib), Ustekinumab, Zeposia (ozanimod)]
Approval duration
12 months