Entyvio Pen

Generic: Entyvio

Vial

Cytokine And Cam Antagonists

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Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBS Federal Basic Option 2026
via Entyvio 		Tier 5 - Non-Preferred Specialty ✓ — — PA
BCBS Federal Standard Option 2026
via Entyvio 		Tier 5 - Non-Preferred Specialty ✓ — — PA
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Local 2026
via Entyvio 		Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Value 2026
via Entyvio 		Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Advantage 2026
via Entyvio 		Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Care 2026
via Entyvio 		Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Home with UNC Health Alliance 2026
via Entyvio 		Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
Source: CMS QHP JSON  ·  Formulary date: Mar 18, 2026  ·  Checked: 16 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 2 per 28 days PA | QL
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Alignment Health AVA (PPO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Troy Medicare (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — — PA
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — — PA
Blue Medicare PPO Enhanced (PPO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Blue Medicare Essential Plus (HMO-POS)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Blue Medicare Enhanced (HMO-POS)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Blue Medicare Choice (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Blue Medicare Essential (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Experience Health Medicare Advantage (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Healthy Blue + Medicare (HMO-POS D-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Alignment Health Platinum (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Alignment Health NC Duals (HMO-POS D-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Alignment Health smartHMO (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Alignment Health Platinum Select (HMO)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 1.36 per 28 days PA | QL
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC Medicaid Preferred Drug List 2026 Non-Preferred ✓ ✓ — PA | ST
Source: PDF  ·  Formulary date: Apr 1, 2026  ·  Checked: 16 hours, 39 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Entyvio 		Not Covered — — — None
NC State Health Plan - 70/30 Standard PPO 2026
via Entyvio 		Not Covered — — — None
NC State Health Plan - HDHP 2026
via Entyvio 		Not Covered — — — None
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