Beremagene Geperpavec-svdt (Vyjuvek) (CPB 1033, reviewed 2026-06-12)

IMMEDIATE ACTIONS REQUIRED: (1) Billing team must establish mandatory precertification process for J3401 (Vyjuvek) by contacting Aetna GCIT team at (866) 752-7021 or fax (888) 267-3277 before any claims are submitted. (2) Update billing software to flag J3401 claims as requiring prior authorization for all Aetna commercial plans. (3) Implement claim validation rules: J3401 claims MUST include diagnosis code Q81.2 (dystrophic epidermolysis bullosa); claims without this diagnosis will be denied. (4) Providers must confirm prescriber is a dermatologist or wound care specialist before processing claims; add specialty verification to intake forms. (5) Create precertification checklist requiring documentation of: genetic test results confirming COL7A1 mutation, wound assessment confirming clear appearance with adequate granulation tissue, and confirmation no squamous cell carcinoma history exists in affected wounds. (6) Verify target wounds have not received skin graft in prior 3 months and are not healed before claim submission. (7) Educate providers that Vyjuvek cannot be used on wounds previously treated with Zevaskyn (prademagene zamikeracel) or Filsuvez (birch triterpenes). (8) Configure billing system to reject or hold claims for J3401 that do not include required precertification documentation. Claims submitted without precertification will be denied by Aetna.