CommercialPrior AuthMedium impact
Tepezza (teprotumumab-trbw)
Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, Ophthalmology·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their medical policy for Tepezza (teprotumumab-trbw) for Thyroid Eye Disease treatment. The policy establishes strict prior authorization requirements including specific clinical criteria, failed standard therapy requirements, and specialist coordination between endocrinologists and ophthalmologists.
Action Required
Immediately: Billing team must implement prior authorization process for all Tepezza infusions. Ensure providers obtain approval before treatment by documenting: patient ≥18 years old, moderate-to-severe active TED diagnosis with CAS ≥4, failed standard corticosteroid therapy, coordination between endocrinologist and ophthalmologist, and euthyroid status. Use network DSP-Pharmacy for medication procurement. Claims will be denied without prior authorization and considered cosmetic.