Tezepelumab-ekko

This policy covers Tezepelumab‑ekko (Tezspire) as an add‑on maintenance biologic therapy for severe asthma and generally authorizes FDA‑approved uses and select off‑label uses supported by accepted compendia or at least two peer‑reviewed articles. It is for patients aged ≥12 with chronic uncontrolled moderate‑to‑severe asthma despite ≥3 months of an inhaled corticosteroid plus a LABA (or LTRA/theophylline/LAMA), including steroid‑dependent cases; major limits include exclusion for <12 years, acute bronchospasm/status asthmaticus, concomitant use with other antiasthma monoclonal antibodies, requirement that non‑self‑administered formulations meet strict inability-to-self‑administer/anaphylaxis criteria, and applicability subject to the member’s benefit plan and state rules.

"Coverage of any FDA‑approved drug when prescribed for a use recognized as safe and effective in one or more standard medical reference compendia adopted by HHS."