Medicare AdvantagePrior AuthMedium impact
Entyvio® (vedolizumab) (Revised)
Humana·Gastroenterology, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated prior authorization requirements for Entyvio (vedolizumab) effective January 1, 2025. The policy requires step therapy with specific medications before approving Entyvio IV or subcutaneous formulations for ulcerative colitis and Crohn's disease patients.
Action Required
Immediately: Update prior authorization workflows for Entyvio (vedolizumab) prescriptions. Ensure documentation shows patients have tried required step therapy medications (infliximab products plus ustekinumab/Tremfya for IV form, or two specific medications for subcutaneous form) before submitting prior auth requests. Train clinical staff on new step therapy requirements to avoid claim denials.