Has anyone appealed insurance for Entyvio coverage?

Hello!

My GI recommended I start Entyvio, but my insurance denied because I haven’t failed other treatments yet. They will apparently cover humira or stelara which my doctor didn’t recommend bc of the increased risk for side effects. Now he says stelara will be fine… I’m annoyed to be forced into taking a second choice medication when there is a safer option available. Has anyone had success appealing insurance on this kind of situation?

Thanks,
Allison

Stelara is pretty safe, it's arguable whether entyvio is significantly safer.... even with remicade most people will have few or no adverse effects. I've been on several immunosuppressants and I had the most colds when I was taking entyvio (4 colds in 4 months... two of them pretty horrible at that...) go figure. I guess what I'm saying is, don't get too hung up on the safety thing. The difference is not enormous. Entyvio is gut specific, but it also has some effect on the respiratory tract.

You have the right to appeal their denial. You can win and some people do win their appeals. It's something that your GI's office can and should handle for you if you wanted to push the issue.

I've been on Stelara for 5+ years and I really like it. You can give yourself injections at home. Entyvio you need an infusion.

Stelara should work quicker than Entyvio (which is slow acting).