Note: I posted an update to this post on August 19, 2018.
I have spent many months trying to figure out how to get Entyvio Connect, a patient assistance program for individuals on Entyvio, to reimburse my health care provider for the cost of the medication for my infusion in January. It has involved many phone calls to my provider and to Entvyio Connect to get it all sorted out. But I finally did! Here is a guide to how it works.
Note: I have commercial health insurance coverage through a PPO offered by my employer. If you are covered by an HMO, Medicare, Medicaid, or have no insurance, Entyvio Connect may work differently than what I have described below.
What is Entyvio Connect?
Entyvio Connect is a patient assistance program offered by Takeda Pharmaceuticals, the company that manufactures Entvyio. Their website says they offer financial assistance and one-on-one support. In my experience, that is a bit of an exaggeration. They will cover part of the cost of your Entyvio infusion.
What will Entyvio Connect cover?
With Entyvio Connect, you will pay no more than $5 per dose of Entyvio. What they mean by this is that you will pay $5 towards the cost of the drug itself. Entyvio Connect does not cover any of the costs of administering the infusion. The maximum benefit you can receive in one year is $20,000.
How do I enroll in Entyvio Connect?
Your health care provider should enroll you in Entyvio Connect when you begin treatment (you will fill out a form and your provider will submit it). You will need to re-enroll each year and can do that by calling Entyvio Connect at 1-844-368-9846.
My health care provider says they signed me up. What’s next?
You should receive information in the mail about Entyvio Connect. However, I never received anything, even after calling and asking them to resend it. But I was able to verify that I was enrolled by calling, and they gave me all of the patient and insurance ID numbers that I should have received in the mail. They gave me a dizzying number of ID numbers and code words. More on that later.
How does Entyvio Connect work?
From what I gathered after many phone calls, Entyvio Connect works like a secondary health insurance. Therefore, Entyvio Connect will assume that your provider knows what to do to get reimbursed. This was not the case with my provider, so it took a lot of effort on my part to figure it out. Here’s how I made it work for me.
Step 1. My health care provider billed my insurance (Blue Cross Blue Shield) for my infusion. I received an Explanation of Benefits explaining what they covered and how much I owed.
Step 2. I received a bill from my health care provider for the amount I owed. I called the billing office and explained that I am enrolled in a patient assistance program called Entyvio Connect that works like a secondary insurance. I asked if they could bill Entyvio Connect for the remainder of the costs. To do this, they needed the claims mailing address for Entyvio Connect, which is:
P.O. Box 29219
Phoenix, AZ 85038
They also had room for only one ID number. This was tricky because as I mentioned before, Entyvio Connect provided me with many numbers. I had already called the billing office and Entyvio Connect several times, and of course I never got the same person each time so I had to start at the beginning of my explanation each time. Rather than go through that again, I took a guess and provided them the Patient ID number Entyvio Connect gave me. The reimbursement went through, so it seems that was sufficient. The billing office billed Entyvio Connect and in the meantime I did not have to pay the bill they sent me.
Step 3. To be safe, I faxed a copy of my Explanation of Benefits from Blue Cross Blue Shield and a copy of the bill from my provider to Entyvio Connect (fax number 1-855-300-4966), with a cover note explaining that my provider was billing Entyvio Connect for this infusion using my Patient ID number.
Step 4. Months went by, I received another bill for the same amount from my provider, I called Entyvio Connect and they said the claim was being processed, I called my provider’s billing office and asked if I could not pay the bill since they should be getting a payment soon, they agreed. Repeat. I hope you do not have a step 4.
Step 5. I received an Explanation of Benefits from Entyvio Connect. Success! They paid the portion of the costs that were incurred for the drug itself, minus $5. I owed $87 for the cost of administering the infusion, plus $5 for the drug. I received a bill from my provider for $92, which is much better than the $2,500 they originally billed me for.
I had to go through this for two infusions this year, and then I hit my catastrophic maximum under Blue Cross Blue Shield for the year.
This sounds like a lot of work. Is it worth it?
Yes. Entyvio Connect can be a big help in paying for Entyvio, so it’s worth taking the time to figure out. But it can take a lot of time. You may need to keep calling Entyvio Connect, and you may need to walk your provider through the process. But it will save you money.
Anything else I should know?
Takeda has recipes on its website, and will also send you a free cookbook if you sign up to receive emails about Entyvio. I haven’t used it yet, but it seems like a pretty decent cookbook.
Curious about what to expect during an infusion? See my post on the topic.