MedicaidPrior AuthMedium impact
MAB2020121505
Pennsylvania Medicaid (DHS)·PA · Endocrinology, Ophthalmology·Provider Bulletin
Effective date
Jan 5, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid will require prior authorization for all Tepezza (teprotumumab) prescriptions effective January 5, 2021. The drug must be prescribed by specialists for active, moderate-severe thyroid eye disease with specific clinical criteria including Clinical Activity Score ≥4 and failure of corticosteroids.
Action Required
Before January 5, 2021: Billing team must update prior authorization requirements for Tepezza (teprotumumab) prescriptions for Pennsylvania Medicaid patients. Ensure prescribing providers follow new clinical guidelines including specialist consultation requirements (endocrinologist, ophthalmologist, or ocular surgeon), multidisciplinary approach documentation, and Clinical Activity Score ≥4. Claims will be denied without proper prior authorization.