Vyepti® (Eptinezumab-Jjmr) – Commercial Medical Benefit Drug Policyopen_in_new

Vyepti (eptinezumab‑jjmr) is covered for preventive treatment of migraine in adults per ICHD‑3 when patients have either 4–7 migraine days/month with <15 headache days (or provider attests migraine is the predominant diagnosis) or ≥8 migraine days/month; it is not covered for acute migraine attacks or episodic cluster headache and may not be used with other biologic CGRP therapies. Key requirements: dosing must follow FDA labeling (100 mg IV every 3 months; some may benefit from 300 mg), authorizations are limited to 12 months, and patients with ≥8 migraine days/month must have documented failure/contraindication/intolerance to two specified conventional prophylactics (≥2 months each) and two specified CGRP‑targeted therapies (≥3 months each), with documentation of frequency, trials, and response for reauthorization.

"Preventive treatment of migraines in adults when all of the following criteria are met: For initial therapy: Diagnosis of migraine consistent with The International Classification of Headache Disor..."