Burdensome Highmark Policy Amended as a Result of Physician Advocacy

A new proposed Highmark policy — which many physicians described as burdensome — would have required gastroenterologists who prescribe the drug, vedolizumab (Entyvio®), for their patients with moderate-to-severe ulcerative colitis and Crohn’s disease, to provide prior documented evidence of treatment failure/non-response, intolerance to or contra-indications to two different anti-TNF agents before the drug would be approved.

The Pennsylvania Medical Society (PAMED) and Pennsylvania Society of Gastroenterology (PSG) expressed physicians concerns to Highmark in July. As a result, on Sept.16, 2015, Highmark announced it was revising its original proposed policy to only require a one-step anti-tumor necrosis factor (anti-TNF) biologic failure prior to the use of vedolizumab, rather than having to have failed two anti-TNF’s. The policy was effective on November 30, 2015.