MedicaidPrior AuthMedium impact
Tepezza® (teprotumumab) (New)
Humana·IN · Endocrinology, Ophthalmology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
New prior authorization policy for Tepezza (teprotumumab) for thyroid eye disease treatment under Indiana Medicaid, requiring specific clinical criteria including moderate to severe disease and specialist prescription. This is a new coverage policy with strict eligibility requirements and lifetime treatment limitations.
Action Required
By May 1, 2026: Billing team must implement prior authorization workflow for Tepezza (teprotumumab) claims for Indiana Medicaid patients. Ensure providers document all 5 required criteria: thyroid eye disease diagnosis, euthyroid status, specialist prescription, no prior treatment course, and moderate to severe disease. Update billing system to flag these cases for prior auth. Claims without proper authorization will be denied.