Stable on Entyvio for IBD? Fight for continued coverage.

Fight Your Entyvio Formulary Removal

Express Scripts is excluding Entyvio IV in 2026 — but you can appeal especially for continuity of care.

Understanding Your Entyvio (Vedolizumab) Continuity of Care Denial

Express Scripts is excluding Entyvio IV from the National Preferred Formulary effective 2026. If you have Crohn's disease or ulcerative colitis and are stable on Entyvio, you may have rights under continuity of care regulations.

Common Reasons for Denial

! Entyvio IV excluded from formulary effective July 2026
! Plan requires switch to alternative biologic
! Prior authorization now required
! Non-formulary exception denied

How We Help

We help you document your IBD treatment history with Entyvio, explain why switching biologics may trigger disease flares, and cite federal and state laws that protect stable patients from forced medication changes.

Start your Entyvio continuity of care appeal.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ Vedolizumab (Entyvio) has a gut-selective mechanism of action, which may offer advantages for patients who have failed or are intolerant to systemic immunosuppressants.

✓ Switching biologics in IBD carries risk of disease flare, loss of response, and development of anti-drug antibodies.

Financial Assistance Directory

Curated copay foundations, manufacturer programs, and safety-net clinics that may help with the cost while you appeal.

For your condition

Crohn's & Colitis Foundation Patient Aid (opens in a new tab)

Financial-resource navigator for IBD patients, plus their own small emergency assistance fund.

General copay foundations & directories

NeedyMeds (opens in a new tab)

Searchable database of 5,000+ patient assistance, copay, and diagnosis-specific programs. Start here if you are not sure where to look.

Eligibility: No eligibility check - the directory itself is free. Individual programs have their own income and insurance criteria.

Patient Advocate Foundation Co-Pay Relief (opens in a new tab)

Direct copay assistance for insured patients with chronic, life-threatening, or rare conditions. Covers many disease funds.

Eligibility: Generally requires insurance coverage and income up to 400% of the federal poverty level (varies by fund).

Phone: 1-866-512-3861

HealthWell Foundation (opens in a new tab)

Independent charity providing copay, premium, and travel assistance grants across 70+ disease funds.

Eligibility: Must have insurance covering the prescribed treatment; income thresholds vary by fund. Funds open and close as donations allow.

The Assistance Fund (TAF) (opens in a new tab)

Copay, insurance premium, and travel assistance for patients with chronic and rare diseases.

Eligibility: Must have insurance and meet income limits (typically up to 500% FPL, fund-dependent).

Good Days (opens in a new tab)

Copay assistance and other support for chronic-disease patients.

Eligibility: Funds vary by disease and open/close based on availability. Usually requires insurance and income under ~500% FPL.

PAN Foundation (Patient Access Network) (opens in a new tab)

Disease-specific copay assistance funds for ~70 conditions. Funds open and close throughout the year - check the website or sign up for fund-open alerts.

Eligibility: Insurance required; income limits typically 400-500% of FPL depending on the fund.

NORD (National Organization for Rare Disorders) (opens in a new tab)

Patient assistance, copay, and travel programs for people living with rare diseases.

RxAssist Patient Assistance Program Center (opens in a new tab)

Comprehensive directory of manufacturer patient assistance programs. Search by medication to find the manufacturer's free-drug program if you are uninsured or under-insured.

Safety-net clinics & 340B

HRSA Find a Health Center (FQHC locator) (opens in a new tab)

Federally Qualified Health Centers (FQHCs) provide primary care on a sliding-fee scale and dispense many medications at 340B-discounted prices, regardless of insurance status. Often the cheapest path for uninsured or under-insured patients.

HRSA 340B Program (provider directory + program info) (opens in a new tab)

Background on the 340B Drug Pricing Program. Use to verify whether a particular clinic or hospital is a covered entity before assuming discounted pricing applies.

State Pharmaceutical Assistance Program (SPAP) directory (opens in a new tab)

State-run programs (mostly for seniors and people with disabilities) that supplement Medicare Part D and reduce prescription costs. Availability and benefits vary by state.

Medicaid eligibility & application (Healthcare.gov) (opens in a new tab)

If denied insurance is unaffordable, check Medicaid / CHIP eligibility - thresholds and pathways vary by state, and many expansion states cover adults up to 138% FPL.

Program eligibility, fund availability, and contact info change frequently. Verify with each organization before assuming a program is open.

Patient Assistance & Copay Programs

These programs may help reduce your costs while you appeal:

EntyvioConnect

Eligible patients with commercial insurance may pay as little as $5 per infusion. Not for government insurance.

Takeda Patient Assistance Program

Patient assistance for uninsured or underinsured patients who qualify.

Eligibility requirements and program terms may change. Please verify current details directly with each organization.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

Crohn's & Colitis Foundation

Leading nonprofit organization focused on IBD research and patient support.

Frequently Asked Questions

Switching biologics in IBD can trigger disease flares, and patients may develop antibodies that make returning to their original medication difficult. Your appeal should emphasize the risks of switching when stable.

Plans may push for other biologics or JAK inhibitors. Your appeal can explain why Entyvio's gut-selective mechanism is specifically appropriate for your case, especially if you've tried other medications.

Yes. You can request a non-formulary exception based on medical necessity. Your gastroenterologist should provide a letter explaining why Entyvio specifically is needed.

Ready to Fight Your Entyvio (Vedolizumab) Continuity of Care Denial?

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.