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CallVYEPTI(),option1,tospeakwithaVYEPTICONNECTLiaisonandenrolloverthephoneIfyourpatientsgettheirVYEPTIthroughaspecialty pharmacy(SP),theSPformymedicaltreatment,andtousemyinformationto:(1)administertheVYEPTIPatientSupportProgram(s)Ienrollin(collectively,the “Programs”),asapplicable;(2)providemewithpatientsupport,includingfacilitatingtheprovisionofVYEPTItome;(3)providemewithinformationand promotionalmaterialsVyeptiCCRDPriorAuthorizationFormTosubmitthisform,pleasefaxtoCompleteallrequired(*)ields,signwhereindicated,andfaxto VYEPTICONNECTatForquestions,callVYEPTI(),MondayFriday,gn(nETVYEPTICONNECT®ENROLLMENTFORMPatientAuthorizationforUse andDisclosureofPersonalHealthInformation(SignatureandDateRequired)PatientSupportProgramenrollmentformFaxcompletedformto:()Ifthisisan URGENTWhatisVYEPTI?request,pleasecallVYEPTIisaprescriptionmedicineusedfortheVYEPTICONNECT™PatientAuthorizationforUseand DisclosureofProtectedHealthInformationPleaseNote:ThisinformationisforhealthcareproviderstousetoobtainaCompleteallrequired(*)ields,signwhere indicated,andfaxtoVYEPTICONNECTatForquestions,callVYEPTI(),MondayFriday,gnVYEPTICONNECTisanoptionalprogramforpatientsand providersthatprovidessupportthroughoutthepatientjourney frombenefitsinvestigationsthroughappeals aswellVyepticomesinthefollowingdosageforms: •mLsolutioncontainingmgofeptinezumab(mg/mL)persingle-usevialforintravenousinfusionVYEPTI®(vyeep'tee)(eptinezumab-jjmr)injection,for intravenoususe•mLsolutionToenrollintheVYEPTICONNECTCopayAssistanceProgramAnswerthefollowingfivequestions;ReviewtheTermsand Conditions;Checktheauthorizationbutton;SignanddatebelowTermsandConditionsfortheVYEPTICONNECTCopayAssistanceProgram(the“Program”) VYEPTIBrochure()(CIGNA)DonotreceiveVYEPTIVYEPTICONNECT™PatientAuthorizationforUseandDisclosureofProtectedHealthInformation PleaseNote:ThisinformationisforhealthcareproviderstousetoobtainapatientauthorizationfortheVYEPTICONNECTSupportProgram.VYEPTIisa prescriptionmedicineusedforthepreventivetreatmentofmigraineinadultsVYEPTI®(vyeep'tee)(eptinezumab-jjmr)injection,forintravenoususeIfyou’re thinkingaboutstartingorareabouttostartVYEPTI,learnabouttreatmentbenefits,whattoexpectfromanIVinfusion,sideeffects,andmoreDownloadEmail PATIENTINFORMATIONPatientsontheirownEnrollonlineatbyclickingonthe“EnrollToday”buttonItisnotknownifVYEPTIissafeandeffectivein childrenWhatisVYEPTI?Ifyou’rethinkingaboutstartingorareabouttostartVYEPTI,learnabouttreatmentbenefits,whattoexpectfromanIVinfusion,side effects,andmoreSubjecttoconfirmationofeligibility,theProgramprovidessupporttopatientsprescribedVyepti®,andincludesthefollowingservices:facilitation ofaccesstoSubmitaprescription&supportingdocumentationStartbyfaxingacompletedreferralform,alongwithinsurancecard(frontandback),andanychart noteswithmedicationMissing:pdfPATIENTINFORMATION.VYEPTIBrochure.