Topic

Tepezza (teprotumumab)

A collection of 36 issues

Blue Cross Blue Shield Florida's Coverage Criteria for Tepezza: What Counts as "Medically Necessary"?

Answer Box: Getting Tepezza Covered by Florida Blue BCBS Florida Blue requires prior authorization for Tepezza (teprotumumab) with specific thyroid eye disease criteria: active TED diagnosis, Clinical Activity Score documentation, euthyroid status, and ophthalmologist prescriber. Submit PA via Availity.com or call 1-877-719-2583. Coverage decisions are delegated to Prime Therapeutics.
6 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in Washington: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tepezza Covered by UnitedHealthcare in Washington UnitedHealthcare requires prior authorization for Tepezza (teprotumumab-trbw, HCPCS J3241) under the medical benefit for moderate-to-severe thyroid eye disease (TED). Coverage criteria include Clinical Activity Score (CAS) ≥3, euthyroid status (TSH and free T3/T4 within 50% of normal), and documented corticosteroid
6 min read

How to Get Tepezza (Teprotumumab) Covered by Aetna CVS Health in Virginia: Complete Prior Authorization and Appeals Guide

Quick Answer: Aetna CVS Health covers Tepezza for moderate-to-severe thyroid eye disease in Virginia with mandatory prior authorization requiring ophthalmologist evaluation, Clinical Activity Score ≥4, and documented steroid failure. Submit PA through CVS Specialty Pharmacy coordination. If denied, Virginia's Bureau of Insurance offers external review within 120 days
7 min read

How to Get Tepezza (Teprotumumab) Approved by Aetna CVS Health in Georgia: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tepezza Covered by Aetna CVS Health in Georgia Aetna covers Tepezza (teprotumumab) for thyroid eye disease under medical benefit with prior authorization requiring moderate-to-severe TED, ophthalmologist prescription, and documented steroid failures. Submit PA via Aetna provider portal with Clinical Activity Score ≥4, recent thyroid labs, and treatment
6 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in Ohio: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Tepezza Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in Ohio, with coverage limited to 8 lifetime infusions for moderate-to-severe thyroid eye disease. You'll need a Clinical Activity Score (CAS) ≥3, euthyroid thyroid labs, and documented steroid failure or contraindication. Submit
7 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Tepezza Covered by UnitedHealthcare in New York UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) with specific criteria: moderate-to-severe thyroid eye disease (CAS ≥3), euthyroid status, and documented steroid failure or contraindication. Submit through the UHC Provider Portal with complete documentation including Clinical Activity Score, thyroid labs, and
7 min read

How to Get Tepezza (Teprotumumab) Covered by UnitedHealthcare in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Tepezza Coverage with UnitedHealthcare in New Jersey UnitedHealthcare requires prior authorization for Tepezza (teprotumumab) in New Jersey for moderate-to-severe thyroid eye disease. Your ophthalmologist or endocrinologist must submit documentation showing Clinical Activity Score ≥3, euthyroid status, and failed corticosteroid treatment via the UHC Provider Portal. If denied, New
6 min read