MedicaidCoverageMedium impact
Tzield® (Teplizumab-Mzwv) (for Pennsylvania Only)
UnitedHealthcare·PA · Endocrinology, Internal Medicine, Pediatrics·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare Community Plan of Pennsylvania has issued a revised medical policy for Tzield® (Teplizumab-Mzwv), a monoclonal antibody treatment for type 1 diabetes. This is a Medicaid-specific policy for Pennsylvania that becomes effective October 1, 2026. The billing team must implement coverage and authorization requirements for this newly updated policy.
Action Required
By September 15, 2026: Billing and clinical teams must obtain and review the full Tzield® (Teplizumab-Mzwv) policy details from the source URL. Update billing system rules and prior authorization workflows in the Pennsylvania Medicaid module to reflect new coverage criteria, medical necessity requirements, and any authorization thresholds effective October 1, 2026. Notify endocrinology and internal medicine providers of coverage requirements and required documentation. Update claim submission procedures to ensure compliance with new policy terms. Failure to implement authorization requirements may result in claim denials for services provided on or after the effective date.