Which IBD medications are usually covered by your insurer?
Select an insurer, medication, and condition to see typical commercial coverage, prior authorization, and step therapy requirements, all based on publicly available formulary policies.
Yes, Entyvio is typically covered by Aetna, with prior authorization
Most Aetna commercial plans cover Entyvio (vedolizumab) for Crohn's disease, but your prescriber must submit clinical documentation before the plan will pay. Approval is common when criteria are met.
- Prior authorization
Required
Prescriber submits clinical documentation; decision times vary by plan, urgency, and how complete the submission is.
- Step therapy
None
No fail-first in the cited policy; individual plan formularies can still add rules.
- Typical placement
Varies by plan
CPB 0885 is a medical-benefit clinical policy and does not set a pharmacy tier; check your plan's formulary for cost share
- Line of business:
- Commercial
- Reauthorization:
- Documented clinical response required; CPB 0885 does not state a universal renewal period
- PA criteria:
- Moderate-to-severe active Crohn's disease; prescribed by or in consultation with a gastroenterologist; precertification required under CPB 0885. Continuation requires evidence of clinical benefit. The base policy does not list a conventional-therapy prerequisite.
- Exception path:
- None specified
- Scope:
- Aetna commercial medical-benefit policy CPB 0885, principally IV vedolizumab; pharmacy-benefit and self-injected rules may differ.
The access landscape for Crohn's disease
How restrictive each major insurer's standard commercial formulary is, per medication. Select any cell to see the details above.
- Prior auth
- PA + step therapy
- Brand excluded / off formulary
- Varies by local plan
Standard commercial policies; last reviewed Jul 2026. Coverage depends on your exact plan, employer group, state, and whether the drug is infused (medical benefit) or self-injected (pharmacy benefit). Blue Cross Blue Shield coverage is set by independent local Blue companies, and Kaiser Permanente details reflect Kaiser Northwest policy documents. This tool summarizes publicly available policies and is for informational purposes only. Your individual plan may differ from the public documents cited here. It is not medical or insurance advice. Your selections are not saved or sent to a server; they live only in your browser and this page's web address, so you can bookmark or share a result.