Entyvio (vedolizumab)
Billing
Code: J3380
Description: Injection, vedolizumab
Unit: 1 mg
Payment: $21.695
Pay quarter: Q1 2023
Dosage and Frequency
Ulcerative Colitis (UC)
Crohn's Disease (CD)
Induction:
• 300mg IV at weeks 0, 2, and 6
Maintenance:
• 300mg IV every 8 weeks
Crohn's Disease (CD)
Induction:
• 300mg IV at weeks 0, 2, and 6
Maintenance:
• 300mg IV every 8 weeks
Calculate drug reimbursement
Total Reimbursement:
$6,899.01(ASP: $6,508.50, Margin: $390.51)
Code:
J3380# Units to bill:
300Prior Authorization
Prior auth criteria for Entyvio may include but is not limited to:
1. Diagnosis of moderate to severe Ulcerative Colitis, Crohn's Disease, or Fistulizing Crohn's Disease.
2. Patient has tried and failed or is intolerant to a tumor necrosis factor (TNF) antagonist.
3. Patient has an objective sign of inflammation as documented by endoscopy, imaging, or physical exam.
4. Patient must be 18 years of age or older.
5. Benefits of therapy must outweigh the risks.
6. Patient must not have had any live vaccines within the past 4 weeks.
7. Patient must not have had any major surgery within the past 4 weeks.
8. Patient must not have had any serious infections within the past 4 weeks.
9. Patient must not have had any uncontrolled medical conditions that could affect their response to Entyvio.
10. Patient must not have any contraindications or hypersensitivity to Entyvio or its components.
Insurance prior auth guidelines:
Billable NDCs
64764-0300-20
ENTYVIO (TAKEDA PHARMACEUTICALS AMERICA, INC.)
300 MG
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