Medicare AdvantagePrior AuthLow impact
MA08.144c, Tezepelumab-ekko (Tezspire®)
Independence Blue Cross·Pulmonology, Allergy & Immunology·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage updated medical necessity criteria for Tezepelumab-ekko (Tezspire®), a specialty asthma medication. This is a pharmacy policy change that will affect prior authorization requirements and coverage criteria for this biologic drug.
Action Required
By June 15, 2026: Billing and clinical teams should review updated medical necessity criteria for Tezepelumab-ekko (Tezspire®) prescriptions. Ensure prior authorization requests include documentation that meets the new criteria. Verify coverage requirements in billing system for Medicare Advantage patients receiving this specialty asthma medication.