Medicare AdvantagePrior AuthMedium impact
Vyepti® (eptinezumab) (Revised)
Humana·Neurology, Pain Management, Internal Medicine·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jul 23, 2026
Summary
Humana updated its Vyepti (eptinezumab) prior authorization policy for Medicare Advantage plans effective January 1, 2025. The policy requires step therapy with both Emgality AND Qulipta before Vyepti approval for migraine prevention, with exceptions for Medicare Part B continuations and PDP/MA-only plans. Billing teams must ensure prior authorization is obtained and step therapy requirements are documented before claim submission.
Action Required
By January 1, 2025: Billing team must update prior authorization workflows to require documentation of prior treatment with both Emgality AND Qulipta before processing Vyepti requests for Medicare Advantage MAPD plans. Identify which plan types (Medicare Part B, PDP, MA-only) are exempt from step therapy requirements and code accordingly in the billing system. Providers must document step therapy history on all Vyepti authorization requests. Create internal guidelines distinguishing step therapy requirements by plan type (MAPD vs. MA-only vs. PDP). Flag any Vyepti claims lacking step therapy documentation for denial prevention. Failure to obtain prior authorization or verify step therapy completion will result in claim denials.