Ulcerative colitis and Crohn’s disease are conditions that affects hundreds of thousands of people each year. With no known cure, managing symptoms is key to living a healthy and active life. Although diet can play a role in how these conditions affect the body, many people continue to experience bouts of symptoms throughout their lives. As a means to help the body reduce inflammation and the development of ulcers in the digestive tract, medications like Entyvio (vedolizumab) may help.
Does Medicare Cover Entyvio?
Medicare Part D prescription drug plans can vary in benefits and costs. Each plan has its own formulary, or list of covered drugs. The formulary may change as new medications and therapies are introduced to the marketplace or as newer drugs replace outdated medications. Currently, Entyvio is not a part of a National Coverage Determination, and no Local Coverage Determinations under Medicare exist as of April 2019. This means that Medicare patients who are prescribed Entyvio will likely have to pay out-of-pocket for the whole cost.
Medicare Part B May Help
Although Medicare’s Part D prescription drug benefit does not cover Entyvio, some patients may be able to get coverage for Entyvio through Medicare Part B under certain circumstances. Medicare Part B covers medically necessary services in a doctor’s office or in an outpatient setting. If your Medicare-approved physician accepts assignment and administers this injectable medication, Part B may help cover the costs. If the drug is administered by a skilled nursing professional, while in the care of a skill nursing facility, or during an inpatient hospital stay, Medicare Part A may also provide coverage.
Financial Assistance for Entyvio Prescriptions
Despite Entyvio’s status under Medicare, some seniors may be able to take advantage of financial assistance programs to receive discounted pricing on the drug. There are a number of foundations that provide help to lower out of pocket expenses. Financial assistance programs will work directly with drug manufacturers to develop tiered discount plans to ensure that people are able to afford their medications. In fact, Takeda Pharmaceuticals, the manufacturer of Entyvio, offers assistance options for seniors and other patients who qualify to reduce or eliminate out-of-pocket costs. To see if you qualify, speak with a Takeda Pharmaceuticals representative directly.
Develop a Nutrition Plan
In addition to medication your physician may prescribe for you, like Entyvio, there are changes in your diet that may help. and There is no way to completely avoid the potential for a flare-up when dealing with ulcerative colitis or Crohn’s disease, but you and your doctor can design a preventive treatment plan to mitigate the disease’s onset and the length of symptoms. It’s important to discuss your eating habits and symptoms with your physician on a regular basis in order to recognize possible trigger foods and activities. Your doctor can review your unique health challenges and lifestyle concerns to create a nutrition-based approach that may help you avoid medications altogether.