ModifiedCignaPolicy N/A

Migraine - Calcitonin Gene-Related Peptide Inhibitors - Vyepti

Policy Summary

PayerCigna

PolicyMigraine - Calcitonin Gene-Related Peptide Inhibitors - Vyepti

Policy CodePolicy N/A

Change TypeCriteria and administrative revisions (preferred product updates, approval duration increase, wording clarifications)

Effective DateMay 1, 2026

Next Review DateDec 30, 2026

Key ActionObtain prior authorization; document age, baseline monthly migraine days (prior to initiating a migraine‑preventive medication), prior use and inadequate efficacy or intolerance to specified CGRP agents when required, and clinical benefit if already on Vyepti.

POLICY UPDATE CHANGES

Policy name updated from 'Eptinezumab' to 'Migraine - Calcitonin Gene-Related Peptide Inhibitors - Vyepti.'

Removed requirement that patient try botox or at least two standard prophylactic pharmacologic therapies from criteria.

Updated threshold wording from 'prior to initiating Vyepti' to 'prior to initiating a migraine-preventive medication' for the ≥4 monthly migraine days requirement.

Removed Aimovig and Ajovy as preferred product step requirements for Individual and Family Plans.

Authorization duration updated from 6 months to 12 months for initial approval for migraine headache prevention.

Updated Employer and Individual and Family Plans preferred product requirements on multiple effective dates through 05/01/2026.

1FDA-approved indication covered

Required prior therapies listed

12Initial approval duration (months)

J3032Primary billing HCPCS code

Coverage Summary

Cigna coverage policy for prior authorization, clinical criteria, dosing, exclusions, and coding for Vyepti (eptinezumab-jjmr) intravenous infusion for preventive treatment of migraine in adults. The policy requires documentation of patient age and baseline monthly migraine days ≥ 4 (measured prior to initiating a migraine‑preventive medication) as a threshold for the FDA‑approved migraine prevention indication.

Vyepti (eptinezumab‑jjmr) is an intravenous CGRP monoclonal antibody indicated for the preventive treatment of migraine in adults. The recommended dosage per prescribing information is 100 mg IV over approximately 30 minutes once every 3 months, although some patients may benefit from 300 mg IV once every 3 months. The American Headache Society (AHS) 2024 update supports CGRP‑targeting therapies as a first‑line option for migraine prevention. Initial authorization duration in the policy is 12 months.

Key Policy Facts

Coverage Stancecovered_with_criteria

Initial Approval Duration12 months

FDA-approved indication coveredMigraine headache prevention (adults)

Primary billing HCPCS codeJ3032

Medical-Necessity Criteria

FDA-Approved Indication - Migraine Headache Prevention (Initial Approval)

Approve Vyepti for 1 year if the patient meets ALL of the following (A, B, C, and D):

ALL of the following

A: Patient is ≥ 18 years of age
B: Patient has ≥ 4 migraine headache days per month (prior to initiating a migraine-preventive medication)≥ 4 migraine headache days per month
C: If the patient is currently taking Vyepti, the patient has had a significant clinical benefit from the medication as determined by the prescriber
Examples of significant clinical benefit include a reduction in overall number of migraine days per month or reduction in number of severe migraine days per month from the time that Vyepti was initiated.

Coding

Covered HCPCSHCPCSCovered

J3032

Injection, eptinezumab-jjmr, 1 mg

Provider Actions & Billing

Prior Authorization

Prior authorization required

Prior Authorization is required for benefit coverage of Vyepti; approvals provided for the duration noted (initial approval 12 months).

Affected code: J3032
Initial approval duration: 12 months

Documentation Required

Document prior therapies and response

Document patient age, baseline monthly migraine days (prior to initiating a migraine-preventive medication), prior use and inadequate efficacy or intolerance to specified CGRP-targeted agents when required by plan (Aimovig, Ajovy, Emgality, Qulipta), and clinical benefit if already on Vyepti.

Age (patient ≥ 18 years)

Background, Evidence & Definitions

Vyepti is a calcitonin gene‑related peptide (CGRP) inhibitor administered by intravenous infusion and is indicated for the preventive treatment of migraine in adults.

The prescribing information recommends 100 mg IV over ~30 minutes once every 3 months; some patients may benefit from 300 mg IV once every 3 months. Prior authorization is required and approvals are provided per the policy dosing and duration.

Evidence	Detail
Recommended dosage (per PI)	100 mg IV every 3 months; some patients may benefit from 300 mg
Guideline position	AHS 2024 update: CGRP-targeting therapies can be considered first-line for prevention

Term	Definition
Chronic migraine	Headache occurring on ≥ 15 days/month for > 3 months with features of migraine on ≥ 8 days/month.
Episodic migraine	Headaches occurring < 15 days/month.

Revision History

2024-05-30name_change

Policy name updated from 'Eptinezumab' to 'Migraine - Calcitonin Gene-Related Peptide Inhibitors - Vyepti.'

2024-05-30criteria_revised

Removed requirement that patient try botox or at least two standard prophylactic pharmacologic therapies from criteria (criteria requiring trials of botox or two standard preventive classes removed).

2024-05-30criteria_clarified

Updated threshold wording from 'prior to initiating Vyepti' to 'prior to initiating a migraine-preventive medication' for the ≥4 monthly migraine days requirement.

Policy Summary

PayerCigna

PolicyMigraine - Calcitonin Gene-Related Peptide Inhibitors - Vyepti

Policy CodePolicy N/A

Change TypeCriteria and administrative revisions (preferred product updates, approval duration increase, wording clarifications)

Effective DateMay 1, 2026

Next Review DateDec 30, 2026

On This Page

D: Preferred product criteria is met for the product as listed in the below tables

Dosing

Approved dosing per policy:

ALL of the following

Recommended dosage per prescribing information is 100 mg IV over approximately 30 minutes once every 3 months; some patients may benefit from 300 mg IV once every 3 months100 mg IV every 3 months (some patients may benefit from 300 mg)
Requests for doses outside established dosing will be considered case-by-case by a clinician
Approve up to 300 mg administered by intravenous infusion once every 3 monthsup to 300 mg every 3 months

Employer Plans - Prior Therapy Requirements (Initial Authorization)

For Employer Plans: Approve Vyepti when patient meets ONE of the following (A or B):

ANY of the following

A
- 1: Aimovig (erenumab-aooe) [requires prior authorization]
- 2: Ajovy (fremanezumab-vfrm) [requires prior authorization]
- 3: Emgality (galcanezumab-gnlm) [requires prior authorization]
- 4: Qulipta (atogepant) [requires prior authorization]
B
- 1: Aimovig (erenumab-aooe) [requires prior authorization]
- 2: Ajovy (fremanezumab-vfrm) [requires prior authorization]
- 3: Emgality (galcanezumab-gnlm) [requires prior authorization]
- 4: Qulipta (atogepant) [requires prior authorization]

Not Medically Necessary (Exclusions)

Vyepti is considered not medically necessary for any use not meeting policy criteria, including:

ANY of the following

Acute treatment of migraine
Cluster headache, treatment or prevention
Concurrent use with another CGRP inhibitor prescribed for migraine headache prevention (Aimovig, Ajovy, Emgality, Qulipta)
Concurrent use with Nurtec ODT (rimegepant) when used as a preventive treatment of migraine

Baseline monthly migraine days (prior to initiating a migraine-preventive medication)

Prior use and inadequate efficacy or intolerance to specified CGRP agents (Aimovig, Ajovy, Emgality, Qulipta) when required by plan

Clinical benefit if patient is currently receiving Vyepti (as determined by prescriber)

Billing Rule

Use most appropriate codes and eligibility

When billing, providers must use the most appropriate codes as of the effective date; claims without covered diagnosis/procedure codes under this policy will be denied as not covered.

Claims submitted without covered diagnosis/procedure codes under this policy will be denied.

Denial Risk

Denial for non-covered uses

Claims for Vyepti for acute migraine treatment, cluster headache, concurrent CGRP inhibitors for prevention, or concurrent Nurtec ODT for prevention will be denied as not medically necessary.

Acute treatment of migraine
Cluster headache (treatment or prevention)
Concurrent use with another CGRP inhibitor prescribed for migraine prevention (Aimovig, Ajovy, Emgality, Qulipta)
Concurrent use with Nurtec ODT when used as a preventive treatment of migraine

Step Therapy

Preferred product / step requirements

Employer and Individual/Family plans have specified prior therapy requirements involving other CGRP-targeted products (Aimovig, Ajovy, Emgality, Qulipta) as detailed in policy prior to approval.

Employer plans: trial of ALL of Aimovig, Ajovy, Emgality, and Qulipta (or if currently on Vyepti, tried TWO of these)
Individual/Family plans: trial of ALL of Aimovig, Ajovy, Emgality, and Qulipta OR currently receiving Vyepti
Plan-specific preferred product lists and requirements may differ and have been updated with multiple effective dates

2024-07-15authorization_change

Authorization duration for initial approval updated from 6 months to 12 months for migraine headache prevention.

2024-07-15step_therapy_update

Removed Aimovig and Ajovy as preferred product step requirements for Individual and Family Plans.

2026-05-01step_therapy_updateLatest

Updated Employer and Individual and Family Plans preferred product (step) requirements with multiple effective-date updates through 05/01/2026.