Trends in Teprotumumab Insurance Authorization and Socioeconomic Determinants of Teprotumumab Access

Abstract

Background: Teprotumumab is a novel biologic Food and Drug Administration (FDA)-approved medication for thyroid eye disease (TED). Cost remains a significant barrier to medication access. The present study analyzed the contribution of patient socioeconomic and clinical factors on access and eligibility for TED treatment with teprotumumab.

Methods: This study is a retrospective chart review of 93 TED patients receiving care at a tertiary care academic hospital between December 2019 and December 2023, for whom a prior authorization (PA) for teprotumumab treatment was submitted. We collected sociodemographic data, smoking status, insurance type, clinical activity score (CAS), and prior attempted treatments, as well as PA approval status and reason for denial, if applicable. Data were compared between patients approved or denied PA at the first request using a t-test, Fishers exact test, and descriptive analysis, as appropriate.

Results: PA was denied for 13 patients (14%). PA was significantly more likely to be approved for patients with Medicare coverage and denied for those Medi-Cal coverage and geographically further away from the hospital. Five PAs were denied in 2020 (38%), five in 2021 (38%), two in 2022 (15%), and one in 2023 (8%). Common reasons for denial included collection of thyroid labs over 30 days prior to the request (n = 4, 31%), lack of prior oral corticosteroid trial (n = 3, 23%), and administrative error (n = 3, 23%). Ten (77%) patients received subsequent approval.

Conclusions: Insurance type, geographic location, and socioeconomic status are important factors that may affect teprotumumab authorization. PA denials decreased after 2022, likely secondary to updated TED guidelines and drug availability. Compliance with insurance requirements may streamline the authorization process and increase PA approval rates.

J Endocrinol Metab. 2024;14(4):159-165
doi: https://doi.org/10.14740/jem997