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With the right evidence and a well-crafted appeal, you can overturn unjust denials, prevent care delays, and protect yourself from unnecessary medical expenses.
1 out of 5 denied
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What’s in your winning appeal?
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Chronic migraines have decimated my quality of life. Before Vyepti, I experienced relentless, daily migraines—every single day of the month, with each episode often lasting a full day or longer.
These attacks brought severe headache pain, nausea, and overwhelming difficulty concentrating, rendering me unable to properly care for my family, function in my professional capacity, or participate in normal home or leisure activities.
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Your decision fails to reflect the standards recognized by the migraine and neurology community. The American Headache Society, in their recent position statement, recognizes CGRP-targeted therapies—including eptinezumab (Vyepti)—as first-line options for migraine prevention due to their strong evidence base and favorable tolerability profile, without requiring failure of non-CGRP therapies (see References).
Large, peer-reviewed phase 3 clinical trials (see References) have conclusively demonstrated that eptinezumab provides substantial reductions in monthly migraine days for patients with chronic migraine, consistent with the improvements I have experienced.
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The Affordable Care Act obligates health plans to cover essential health benefits and to avoid unreasonable denials of medically necessary treatments. In my case, migraine management is an essential health need, and the sustained, documented improvements with Vyepti—after failing numerous alternatives—require an evidence-based, patient-centered approach to approval.
I am expressly appealing under the ACA’s stipulations to ensure a comprehensive and fair review of my claim, free from inappropriate administrative denials.
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