CommercialCoverageMedium impact
08.00.41b, Teprotumumab-trbw (Tepezza®)
Independence Blue Cross·Endocrinology, Ophthalmology·Pharmacy
Effective date
Jan 6, 2025
We identified it
Jun 19, 2026
Summary
Commercial insurance policy for Teprotumumab-trbw (Tepezza®), a medication for thyroid eye disease, has been updated with changes to coverage criteria, medical necessity requirements, and billing codes. This affects pharmacy benefits and may impact prior authorization or billing procedures.
Action Required
By January 6, 2025: Billing and pharmacy teams must review the updated Tepezza® policy at the source URL to understand new coverage criteria and medical necessity requirements. Update billing procedures and prior authorization workflows as specified in the full policy. Ensure documentation meets new medical necessity criteria to avoid claim denials.