Tepezza® (Teprotumumab-Trbw) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers Tepezza (teprotumumab‑trbw) for thyroid eye disease only for patients with moderately to severely active TED (symptomatic active disease with ≥1 sign such as lid retraction ≥2 mm, proptosis ≥3 mm above race/sex norms, or diplopia) or stable chronic inactive disease with ≥3 mm proptosis (or ≥3 mm increase from baseline), with patients euthyroid or with mild controlled thyroid dysfunction, prescribed by an ophthalmologist or endocrinologist, and—if no significant proptosis or diplopia—after intolerance, failure, or contraindication to systemic glucocorticoids. Tepezza must be dosed per FDA labeling, not combined with other biologic immunomodulators, is limited to a maximum of 8 lifetime infusions, and use beyond 8 doses is not medically necessary.

"Diagnosis of thyroid eye disease (TED)."

Sign up to see full coverage criteria, indications, and limitations.