MedicaidPrior AuthMedium impact
Tepezza® (teprotumumab) (New)
Humana·LA · Endocrinology, Ophthalmology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana is implementing a new prior authorization policy for Tepezza (teprotumumab) for Louisiana Medicaid patients with thyroid eye disease, effective May 1, 2026. The policy requires five specific criteria to be met including diagnosis confirmation, specialist prescribing, and evidence of moderate to severe disease before approval.
Action Required
Before May 1, 2026: Billing team must implement prior authorization requirements for all Tepezza (teprotumumab) claims for Louisiana Medicaid patients. Ensure providers document all five criteria: thyroid eye disease diagnosis, euthyroid status, specialist prescribing, no prior therapy, and moderate to severe disease indicators. Update systems to flag these requirements before billing. Claims will be denied without proper authorization.