Entyvio® (vedolizumab)

Authorization forms

Traditional, Optimized & Medicaid (03/2019)

 No prior authorization is required for Medicare

No prior authorization required for:

  • Emergency room
  • Inpatient
  • Skilled nursing facility

For further information, please see the Injectable Drugs page

Code(s): J3380

Benefit: Medical

Notes: For treatment of adult Crohn's disease and ulcerative colitis