MedicaidCoverageMedium impact
Tzield® (Teplizumab-Mzwv)
UnitedHealthcare·NJ · Endocrinology, Pediatrics, Internal Medicine·Medical Benefit Drug Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare Community Plan of New Jersey has issued a revised medical policy for Tzield® (Teplizumab-Mzwv), a newly approved immunotherapy drug. The policy details coverage criteria, prior authorization requirements, and billing guidelines for this Medicaid benefit effective October 1, 2026. Billing teams must implement new prior authorization workflows and update systems to reflect this new drug coverage.
Action Required
By September 15, 2026: Billing team and prior authorization staff must review the complete Tzield® policy document at the provided URL to identify all specific prior authorization requirements, covered indications, and billing codes. Update the billing system and prior authorization templates to reflect Tzield® coverage criteria and any authorization workflows. Notify providers in endocrinology and pediatrics who treat type 1 diabetes of the new coverage effective October 1, 2026. Establish a process to obtain prior authorization before Tzield® administration to avoid claim denials. Train front-desk and billing staff on new authorization procedures.