HCPCS J3031 is officially defined as "Injection, fremanezumab-vfrm, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered)." HCPCS J3031 is referenced in 4 tracked payer policy changes from Sentara Health Plans, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J3031 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
A 07/15/2026 policy history entry changed Ajovy (fremanezumab-vfrm) from not medically necessary to medically necessary, added coverage criteria and quantity limits for Ajovy, updated the quantity limit for Emgality (galcanezumab-gnlm), and removed the requirement that these medications be prescribed by or in consultation with a headache specialist. Prior authorization is required for these medications. Vyepti (eptinezumab-jjmr) is considered not medically necessary because other formulary alternatives are covered by the plan for the preventive treatment of migraines. The use of samples by an individual is not considered current or stable therapy to satisfy policy requirements.
Aetna covers eptinezumab-jjmr (Vyepti) for commercial medical plans, and precertification of Vyepti is required for Aetna participating providers and members in applicable plan designs. Aetna considers Vyepti medically necessary for preventive treatment of migraine in an adult member who has not received at least 3 months of treatment with the requested medication. Aetna considers continuation medically necessary for adult members requesting reauthorization for preventive treatment of migraine when the member has received at least 3 months of treatment and had a reduction in migraine days per month from baseline. Aetna considers all other indications experimental, investigational, or unproven.
This Aetna policy addresses Vyepti (eptinezumab-jjmr) for commercial medical plans and requires precertification from Aetna participating providers and members in applicable plan designs. Aetna considers Vyepti medically necessary for preventive treatment of migraine in an adult member who has not received at least 3 months of treatment with the requested medication, and considers continuation medically necessary for adults who have received at least 3 months of treatment and had a reduction in migraine days per month from baseline. The recommended dosage is 100 mg given as an intravenous infusion over approximately 30 minutes every 3 months, some individuals may benefit from 300 mg every 3 months, and all other indications are considered experimental, investigational, or unproven.
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