MedicaidPrior AuthMedium impact
Tepezza® (teprotumumab) (New)
Humana·OH · Endocrinology, Ophthalmology·Medicaid
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Ohio has established a new prior authorization policy for Tepezza (teprotumumab) infusions used to treat thyroid eye disease. The policy requires specific clinical criteria including moderate to severe disease symptoms, specialist prescribing, and lifetime treatment limits.
Action Required
By May 1, 2026: Billing team must implement prior authorization requirements for Tepezza (teprotumumab) infusions for Humana Medicaid Ohio members. Ensure providers document all 5 criteria: thyroid eye disease diagnosis, euthyroid status, specialist prescribing, no prior treatment course, and moderate to severe disease symptoms. Update system to flag these infusions for prior auth. Claims will be denied without proper authorization.