CurrentCignaPolicy N/A

Vyepti (eptinezumab) prior authorization for migraine

Form and prior authorization requirements for coverage of Vyepti (eptinezumab) for migraine treatment and prevention under Cigna pharmacy/medical benefits; intended for prescribers and office staff submitting PA requests.

Policy Summary

PayerCigna

PolicyVyepti (eptinezumab) prior authorization for migraine

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionComplete the prior authorization form with required patient identifiers, prescriber signature, ICD-10, dosing, administration site, and documentation of prior CGRP trials or benefit.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

5 business daysstandard response time

≥4 daysmigraine frequency threshold

All 4 listedrequired prior trials

Fax or phonesubmission methods

Coverage Criteria

Initial therapy

Covered when ALL of the following are met (per prescriber attestation on form):

Patient has appropriate diagnosis: Patient diagnosis indicated on form (acute treatment of migraine, cluster headache treatment or prevention, migraine prevention, or other) and corresponding ICD-10 provided

Migraine frequency: Patient had greater than or equal to 4 migraine headache days per month prior to initiating a migraine-preventative medication>=4 days/month

Prior CGRP preventive therapy trials: Patient has tried ALL of: Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Qulipta (atogepant)

Prescriber must attest prior use on form

Policy Summary

PayerCigna

PolicyVyepti (eptinezumab) prior authorization for migraine

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionComplete the prior authorization form with required patient identifiers, prescriber signature, ICD-10, dosing, administration site, and documentation of prior CGRP trials or benefit.

SourceLink

On This Page

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Prior inadequate efficacy or intolerance: Patient had inadequate efficacy or significant intolerance to ALL of: Aimovig, Ajovy, Emgality, and Qulipta (per prescriber attestation)

Requires prescriber attestation on form

Concomitant therapy restrictions: Prescriber must indicate whether Vyepti will be used in combination with another CGRP inhibitor or with Nurtec ODT when used as preventive therapy

Combination use must be documented on form

Administration and sourcing information: Provider must state where medication will be obtained and where it will be administered; infusion should occur in the least intensive, medically appropriate setting per some Cigna plans

Provider to specify site of care on form

Continuation Therapy

Continuation/renewal considerations:

Current use benefit: If currently taking Vyepti, prescriber must attest the patient had a significant clinical benefit from the medication as determined by the prescriber

Examples of significant clinical benefit include reduction in overall number of migraine days per month or reduction in number of severe migraine days per month

Infusion of Vyepti should be scheduled in the least intensive, medically appropriate setting per some Cigna plans. The prior authorization form requires the provider to state where the medication will be administered (home, physician’s office, hospital outpatient, or other) and to indicate whether the patient is a candidate for redirection to an alternate setting (for example, physician office or home). If redirection is not appropriate, the request should include a medical necessity rationale explaining why a more intensive setting is required.

Requests for Vyepti in patients who have not met the form’s baseline requirements may be considered not medically necessary. Specifically, the form requires documentation that the patient had ≥4 migraine headache days per month prior to initiating a migraine-preventive medication and that the patient has tried and had inadequate efficacy or significant intolerance to all of the listed CGRP preventive therapies: Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Qulipta (atogepant). Absence of these attestations or documentation may result in denial.

Coding and Clinical Thresholds

Requested drug optionsmixed

Vyepti 100mg/ml vial

Requested medication option listed on form

Migraine frequency threshold

Migraine days per month threshold>= 4 migraine headache days/month (prior to initiating a migraine-preventative medication)

Documentation methodPrescriber attests on prior authorization form that patient had >=4 migraine days/month

RelevanceRequired for initial therapy determination per form criteria

Provider Actions and Prior Authorization

Documentation Required

Required documentation

Prior authorization required. Complete the Cigna prior authorization form and include patient identifiers and prescriber signature. Failure to submit all required documentation may delay or result in denial of the request.

Required: completed prior authorization form with patient name, Cigna ID, date of birth, and prescriber signature
Include clinical information documenting diagnosis, dosing, duration, and frequency
Attach documentation of prior therapies and clinical response where applicable

Step Therapy

Step therapy / prior biologic trials

Step therapy applies. Prior to approval, the prescriber must document trials of the listed CGRP-targeted agents and attest the outcomes. If the prescriber does not attest inadequate efficacy or intolerance to the required agents, the request may be denied.

Trials required: Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Qulipta (atogepant)
Each trial should be documented on the form and include dates, dose, and reason for discontinuation (lack of efficacy or intolerance)
Note: These agents require prior authorization themselves — include approval/denial documentation when available

Prior Authorization

Prior therapy requirement

Prior therapy requirement: prescriber must attest that the patient had inadequate efficacy or significant intolerance to ALL required agents listed (Aimovig, Ajovy, Emgality, Qulipta) when applicable. If the patient is currently receiving Vyepti, indicate whether a significant clinical benefit has been achieved (for example, reduction in monthly migraine days or severe migraine days).

If currently taking Vyepti, indicate Yes/No to significant clinical benefit and provide objective details (change in monthly migraine days or severity)
If not all prior agents were tried due to contraindication or intolerance, provide supporting clinical rationale and documentation

Initial Therapy Criteria

Initial therapy

Initial approval criteria per form

Diagnosis and frequency: Patient diagnosis documented on form and had >=4 migraine headache days per month prior to initiating preventive therapy>=4 days/month

Prescriber attestation required

Prior therapy trials: Patient has tried and had inadequate efficacy or significant intolerance to Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Qulipta (atogepant)

Prescriber must indicate prior use and inadequate response or intolerance on form

Continuation and Renewal Criteria

Renewal

Continuation requires demonstration of benefit while on therapy

Ongoing benefit: If patient is currently taking Vyepti, prescriber must confirm the patient experienced significant clinical benefit (e.g., reduced migraine days per month or reduced severity) while on therapy

Prescriber signature attests to accuracy

Step Therapy Requirements

Step	Required prior trials (prescriber attestation)
1	Patient has tried ALL of the following prior to Vyepti: Aimovig (erenumab), Ajovy (fremanezumab), Emgality (galcanezumab), and Qulipta (atogepant); prescriber must attest inadequate efficacy or significant intolerance to each

Site of Care / Administration

Note

Site of care — indicate administration site and redirection candidacy

Provider must indicate the planned administration site on the form; per some Cigna plans, infusion must occur in the least intensive, medically appropriate setting and the form asks whether the patient is a candidate for redirection to an alternate setting.

Select where drug will be administered (home, physician's office, hospital outpatient, or other) on the form [[chunk 6]]
Answer whether the patient is a candidate for re-direction to an alternate setting and provide medical necessity rationale if not eligible [[chunk 6]]
Provide facility/administration details when applicable (facility name, Tax ID, address) [[chunk 5]]

Background

Vyepti (eptinezumab) is an intravenously administered calcitonin gene‑related peptide (CGRP) monoclonal antibody used for migraine prevention. The prior authorization form collects clinical information relevant to infusion therapy, including whether Vyepti will be used with other CGRP inhibitors or with Nurtec ODT, the patient’s baseline migraine frequency (≥4 days/month threshold), prior trials and outcomes with other CGRP preventive agents, and where the infusion will be obtained and administered.

Definitions

Examples of significant clinical benefit

Reduction in overall migraine daysDecrease in the total number of migraine headache days per month from the time Vyepti was initiated

Reduction in severe migraine daysDecrease in the number of severe migraine days per month after starting therapy

Improved response to acute therapyClinical improvement enabling better response or reduced need for acute migraine treatments

Functional improvementImproved ability to perform daily activities due to fewer or less severe migraines