Vedolizumab (Entyvio) (CPB 0885, reviewed 2026-06-30)

By June 30, 2026: (1) Billing and Prior Auth teams must update authorization protocols to require precertification for vedolizumab (J3380) for all four indications: Crohn's disease, ulcerative colitis, immune checkpoint inhibitor-related toxicity, acute graft versus host disease, and CAR T-cell-related toxicity. (2) Providers and clinical staff must verify that prescribers are credentialed specialists (gastroenterologist, hematologist, or oncologist as applicable per indication). (3) Update precertification request forms and submission instructions to include specialty-specific criteria: for immunotherapy-related toxicity, document inadequate corticosteroid response or contraindication; for graft-versus-host disease, document corticosteroid inadequacy or contraindication; for CAR T-related toxicity, document steroid-refractory or recurrent diarrhea. (4) For continuation of therapy requests, require documentation of clinical response (remission, disease activity improvement, or biomarker improvements per indication-specific criteria). (5) Update billing system to flag J3380 claims for prior authorization before submission and enforce the no-concomitant-biologic rule (deny claims if patient is simultaneously on another biologic for same indication). Contact Aetna precertification at (866) 752-7021 or fax (888) 267-3277. Failure to obtain precertification will result in claim denials.