Copay support
May reduce eligible commercially insured patients' ENTYVIO medication cost to as little as $0 per dose, subject to annual limits.
What it does
Supports eligible medication out-of-pocket costs under medical- or pharmacy-benefit claims. Infusion claims can require an EOB for each dose. The published standard annual maximum is $20,000, reduced to $9,000 for identified maximizer plans.
Open official program pageAvailable to eligible commercially insured patients prescribed ENTYVIO, subject to the current terms and plan design.
Government program exclusions: Medicare, Medicaid, TRICARE, VA, DoD, Other federal or state healthcare programs
Send the prescription or infusion order through the normal treatment channel.
Provide medical and pharmacy benefit details during enrollment.
Submit the EOB after each infusion when required by the program.
Select copay support in the patient enrollment flow or on the provider form. Give the resulting benefit details to the pharmacy or infusion site and submit infusion EOBs when requested.
Best for: Patients or caregivers who can complete the official web form
Enter the requested patient, prescription, contact, and insurance information; select the services requested.
Owner: Patient or caregiver
Patient, EntyvioConnect, Pharmacy Or Infusion Site
EntyvioConnect
Benefits investigation, authorization, savings, temporary access, patient assistance, and nurse support.
Monday-Friday, 8 AM-8 PM ET
Comprehensive official HCP page describing service eligibility, duration, and benefit limits.
Patient-facing cost support page for ENTYVIO.
Have ready: Condition, Current treatment status, IV or Pen, Insurance, Prescriber, Consent
Review the authorization and program terms, provide consent, and submit the form.
Owner: Patient or caregiver
Best for: Services requiring clinical information, a prescription, or prescriber attestation
Patient completes demographics and the authorization/consent section of the official form.
Owner: Patient
Have ready: Contact information, Signature and date
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Completed patient authorization, Insurance cards, Prescription and prescriber signature
Submit the completed form by fax to 1-877-488-6814.
Owner: Clinic staff
After enrollment: Provide benefit information to the pharmacy or infusion provider. For medical-benefit dosing, retain each EOB and follow the program's claim-submission process.
If there is a problem: Call EntyvioConnect about rejected claims, missing EOBs, or an incorrect maximizer designation.
Official enrollment form includes patient, provider, insurance, prescription, and service sections.
