​AmeriHealth has reclassified the specialty drug Tezspire (tezepelumab-ekko) as a medical benefit drug, effective December 17, 2021. Tezspire is approved by the U.S. Food and Drug Administration (FDA) for the treatment of severe asthma as add-on maintenance therapy.​

Background

AmeriHealth proactively reviews all specialty drugs in the FDA pipeline. In October 2021, AmeriHealth added tezepelumab to the Self-Administered Drugs policy (#08.00.78.ai), in anticipation of its FDA approval as a subcutaneously administered drug. However, when the FDA approved the drug on December 17, 2021, the label stated that it must be administered by a health care provider. As a result, tezepelumab will be removed from our Self-Administered Drugs policy. An updated version of that policy will be available, effective April 11, 2022.

Going forward

Retroactively effective to December 17, 2021, Tezspire is eligible for coverage under the medical benefit. A new medical policy listing coverage criteria for the drug will become effective April 11, 2022. In the interim, requests for Tezspire will be reviewed in accordance with FDA prescribing information and AmeriHealth-recognized drug compendia.