ModifiedmhnPolicy CP.PHAR.489

Eptinezumab-jjmr (Vyepti) for migraine prophylaxis

Policy governing medical necessity criteria, authorization, continued therapy, dosing, and coding for eptinezumab-jjmr (Vyepti) for migraine prevention in adult Medicaid members.

Policy Summary

Payermhn

PolicyEptinezumab-jjmr (Vyepti) for migraine prophylaxis

Policy CodePolicy CP.PHAR.489

Change TypeCode addedconcurrent-use clarificationapproval duration modified

Effective DateSep 1, 2020

Next Review Date

Key ActionSubmit prior authorization with supporting clinical documentation showing diagnosis, migraine frequency, prior preventive therapy failures, and response to therapy.

SourceLink

POLICY UPDATE CHANGES

Added HCPCS code J3032 for injection, eptinezumab-jjmr, 1 mg.

Clarified that Vyepti should not be prescribed concurrently with certain other CGRP inhibitors, and added Zavzpret (a nasal product) to that list.

Initial and continuation approval duration was modified (noted as changed from 6 to 12 months in a future-dated annual review entry).

≥4migraine days/month required

2failed oral preventives required

100 mg q3mstandard dose

300 mg

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