Vyepti^TM will have authorization and site-of-care requirements for commercial members effective May and July 2020

We're adding authorization and site-of-care requirements for Vyepti (eptinezumab-jjmr), a specialty drug covered under the medical benefit, for BCN HMO^SM (commercial) and Blue Cross' PPO (commercial) members.

Vyepti will require authorization and will have site-of-care requirements for members who begin therapy on or after the following dates:

• BCN HMO members: May 28, 2020
• Blue Cross' PPO members: July 1, 2020

Currently the HCPCS code for this drug is J3590. However, as of July 1, 2020, the HCPCS code will be C9063.

More about the authorization requirements

These requirements apply only to groups that are currently participating in the standard commercial Medical Drug Prior Authorization Program for drugs administered under the medical benefit. These changes don't apply to members covered by the Federal Employee Program^® Service Benefit Plan.

Authorization isn't a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

List of requirements

For a list of requirements related to drugs covered under the medical benefit, please see the Blue Cross and BCN utilization management medical drug list for Blue Cross PPO (commercial) and BCN HMO (commercial) members (PDF) document on this website:

• BCN Medical Benefit Drugs - Pharmacy page
• Blue Cross Medical Benefit Drugs - Pharmacy page

We'll add the Vyepti information to the requirements list prior to the dates on which authorization is required.

Posted: May 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network