Limited Coverage Drugs - Vedolizumab

Generic Name

vedolizumab

Strength

300 mg/vial

Form

Solution for Infusion

Special Authority Criteria

Approval Period
  1. Treatment of moderate to severe active Crohn's disease, according to established criteria* when prescribed by a gastroenterologist.

First approval (induction period): 3 doses
Renewal: 1 year

  1. Treatment of moderate to severe Ulcerative Colitis according to established criteria* when prescribed by a gastroenterologist.

First approval (induction period): 3 doses
Renewal: 1 year

* Click on the appropriate Special Authority Form below for full criteria.

Practitioner Exemptions

  • None

Special Notes

  • PharmaCare covers a maximum of 56 days per fill for vedolizumab.

Special Authority Request Form(s)