Posted 8/6/2014 7:06 AM (GMT -7)
It's ridiculous because all of these drugs are essentially price-fixed. One dose of Entyvio is around $5000. After the loading dose, it's every 8 weeks, so the monthly cost is $2500. A package of Humira (2 shots) is around $2500. Same monthly cost as Entyvio if given once every two weeks, which is the FDA-approved dose. Stelara, Cimzia, same monthly cost - $2500. I don't know the monthly cost for Remicade since the dosage varies by person, but I would imagine it's about the same, plus the cost of infusion. The cost of infusion isn't too high where I go (local infusion center at GI office) either - Aetna paid $150 for it. So these insurance companies make you jump through hoops and push the "cheaper" option, but the costs don't differ that much. Aetna has special deals with "preferred" pharmaceutical companies (Janssen, Abbvie) so their costs for those drugs (Remicade, Simponi, Stelara, Humira) are slightly less but still in the same ballpark as the non-preferred.
Anyway, Aetna has finally published a Clinical Policy Bulletin for Entyvio, which is an interesting read. You can see if your insurance company has a similar document published. It's the standard guidelines for covering Entyvio: