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: Jul 1, 2026  ·  Checked: 19 hours, 24 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: Jul 1, 2026  ·  Checked: 19 hours, 24 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
BCBSNC Blue Home with UNC Health Alliance 2026
via Entyvio 		Tier 5 - Specialty ✓ — ✓ Restricted Access; Limited Distribution PA | QL
BCBSNC Blue Local 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 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
Source: CMS QHP JSON  ·  Formulary date: Jun 10, 2026  ·  Checked: 19 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
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
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
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Entyvio 		Tier 5 - Specialty ✓ — ✓ 2 per 28 days PA | QL
Source: PDF  ·  Formulary date: Jul 1, 2026  ·  Checked: 19 hours, 23 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: Jul 1, 2026  ·  Checked: 19 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
NC State Health Plan - 80/20 Plus PPO 2026
via Entyvio 		Tier 5 - Preferred Brand Specialty ✓ — ✓ Preferred for PA | QL
NC State Health Plan - 70/30 Standard PPO 2026
via Entyvio 		Tier 5 - Preferred Brand Specialty ✓ — ✓ Preferred for PA | QL
NC State Health Plan - HDHP 2026
via Entyvio 		Tier 5 - Preferred Brand Specialty ✓ — ✓ Preferred for PA | QL
Source: CMS QHP JSON  ·  Checked: 19 hours, 23 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
AIAN Cost Share | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic Standard | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic Standard | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Classic Standard | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Secure
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Elite Saver Plus
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Secure | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Classic 4700 | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Elite + PCP Saver Plus | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Classic | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Diabetes | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple PCP Saver | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Gold Elite Saver Plus | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Chronic Care CKM | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Bronze Simple Diabetes | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Chronic Care CKM | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
AIAN Cost Share
via Entyvio 		Tier 5 - Specialty ✓ — ✓ PA | QL
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