Patient assistance
May provide ENTYVIO at no cost to eligible patients without insurance or with insufficient insurance benefits.
What it does
Takeda's patient-assistance pathway evaluates insurance insufficiency, financial eligibility, prescription, and provider information before arranging no-cost product.
Open official program pagePotentially available to patients who meet Takeda's current financial and coverage criteria and lack adequate insurance benefits for ENTYVIO.
Complete and sign the patient portion of the current Takeda assistance application.
Provide income evidence requested by the program.
Ask EntyvioConnect or Help At Hand to screen the patient. The patient and prescriber complete their application sections and submit financial, insurance, and prescription records.
Best for: Patients who may lack adequate coverage
Provide the requested prescription, insurance, contact, and consent information.
Owner: Patient or caregiver
Have ready: Prescription details, Insurance card, Prescriber contact information
Patient, Prescriber And Clinic Staff, Takeda Help At Hand Or EntyvioConnect
EntyvioConnect
Benefits investigation, authorization, savings, temporary access, patient assistance, and nurse support.
Monday-Friday, 8 AM-8 PM ET
Describes Takeda's patient assistance for eligible patients without insurance or with insufficient coverage.
Comprehensive official HCP page describing service eligibility, duration, and benefit limits.
Provide current insurance details, denial information, or uninsured status.
Complete the provider section and submit a valid ENTYVIO prescription.
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: Patient authorization, Income evidence, Insurance or denial evidence, Provider certification, Prescription
Submit the completed form by fax to 1-877-488-6814.
Owner: Clinic staff
After enrollment: The program communicates the eligibility decision and, if approved, product-ordering and delivery instructions.
If there is a problem: Call to determine whether the patient or provider portion, financial evidence, insurance information, or prescription is incomplete.
Official enrollment form includes patient, provider, insurance, prescription, and service sections.
