MedicaidPrior AuthLow impact
MAB2023063003
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Ophthalmology·Provider Bulletin
Effective date
Jul 10, 2023
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has updated prior authorization requirements for Tepezza (teprotumumab-trbw), a drug for thyroid eye disease. The policy removes previous requirements for active thyroid eye disease documentation and euthyroid status, while maintaining other clinical criteria including specialist prescribing and moderate-severe disease documentation.
Action Required
For practices treating thyroid eye disease: Review updated Pennsylvania Medicaid prior authorization guidelines for Tepezza. Ensure prescribing providers are endocrinologists, ophthalmologists, or ocular surgeons specializing in thyroid eye disease. Document moderate-severe thyroid eye disease criteria and history of corticosteroid failure/contraindication when submitting prior authorization requests.