Medicare AdvantagePrior AuthLow impact
Tzield (teplizumab) intravenous solution (Revised)
Humana·Endocrinology, Pediatrics, Internal Medicine·Medicare Advantage
Effective date
Apr 26, 2023
We identified it
Jun 25, 2026
Summary
Humana Medicare Advantage has revised its prior authorization policy for Tzield (teplizumab) intravenous solution, a drug indicated to delay Stage 3 Type 1 diabetes onset in patients with Stage 2 Type 1 diabetes. The policy requires prior authorization for this drug based on confirmed Stage 2 T1D diagnosis (at least two positive pancreatic islet autoantibodies with dysglycemia). Approvals are granted in plan year durations or through clinical review, with no specific billing code changes mentioned.
Action Required
By May 27, 2026 (revision date): Billing team should review and ensure current systems reflect this revised policy. For any Tzield claims submitted to Humana Medicare Advantage plans, verify that prior authorization is obtained before billing. Add Tzield to internal prior authorization tracking lists. Confirm patient has documented Stage 2 Type 1 Diabetes diagnosis (two or more pancreatic islet autoantibodies confirmed) before processing authorization requests. Note: This policy is informational; no workflow changes are required immediately unless your practice treats Type 1 diabetes patients with this medication.