Teprotumumab-trbw

Covers teprotumumab‑trbw (IV teprotumumab) for treatment of adults (≥18 years) with thyroid eye disease (TED), particularly moderate‑to‑severe disease manifestations such as lid retraction ≥2 mm, moderate‑to‑severe soft tissue involvement, proptosis ≥3 mm, diplopia, or corneal exposure (FDA indication allows use regardless of disease activity or duration). Coverage is limited to the FDA‑approved regimen (10 mg/kg IV initial dose then 20 mg/kg IV every 3 weeks for seven additional infusions, total 8), is not covered for repeat courses beyond the initial 8 doses or for pediatric patients, excludes patients with prior surgical treatment (per trials), and requires dosing/indication consistency with authoritative sources or supporting peer‑reviewed evidence for off‑label uses.

"Therapies are covered only when proven effective for the relevant diagnosis or procedure."