UnitedHealthcare Vedolizumab (Entyvio) prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Vedolizumab (Entyvio) (CPT J3380), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for Vedolizumab (Entyvio) (CPT J3380).
Medical-necessity criteria UnitedHealthcare generally applies
Prior authorization required. Moderately-to-severely active Crohn's disease or ulcerative colitis AND a history of failure, contraindication, or intolerance to at least one of a TNF blocker, an immunomodulator, or a corticosteroid (or corticosteroid dependence). Dosed per FDA labeling; initial and continued authorization up to 12 months; continuation requires documented positive clinical response.
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 UnitedHealthcare policy.
Commonly required documentation
- Diagnosis
- documented failure/contraindication/intolerance to a conventional therapy or corticosteroid dependence
- FDA-compliant dosing.
Situations to verify before submitting
UnitedHealthcare may not cover Vedolizumab (Entyvio) in these situations. Verify against the current policy rather than assuming a denial:
- Not covered concomitantly with listed targeted immunomodulators (adalimumab, certolizumab, mirikizumab, upadacitinib, golimumab, risankizumab, guselkumab, ustekinumab, tofacitinib) or with natalizumab
How to submit
- Method: UnitedHealthcare provider portal (medical benefit drug review)
- Portal: UnitedHealthcare Provider Portal
Source
Source: UHC Commercial Medical Benefit Drug Policy Entyvio/Vedolizumab (eff 2025-07-01). Code J3380. Last verified 2026-06-17.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Vedolizumab (Entyvio)?
Yes. UnitedHealthcare generally requires prior authorization for Vedolizumab (Entyvio) (CPT J3380).
What does UnitedHealthcare require to approve Vedolizumab (Entyvio)?
Prior authorization required. Moderately-to-severely active Crohn's disease or ulcerative colitis AND a history of failure, contraindication, or intolerance to at least one of a TNF blocker, an immunomodulator, or a corticosteroid (or corticosteroid dependence). Dosed per FDA labeling; initial and continued authorization up to 12 months; continuation requires documented positive clinical response. Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
Turnaround varies by plan and submission method. Check the UnitedHealthcare portal for current timeframes.
Submitting Vedolizumab (Entyvio) to UnitedHealthcare?
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.