Teprotumumab-trbw (Tepezza)
EVICORE-MEDICAL_DRUG-4C844E76
Teprotumumab‑trbw (Tepezza) is covered only for the FDA‑approved indication of thyroid eye disease (including Graves’ ophthalmopathy/orbitopathy) with active disease of at least moderate severity and is not covered for non‑FDA/off‑label indications. Approval (up to 6 months) requires patients be ≥18 years old, have not received 8 total doses per treated eye, be prescribed by or in consultation with an ophthalmologist/endocrinologist/thyroid‑eye‑disease specialist, and provide documentation of diagnosis, disease activity/severity, age, specialist involvement, and prior dosing.
"Tepezza is indicated for the treatment of thyroid eye disease."
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