Description: Inj tezepelumab-ekko, 1mg
Unit: 1 mg
Pay quarter: Q4 2023
Dosage and Frequency
• 210mg SQ every 4 weeks
Calculate drug reimbursement
(ASP: $3,680.94, Margin: $220.86)
# Units to bill:210
Prior auth criteria for Tezspire may include but is not limited to:
1. The patient must be 18 years of age or older.
2. The patient must have a diagnosis of a chronic or acute condition that is indicated by Tezspire.
3. The patient must have failed to respond adequately to conventional treatments.
4. The patient must have had no adverse reactions to Tezspire in the past.
5. The patient must have a valid prescription for Tezspire.
6. The patient must have the appropriate laboratory tests and/or imaging studies to confirm the diagnosis.
7. The patient must have completed all necessary pre-treatment evaluations recommended by their healthcare provider.
Insurance prior auth guidelines:
Tezspire (AMGEN INC.)
TEZSPIRE (AMGEN INC.)