Tezspire® (Tezepelumab-Ekko) – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers provider‑administered Tezspire (vial or prefilled syringe) as add‑on maintenance treatment for patients ≥12 with severe asthma, excludes the self‑administered prefilled pen (pharmacy benefit) and concurrent use with anti‑IL‑5, anti‑IgE, or anti‑IL‑4 biologics, and Tezspire is not indicated for acute bronchospasm or status asthmaticus. Coverage requires documentation of severe uncontrolled asthma (e.g., ACQ>1.5 or ACT<20, ≥2 systemic corticosteroid bursts, asthma‑related ER/hospital visit, or FEV1<80% predicted), use with an ICS‑containing optimized regimen (maximally‑dosed ICS/LABA or ICS plus another controller), prescription by a pulmonologist or allergist/immunologist, dosing per FDA labeling, and approvals limited to ≤12 months with evidence of clinical benefit for reauthorization.

"Listed diagnosis codes (referenced): "J45."

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