Guide to the Entyvio Connect Claim Form and Reimbursement

Entyvio Connect Claim Form - Submitting for Reimbursement

Entyvio (vedolizumab) is a prescription medication used to treat ulcerative colitis and Crohn's disease. It works by targeting the gut endothelium to reduce inflammation. While effective, Entyvio can be expensive, with each infusion costing thousands of dollars.

That's where the Entyvio Connect support program comes in. This program from the manufacturer provides resources to help patients get access to Entyvio treatment, including reimbursement assistance. Here's what you need to know about completing the Entyvio Connect claim form to seek coverage for Entyvio infusions.

What is Entyvio Used For?

Entyvio is an intravenous medication used to treat moderate to severe ulcerative colitis and Crohn's disease in adults. Ulcerative colitis causes inflammation and ulcers in the large intestine and colon, leading to symptoms like diarrhea, rectal bleeding, and abdominal pain.

Entyvio works by blocking the action of an integrin protein called α4β7 that plays a role in intestinal inflammation. This helps calm immune system activity in the gastrointestinal tract.

How Entyvio Treatment Works

Entyvio is administered through a 30-60 minute intravenous infusion at a doctor's office or infusion center. For ulcerative colitis, the starting dose schedule is:

• 0 weeks - Initial infusion
• 2 weeks - Second loading infusion
• 6 weeks - Third loading infusion
• Every 8 weeks - Maintenance infusion

Some patients may need more frequent maintenance dosing. Improvement in symptoms may take up to 16 weeks. Entyvio is a long-term treatment as symptoms can return if infusions are stopped.

Who is Eligible for Entyvio?

Entyvio is FDA approved for adults with moderate to severe active ulcerative colitis or Crohn's disease who have:

• An inadequate response or intolerance to other therapies like steroids, immunomodulators, or TNF blockers.
• Tried eliminating certain foods and making lifestyle modifications without improvement in symptoms.
• Ongoing inflammation and ulcers seen on endoscopy while on other medications.

Entyvio is not for people with a hypersensitivity to the medication or its components. Rare cases of PML, a serious brain infection, have occurred.

What is Entyvio Connect?

Entyvio Connect is a support program offered by Entyvio's manufacturer, Takeda Pharmaceuticals. It provides a range of services to help patients start and stay on Entyvio treatment through insurance coverage assistance. The main components of Entyvio Connect include:

• Benefit investigation - Helps understand insurance coverage for Entyvio.
• Prior authorization support - Assists with obtaining prior approval from insurance.
• Claims and appeals assistance - Helps secure reimbursement for Entyvio infusions.
• $0 co-pay program - Offers co-pay coupons for eligible patients.

Completing the Entyvio Connect Enrollment Form

To utilize Entyvio Connect's services, you first need to complete an enrollment form. This can be done online or through your doctor's office. The form collects basic information such as:

• Patient name, DOB, contact details
• Provider information
• Health insurance information
• Prescription info and dates
• Consent to contact patient and share health data

Completing this enrollment form registers you with the program. A dedicated case manager will then reach out to get the process started.

Entyvio Connect Coverage Investigation

After enrollment, an Entyvio Connect case manager will verify your insurance benefits related to Entyvio treatment. This includes:

• Confirming whether Entyvio is covered.
• Checking requirements like prior authorization.
• Reviewing co-pay and deductible details.
• Finding potential ways to reduce out-of-pocket costs.

Your case manager will inform both you and your doctor about your benefits, so you know what to expect cost-wise for Entyvio infusions.

Prior Authorization Support

Many insurance plans require prior authorization before they will cover Entyvio. This means your doctor must provide documentation showing Entyvio is medically necessary for your condition.

Entyvio Connect has a team that will walk your doctor's office through the prior auth process. This includes ensuring the right medical info is submitted to increase the chances of approval.

Claims and Appeals Assistance

Even with an approved prior authorization, claims for Entyvio infusions may still be denied or only partially reimbursed by insurance. Entyvio Connect can provide assistance with resolving claims issues and denied reimbursements.

A dedicated case manager can help coordinate the appeals process and advocate on your behalf. They know how to best work with insurers to secure coverage for Entyvio treatment.

Co-Pay Assistance Program

Eligible enrolled patients can receive a co-pay card from Entyvio Connect that covers up to $15,000 per year in out-of-pocket infusion costs. This helps significantly reduce the cost burden if you have a high deductible or co-insurance responsibility.

To qualify, you must have commercial insurance that covers Entyvio. Government plans like Medicare and Medicaid cannot be used with the co-pay card.

Reimbursement Process

Once insurance coverage is secured through Entyvio Connect, here is the typical reimbursement process for each infusion:

1. Provider buys and bills for Entyvio, usually at higher list price.
2. Claim is submitted to insurance by provider.
3. Insurance processes claim and determines patient cost share responsibility.
4. Provider bills patient for their portion per EOB from insurance.
5. Patient submits reimbursement request to Entyvio Connect.
6. Entyvio Connect reviews and reimburses the patient for their cost share amount.

Keeping all invoices and EOBs is crucial for submitting for reimbursement from Entyvio Connect after each infusion.

Get Assistance Paying for Entyvio

The Entyvio Connect program provides invaluable assistance with securing insurance coverage and reimbursement for costly Entyvio ulcerative colitis treatment. Be sure to complete all required forms and work closely with your dedicated case manager to reduce the financial burden of needed infusions.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.