Tezepelumab-ekko (Tezspire®)

By November 15, 2026: Billing team must prepare systems for Tezspire® (Tezepelumab-ekko) prior authorization requirements. (1) Configure billing software to require prior authorization for HCPCS code J3241 (210mg subcutaneous injection every 4 weeks) for both asthma and CRSwNP diagnoses. (2) Implement specialty validation rules requiring prescriber credentials as allergist/immunologist or pulmonologist (for asthma) or allergist/immunologist or otolaryngologist (for CRSwNP). (3) Create prior authorization submission templates requiring: for asthma initial requests—documentation of previous biologic use within 12 months OR uncontrolled asthma criteria plus high-dose ICS and additional controller documentation; for CRSwNP initial requests—nasal endoscopy/CT findings showing polyp severity plus prior treatment failure documentation. (4) Update claims processing to deny claims without prior authorization. (5) Notify providers in these specialties of new policy, dosing limits (210mg every 4 weeks), and contraindication with other biologic/targeted synthetic drugs for same indication. (6) Train front-desk and billing staff on new authorization workflow. Non-compliance will result in claim denials effective December 1, 2026.