Entereg

Indicated For

postoperative ileus after bowel resection surgery

About This Medication

# Entereg (Alvimopan) Patient Guide: How to Get Entereg at Low or No Cost Entereg (alvimopan) is **not available through traditional patient assistance programs** because it is distributed exclusively to enrolled hospitals under the strict Alvimopan REMS program, required by the FDA for safety reasons.[1][2][4] This guide explains access, costs, and support options for hospitalized patients needing this medication to accelerate gastrointestinal recovery after bowel resection surgery.[1][5] ## About Entereg (Alvimopan) Entereg is an oral capsule (12 mg) classified as a peripherally acting mu-opioid receptor antagonist. It blocks opioids' effects in the gut—causing slowed motility and postoperative ileus—without affecting pain relief in the brain.[2][4][5] It's indicated only for short-term, inpatient use: one dose (12 mg) 30 minutes to 5 hours before partial large or small bowel resection surgery with primary anastomosis, followed by 12 mg twice daily starting the first postoperative day, up to 7 days or hospital discharge (maximum 15 doses).[2][5][7][8] **Why the restrictions?** Long-term studies showed a potential risk of heart events with opioids, so the FDA limits Entereg to hospitals via the Alvimopan REMS (formerly E.A.S.E. program). Hospitals must enroll at alvimopanrems.com or call 1-800-278-0340, receive education, and ensure only short-term use.[1][2][4][7] A full course (15 capsules) costs about $1,125 ($75 per capsule), typically covered by hospital billing, not retail pharmacies.[5] ## Who Qualifies for Entereg **Patient eligibility:** Adults undergoing qualifying bowel resection surgery in an enrolled hospital. Not for children, outpatient use, or non-FDA indications like chronic opioid constipation.[4][6][7][8] Your surgeon or hospital team decides based on procedure. **Hospital eligibility:** Must perform bowel resections, enroll in REMS, provide staff education, and follow dosing limits.[1][2] No traditional manufacturer patient assistance program exists, as there's no named program, manufacturer copay card, or direct-to-patient distribution in the details provided.[1-8] ## Income Eligibility and Financial Assistance Entereg lacks specific income-based patient assistance. Costs are hospital-billed, often to insurance. For low-income patients: | Household Size | Potential Aid Programs | Income Threshold (Example: 2025 Federal Poverty Level 400%) | Notes | |---------------|-------------------------|-------------------------------------------------------------|-------| | Individual | Medicare Extra Help | ~$50,000 annually | Reduces Part D copays; apply via SSA.[3] | | Couple | Medicare Extra Help | ~$68,000 annually | No premiums/deductibles for eligible.[3] | | Family of 3 | State Pharmaceutical Aid | Varies by state (e.g., PA PACE/PACENET) | Check Medicare.gov for state programs.[3] | | Family of 4 | Medicare Extra Help | ~$85,000 annually | Assets also considered.[3] | These are general low-income benchmarks (e.g., 400% FPL); exacts vary yearly. Hospitals may offer charity care; ask social workers.[3] ## Insurance Requirements Entereg is inpatient-only, billed via hospital DRG, not outpatient pharmacy claims.[1][4] - **Commercial insurance:** Often covered; check copays/deductibles. - **Medicare Part A (hospital):** Typically covers; no out-of-pocket max, but Part D may apply post-discharge (rare).[3] - **Medicare Part D:** Limited role; consider Extra Help for copays or Prescription Payment Plan (spread costs to $2,000 annual cap in 2025).[3] - **Medicaid:** Usually covers inpatient meds. No insurance? Hospitals assess based on income; contact financial aid.[3] ## Step-by-Step: How to Access Entereg 1. **Undergo qualifying surgery:** Discuss with surgeon pre-op if ileus risk is high.[5] 2. **Confirm hospital enrollment:** Ask if enrolled in Alvimopan REMS (alvimopanrems.com or 1-800-278-0340).[1][4] 3. **Get prescribed:** Surgeon orders per protocol (pre-op + up to 14 post-op doses).[7][8] 4. **Handle costs:** Hospital bills insurance; request financial counseling for uninsured/low-income. 5. **Apply for aid if needed:** For copays, use Medicare Extra Help (ssa.gov) or state programs.[3] 6. **90-day supply N/A:** Inpatient-only, no refills.[3][4] ## Timeline and Delivery - **Processing:** REMS enrollment is hospital-level (one-time); drug ordered via specialty distribution.[1][4] - **Dosing timeline:** Pre-op dose, then BID post-op; max 15 doses or discharge (~7 days).[2][5] - **Delivery:** Hospital pharmacy dispenses directly to patient—no home delivery or mail-order.[1][4] Approval is immediate if hospital enrolled; no patient-level delays.[1] ## Alternatives if Denied or Ineligible - **Non-drug options:** Supportive care (NG tube, fluids, early feeding) for ileus.[5] - **No biosimilars:** Unique REMS drug.[1] - **Financial alternatives:** Medicare Payment Plan, Extra Help, state aid, hospital charity, or 90-day scripts (if applicable elsewhere).[3] - **Clinical alternatives:** Methylnaltrexone or lubiprostone for opioid ileus (off-label).[5] Contact hospital pharmacist for options. ## Important Disclaimer This guide is for informational purposes only and based on available data as of 2026. Entereg access is hospital-controlled under REMS—no direct patient program exists. Consult your doctor, hospital social worker, or call 1-800-278-0340 for latest details. Costs/eligibilities change; verify with insurers. Not medical/financial advice. (Word count: 912)

Program information last verified: March 25, 2026