EntyvioConnect Start Program

Funded

About

The EntyvioConnect Start Program offers significant benefits for patients prescribed Entyvio or Entyvio Pen. This program provides eligible new-to-therapy patients who have received a prior authorization denial from their commercial insurance the opportunity to receive Entyvio at no cost for up to one year. This exclusive one-time offer can help patients access necessary treatments smoothly and affordably through a contracted non-commercial specialty pharmacy.

Insurance requirements: Commercially insured, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible newtotherapy patients who have received a prior authorization denial from their commercial insurance can receive Entyvio at no cost for up to one year

•If a patient enrolled in the Start Program is still appealing coverage at one year, the patient may be eligible for additional Entyvio under the Start Program

•Patients must submit evidence of prior authorization denial from their commercial insurance and other required documents

•Free product provided through the Start Program is only available through the Start Program’s contracted noncommercial specialty pharmacy

•The Start Program is a onetime offer per patient

•HCP and patient should complete enrollment form; HCP should fax completed enrollment form to 18774886814

•Call 1855ENTYVIO (18553689846) with any questions, Monday to Friday, from 8am to 8pm ET (except holidays)

Enrollment Forms

Enrollment Form