Does Medicare cover Entyvio?
Entyvio is a brand-name prescription biologic drug. It contains the active ingredient vedolizumab. Biosimilars are generic versions of biologic medications, but only the brand-name version of this drug is currently available. Biosimilar medications are very similar to the original biologic version, but due to the complex manufacturing process, they are not identical.
Medicare Part B may cover Entyvio (vedolizumab) if a doctor or another healthcare professional prescribes it as is.
Private insurance companies administer Part D prescription drug plans on Medicare’s behalf, so drug costs and drug availability can vary by plan type and plan provider.
If a person has moderate to severe ulcerative colitis or Crohn’s disease, a doctor or another healthcare professional may prescribe Entyvio (vedolizumab), and when medically necessary, Medicare may cover some or all eligible expenses.
Medicare Part B covers limited outpatient medications, including medications a person receives in a doctor’s office, hospital outpatient department, or other medical facility, and as Entyvio (vedolizumab) is mainly given via intravenous (IV) infusion, coverage will usually be from Part B.
After receiving successful IV infusions of this medication, a doctor may suggest switching to a subcutaneous injection, or an injection under the skin.
Once a person has paid the Part B deductible, which is $257 in 2025, they will be responsible for a 20% coinsurance.
If a person needs take-home medications, Part D prescription drug plans will cover eligible costs.
Not all Part D prescription drug plans have a deductible, but if an individual’s specific plan has one, they will join at this stage.
Once they have paid the deductible in full, the plan will begin paying its share of eligible expenses.
During this stage, a person will pay a 25% coinsurance toward the cost of Entyvio (vedolizumab).
In 2025, individuals will continue paying the 25% coinsurance until they have paid a total of $2,000. In 2026, this is expected to increase to $2,100.
During this stage, a person will pay no further costs toward their prescription drugs for the remaining calendar year.
They will receive an explanation of benefits (EOB) the month after their pharmacy bills their plan provider. The EOB will detail the following:
Entyvio is a brand-name medication containing the active ingredient vedolizumab. The Food and Drug Administration (FDA) has approved this medication for treating ulcerative colitis and Crohn’s disease.
Entyvio (vedolizumab) is in a class of medications called integrin receptor antagonists.
They work by blocking the effects of a specific type of protein called integrin. Integrin causes white blood cells, which are responsible for inflammation, to enter a person’s digestive tract.
People with inflammatory bowel disease, including ulcerative colitis and Crohn’s disease, have an overactive immune system that causes inflammation.
Experts believe that Entyvio reduces inflammation in the digestive tract by blocking integrin. However, the exact mechanism of action or how it works is unknown.
When a person first begins taking Entyvio (vedolizumab), they will generally receive it as an IV infusion. After the initial dosage, which may be split into two doses, individuals may be able to receive a subcutaneous injection or an injection under the skin.