Aetna Vedolizumab (Entyvio) prior authorization requirements (2026)
What Aetna generally requires to approve Vedolizumab (Entyvio) (CPT J3380), for Commercial plans. Yes. Aetna generally requires prior authorization for Vedolizumab (Entyvio) (CPT J3380).
Medical-necessity criteria Aetna generally applies
Precertification required (prescribed by/with a gastroenterologist). Moderately-to-severely active Crohn's disease or ulcerative colitis. Dosing 300 mg IV at weeks 0 and 2, then 300 mg IV every 8 weeks (or 108 mg subcutaneously every 2 weeks) from week 6; therapy is discontinued in patients showing no therapeutic benefit by week 14. Reauthorization requires remission or positive clinical response (CD: abdominal pain, diarrhea, weight, hematocrit, mucosal appearance, CDAI; UC: stool frequency, rectal bleeding, urgency, CRP, fecal calprotectin, mucosal appearance, Mayo/UCEIS).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Vedolizumab (Entyvio). Confirm the covered diagnosis list against the current Aetna policy.
Commonly required documentation
- Diagnosis (moderate-to-severe CD or UC)
- week-14 benefit assessment for continuation
- specialist prescriber.
Situations to verify before submitting
Aetna may not cover Vedolizumab (Entyvio) in these situations. Verify against the current policy rather than assuming a denial:
- Concomitant use with any other biologic or targeted synthetic drug is considered experimental/investigational
How to submit
- Method: Aetna precertification (866-752-7021, fax 888-267-3277)
- Portal: Availity
Source
Source: Aetna CPB 0885 Vedolizumab (last review 2025-12-03). Code J3380. Aetna does not mandate a step-therapy trial for initial approval. Last verified 2026-06-17.
Frequently asked questions
Does Aetna require prior authorization for Vedolizumab (Entyvio)?
Yes. Aetna generally requires prior authorization for Vedolizumab (Entyvio) (CPT J3380).
What does Aetna require to approve Vedolizumab (Entyvio)?
Precertification required (prescribed by/with a gastroenterologist). Moderately-to-severely active Crohn's disease or ulcerative colitis. Dosing 300 mg IV at weeks 0 and 2, then 300 mg IV every 8 weeks (or 108 mg subcutaneously every 2 weeks) from week 6; therapy is discontinued in patients showing no therapeutic benefit by week 14. Reauthorization requires remission or positive clinical response … Always confirm against the current Aetna policy.
How long does a Aetna prior authorization take?
Turnaround varies by plan and submission method. Check the Aetna portal for current timeframes.
Submitting Vedolizumab (Entyvio) to Aetna?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.