Medicare AdvantagePrior AuthMedium impact
Vyepti® (eptinezumab) (Revised)
Humana·Neurology, Pain Management, General Practice·Medicare Advantage
Effective date
Jan 1, 2025
We identified it
Jun 25, 2026
Summary
Humana has revised its Vyepti (eptinezumab) prior authorization policy effective January 1, 2025, with updates published October 8, 2025. The policy now requires step therapy—prior treatment with both Emgality AND Qulipta—before Vyepti approval for Medicare Advantage members, with exceptions for Medicare Part B continuation therapy and PDP/MA-only plans. Billing teams must implement step therapy verification and prior authorization workflows immediately.
Action Required
By November 15, 2025: Billing team must implement prior authorization requirements for all Vyepti (eptinezumab) requests for Medicare Advantage MAPD plans. Specifically: (1) Update billing software to automatically flag Vyepti requests requiring prior authorization; (2) Modify authorization checklist to verify patient has received BOTH Emgality AND Qulipta as step therapy before approval; (3) Document exception rules in system: Medicare Part B requests do not require step therapy if continuation within 365 days; PDP and MA-only plans do not require step therapy—only MAPD plans require full step therapy. (4) Train billing and authorization staff on the new criteria. Claims for Vyepti without required step therapy documentation will be denied. Ensure all providers receive updated guidelines before claims are submitted.