ACCESS AND REIMBURSEMENTRESOURCES
To help guide your patients throughout the access process
FIND AN INFUSION SERVICE PROVIDER IN YOUR AREA.
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Lundbeck is committed to patient access and providing support through a VYEPTI CONNECT liaison or a Field Reimbursement Specialist. Below are resources that may be helpful.
Downloadable resources
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VYEPTI CONNECT Enrollment Form
Complete this enrollment form to begin the benefits investigation process.
VYEPTI CONNECT Copay Assistance Program Overview
Information on how your eligible commercially insured patients can enroll and the program's eligibility requirements.
Billing and Coding Guide
Information that may be helpful when submitting claims for VYEPTI.
Distribution and Infusion Location Guide
Information about acquiring VYEPTI under the medical benefit and the settings where it can be infused.
VYEPTI Purchasing Process Overview
Information about acquiring VYEPTI through a Specialty Pharmacy and buy-and-bill.
Specialty Pharmacy Checklist
Information on how to successfully submit necessary information to a Specialty Pharmacy for a patient's prescription.
Sample Letter of Medical Necessity
Information about what may be needed to complete a Letter of Medical Necessity.
Sample Letter of Appeal
Information about what may be needed to complete a Letter of Appeal.
Sample Letter of Medical Exception
Information about what may be needed to complete a Letter of Medical Exception.
Site of Care Transition Form
Download and fill out patient information for transition to a new infusion location.
Healthcare Provider Attestation
Healthcare providers with patients who do not wish to enroll in VYEPTI CONNECT, but still want access support from a Field Reimbursement Specialist, should download and submit this form.
Field Reimbursement Specialist Patient Authorization
Healthcare providers in California with patients who do not wish to enroll in VYEPTI CONNECT, but still want access support from a Field Reimbursement Specialist, should download and submit this form in addition to the Healthcare Provider Attestation; authorization can be sent via fax.
VYEPTI CONNECT Copay Assistance Program Terms and Conditions
Review the Terms and Conditions for the VYEPTI CONNECT Copay Assistance Program.
The resources on this page are for informational purposes only and are not intended to provide reimbursement or legal advice. The information presented here does not guarantee payment or coverage.
IMPORTANT SAFETY INFORMATION
AND INDICATION
Contraindications
VYEPTI is contraindicated in patients with serious hypersensitivity to eptinezumab-jjmr or to any of the excipients. Reactions have included anaphylaxis and angioedema.
INDICATION
VYEPTI is indicated for the preventive treatment of migraine in adults.
Warnings and Precautions
Hypersensitivity Reactions: Hypersensitivity reactions, including angioedema, urticaria, facial flushing, dyspnea, and rash, have occurred with VYEPTI in clinical trials and in the postmarketing setting. Most hypersensitivity reactions occurred during infusion and were not serious, but often led to discontinuation or required treatment. Serious hypersensitivity reactions may occur. Cases of anaphylaxis have been reported in the postmarketing setting. If a hypersensitivity reaction occurs, consider discontinuing VYEPTI, and institute appropriate therapy.
Adverse Reactions
The most common adverse reactions (≥2% and at least 2% or greater than placebo) in the clinical trials for the preventive treatment of migraine were nasopharyngitis and hypersensitivity.
For more information, please see the Full Prescribing Information and Patient Information.
IMPORTANT SAFETY INFORMATION
AND INDICATION
Contraindications
VYEPTI is contraindicated in patients with serious hypersensitivity to eptinezumab-jjmr or to any of the excipients. Reactions have included anaphylaxis and angioedema.
INDICATION
VYEPTI is indicated for the preventive treatment of migraine in adults.
Warnings and Precautions
Hypersensitivity Reactions: Hypersensitivity reactions, including angioedema, urticaria, facial flushing, dyspnea, and rash, have occurred with VYEPTI in clinical trials and in the postmarketing setting. Most hypersensitivity reactions occurred during infusion and were not serious, but often led to discontinuation or required treatment. Serious hypersensitivity reactions may occur. Cases of anaphylaxis have been reported in the postmarketing setting. If a hypersensitivity reaction occurs, consider discontinuing VYEPTI, and institute appropriate therapy.
Adverse Reactions
The most common adverse reactions (≥2% and at least 2% or greater than placebo) in the clinical trials for the preventive treatment of migraine were nasopharyngitis and hypersensitivity.
For more information, please see the Full Prescribing Information and Patient Information.
© 2023 Lundbeck. All rights reserved. VYEPTI and VYEPTI GO are registered trademarks, and VYEPTI CONNECT and Migraine Victors Program are trademarks of Lundbeck Seattle BioPharmaceuticals, Inc. EPT-B-100032v14
This website is intended for US healthcare professionals only.
