Anti-TSLP monoclonal antibody

Tezspire (tezepelumab) Letter of Medical Necessity

Tezspire (tezepelumab) is the only severe asthma biologic without a phenotype/biomarker restriction, making it useful for non-T2 high patients. PAs require severity documentation.

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FDA-Approved Indications

● severe asthma without phenotype restriction

Why Tezspire Prior Authorization Gets Denied

The most common denial reasons across major payers:

1. Step therapy through other biologics
2. Severity not documented
3. Phenotype reasoning missing

What to Include in a Tezspire Letter of Medical Necessity

Document severe asthma criteria, prior biologic trials and outcomes, phenotype data (or lack thereof), exacerbation history, and FEV1.

Key clinical evidence to cite:

✓ NAVIGATOR, SOURCE trials

Relevant guidelines:

📖 GINA Asthma Strategy

Tezspire Prior Authorization Criteria

Standard criteria across major US payers for Tezspire. Specific criteria vary by plan — RxCheckUp tailors each LMN to your patient's exact payer policy.

Typical step therapy requirements:

→ Step therapy through other biologics

Required documentation:

✓ ICD-10 diagnosis code with specificity
✓ Prior therapy history with dates, doses, and discontinuation reasons
✓ Specialist evaluation (where applicable)
✓ Baseline disease activity or biomarker results
✓ Clinical rationale citing FDA labeling or guidelines

Approval details:

Initial approval: typically 6 months. Renewal: 12 months with documented clinical response.

Payers Covering Tezspire

RxCheckUp tailors each LMN to the specific payer's medical policy and step therapy requirements:

UnitedHealthcareAetnaCignaBCBS

Tezspire Prior Authorization FAQ

Why was my Tezspire prior authorization denied?

The most common denial reasons for Tezspire are: Step therapy through other biologics; Severity not documented; Phenotype reasoning missing.

What should a Tezspire Letter of Medical Necessity include?