№ lp_2_3_43173
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Formal medical letter documenting the necessity and justification for VYEPTI® administration in an adult patient with chronic or episodic migraine, including treatment history, current response, comorbidities, and recommended dosing.
Date: [Date]
Patient: [Patient’s First and Last Name]
Date of Birth: [Patient’s Date of Birth]
Insurance Company: [Insurance Company Name]
Subscriber ID #: [Insurance Subscriber ID]
Subscriber Group #: [Insurance Group ID]
Insurance Company Contact: [Insurance Company Contact]
Insurance Company Address: [Insurance Company Address]
Insurance Company City, State ZIP: [Insurance Company City, State ZIP]
Medication: VYEPTI® (eptinezumab-jjmr) [100 mg/300 mg]
Indication: Preventive treatment of chronic/episodic migraine
ICD-10 Code: [ICD-10 code]
Prior Treatments: [List prior treatments with dates and reasons for discontinuation]
Dose Initiation: [100 mg/300 mg]
Dose Escalation: [If applicable, 300 mg]
Treatment Continuation: [Current VYEPTI dose and response]
Physician: [Physician’s Name]
Provider Identification Number: [Provider Identification Number]
Practice Name: [Name of Practice]
Practice Phone Number: [Phone Number]
Enclosures: Original Letter of Medical Necessity, patient clinical/diagnostic notes, relevant lab reports, published clinical references
Price: 8 / 10 USD
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GALCANEZUMAB for chronic migraine: PBAC minor resubmission and listing details 2019–2020
Year: 2019–2020
Region / country: Australia
Subject: Chronic migraine treatment and drug listing
Document type: Public Summary Document (PSD)
Organization / authority: Pharmaceutical Benefits Advisory Committee (PBAC), TGA
Drug: Galcanezumab (Emgality)
Other drugs referenced: Fremanezumab, Erenumab, Botox
Target population: Adults with chronic migraine unresponsive to at least three prophylactic migraine medications
Administration form: Injection 120 mg/1 mL pre-filled pen
Prescription restrictions: Streamlined listing, treatment by neurologist required, specific clinical criteria for migraine frequency and prior treatment response
Consumer input: Included 186 individuals, 2 health professionals, 1 organization
Cost analysis: Cost-minimisation analysis (CMA) versus Botox
Risk sharing arrangement: Included, with expenditure cap adjustments
Migraine Dietary Triggers: An Evidence-Based Review
Category: Health Condition/ Disease
Subcategory: Intervention
Last Updated: 2014-03-11
Keywords: headache, migraine, attack, migrainous head pain, aura, neurological disorder, nervous system
Evidence: B, C & D
Grade of Evidence: B, C & D
Context: A systematic review and critical analysis of dietary components that are self-reported as triggers for migraines, based on cross-sectional, case-control, experimental, and cohort studies.
Letter of Medical Necessity for Coverage of Hemiplegic Migraine Panel Testing
Year: 2026
Patient Name: [REDACTED]
Patient DOB: [REDACTED]
Insurance Company: [REDACTED]
Policy Number: [REDACTED]
Group Number: [REDACTED]
ICD10 Codes: [REDACTED]
Test Name: Hemiplegic Migraine Panel
CPT Codes: 81406x1, 81407x1, 81479x1
Laboratory: GeneDx, Inc.
Laboratory Address: 207 Perry Parkway, Gaithersburg, MD 20877
Laboratory NPI: 1487632998
Laboratory TAXID: 205446298
Laboratory CLIA: 21D0969951
Ordering Provider: [REDACTED]
Purpose: Request for insurance coverage for medically necessary genetic testing
Clinical Indications: Hemiplegic migraine with aura, family and personal medical history, uninformative prior genetic tests
Relevant Genes: CACNA1A, SCN1A, ATP1A2, PRRT2
Clinical Features: Aura, hemiplegic attacks, ataxia, intellectual disability, risk of seizures
Inheritance Pattern: Autosomal dominant for familial hemiplegic migraine
Target Population: Individuals with hemiplegic migraine symptoms and family history of similar disorders
References: Albury et al. 2017; Huang et al. 2017; Pelzer et al. 2018; Jen JC 2001/2015; Noebels et al. 2012; Ebrahimi-Fakhari et al. 2015; Riant et al. 2010
CPD Series – Applied Clinical Neurology: Migraine and Other Headache Disorders, February 2, 2024, Tangent Theater, TCD
Year: 2024
Location: Tangent Theater, Trinity College Dublin, Ireland
Theme: Clinical Neurology, Headache Disorders
Document type: Conference Program
Organizing body: Trinity College Dublin
Course director: Dr Anhar Hassan
Speakers: Prof Anhar Hassan, Ms Helen Cahill, Prof Miriam Galvin, Ms Naomi Thornton, Ms Sharon Moran, Dr Petya Mihaylova, Dr Siobhan Hutchinson, Ms Mary Pilladath, Dr Eddie O’Sullivan, Dr Nicholas Silver, Prof Brian McGuire
Target audience: Healthcare professionals, neurologists, clinicians
Date: February 2, 2024
Schedule: 09:00–16:30
Sessions: Registration, Welcome, Keynote lectures, Panel discussions, Coffee breaks, Lunch, Closing remarks
Context: Detailed agenda of a professional neurology conference including lectures, discussions, and practical sessions on migraine and other headache disorders
Medications used for migraine prevention and treatment
Year: 2023
Region / City: Global
Topic: Migraine Treatment and Prophylaxis
Document Type: Pharmaceutical List
Author: Not specified
Target Audience: Healthcare professionals
Period of validity: Ongoing
Approval Date: Not specified
Date of modifications: Not specified
Topics: NecessityException VYEPTI migraine