J Endocrinol Metab

Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc

Journal website https://www.jofem.org

Original Article

Volume 14, Number 4, August 2024, pages 159-165

Trends in Teprotumumab Insurance Authorization and Socioeconomic Determinants of Teprotumumab Access

**Table 1.** Socioeconomic Characteristics of the Study Population
	PA approved (N = 80)	PA not approved (N = 13)	P value
*P < 0.05. PA: prior authorization.
Age at visit prior to teprotumumab request (mean, median (range))	57, 60.5 (21 - 82)	52, 52 (32 - 70)	0.26
Biologic sex			0.47
Male	64 (80%)	9 (69%)
Female	16 (20%)	4 (31%)
Race/ethnicity
White	52 (65%)	10 (77%)
Asian	8 (10%)	0
African American	7 (9%)	0
Hispanic/Latino	9 (10%)	2 (15%)
Other	2 (3%)	0
Unknown	2 (3%)	1 (8%)
Employment status			0.22
Employed or student	23 (29%)	5 (38%)
Unemployed	35 (44%)	2 (16%)
Unemployed	6 (8%)	1 (8%)
Disabled	7 (9%)	0
Retired	22 (28%)	1 (8%)
Unknown	22 (28%)	6 (46%)
Distance to clinic (miles) (mean, median (range))	41, 23 (2 - 377)	83, 44 (15 - 263)	0.02*
Median income by zip code ($) (median (range))	58,738 (27,379 - 117,700)	60,884 (28,963 - 100,308)	0.72
Insurance type			0.003*
Medicare	30 (38%)	0
Private	31 (39%)	5 (38%)
Medi-Cal	16 (20%)	8 (62%)
Federal	3 (4%)	0
Secondary insurance			0.1
Yes	25 (31%)	1 (8%)
No	55 (69%)	12 (92%)

Table 1. Socioeconomic Characteristics of the Study Population

PA approved (N = 80)

PA not approved (N = 13)

P value

*P < 0.05. PA: prior authorization.

Age at visit prior to teprotumumab request (mean, median (range))

57, 60.5 (21 - 82)

52, 52 (32 - 70)

0.26

Biologic sex

0.47

Male

64 (80%)

9 (69%)

Female

16 (20%)

4 (31%)

Race/ethnicity

White

52 (65%)

10 (77%)

Asian

8 (10%)

African American

7 (9%)

Hispanic/Latino

9 (10%)

2 (15%)

Other

2 (3%)

Unknown

2 (3%)

1 (8%)

Employment status

0.22

Employed or student

23 (29%)

5 (38%)

Unemployed

35 (44%)

2 (16%)

Unemployed

6 (8%)

1 (8%)

Disabled

7 (9%)

Retired

22 (28%)

1 (8%)

Unknown

22 (28%)

6 (46%)

Distance to clinic (miles) (mean, median (range))

41, 23 (2 - 377)

83, 44 (15 - 263)

0.02*

Median income by zip code ($) (median (range))

58,738 (27,379 - 117,700)

60,884 (28,963 - 100,308)

0.72

Insurance type

0.003*

Medicare

30 (38%)

Private

31 (39%)

5 (38%)

Medi-Cal

16 (20%)

8 (62%)

Federal

3 (4%)

Secondary insurance

0.1

Yes

25 (31%)

1 (8%)

55 (69%)

12 (92%)

**Table 2.** Clinical Characteristics of the Study Population
	PA approved (N = 80)	PA not approved (N = 13)	P value
CAS: clinical activity score; PA: prior authorization.
Average CAS (mean, median (range))	5.5, 5 (1 - 10)	5.7, 6 (2 - 8)	0.68
Current smoker			0.27
Yes	14 (18%)	4 (31%)
No	66 (83%)	9 (69%)
Disease phase			0.51
Active	68 (85%)	11 (85%)
Stable	15 (15%)	2 (15%)
Prior treatment tried			> 0.99
Yes	32 (40%)	5 (38%)
No	48 (60%)	8 (52%)
If prior treatment tried, type	Of 32 patients	Of 5 patients
Radiotherapy	3 (9%)	0
Pulse steroids	7 (22%)	3 (60%)
Oral steroids	13 (41%)	3 (60%)
Decompression surgery	11 (34%)	2 (40%)
Strabismus surgery	3 (9%)	0
Lid surgery	5 (16%)	0
Other	1 (3%)	0
Year of approval/denial	Approval	Denial
2019	2 (3%)	-
2020	33 (41%)	5 (38%)
2021	14 (18%)	5 (38%)
2022	14 (18%)	2 (15%)
2023	17 (21%)	1 (8%)
If denied, reason for denial
Thyroid Labs > 30 days ago	-	4 (31%)
Administrative error	-	3 (23%)
No oral steroids trial	-	3 (23%)
Facility out of network	-	2 (15%)
Patient not euthyroid	-	2 (15%)
CAS too low	-	2 (15%)
Smoking status	-	2 (15%)
No endocrinology evaluation	-	1 (8%)
Limited visual potential	-	1 (8%)
Not medically necessary	-	1 (8%)
If denied, subsequent approval?
Yes	-	10 (77%)
Days to approval (mean, median (range))	-	138, 57 (1 - 476)
No	-	2 (15%)
Unknown	-	1 (8%)

Table 2. Clinical Characteristics of the Study Population

PA approved (N = 80)

PA not approved (N = 13)

P value

CAS: clinical activity score; PA: prior authorization.

Average CAS (mean, median (range))

5.5, 5 (1 - 10)

5.7, 6 (2 - 8)

0.68

Current smoker

0.27

Yes

14 (18%)

4 (31%)

66 (83%)

9 (69%)

Disease phase

0.51

Active

68 (85%)

11 (85%)

Stable

15 (15%)

2 (15%)

Prior treatment tried

> 0.99

Yes

32 (40%)

5 (38%)

48 (60%)

8 (52%)

If prior treatment tried, type

Of 32 patients

Of 5 patients

Radiotherapy

3 (9%)

Pulse steroids

7 (22%)

3 (60%)

Oral steroids

13 (41%)

3 (60%)

Decompression surgery

11 (34%)

2 (40%)

Strabismus surgery

3 (9%)

Lid surgery

5 (16%)

Other

1 (3%)

Year of approval/denial

Approval

Denial

2019

2 (3%)

2020

33 (41%)

5 (38%)

2021

14 (18%)

5 (38%)

2022

14 (18%)

2 (15%)

2023

17 (21%)

1 (8%)

If denied, reason for denial

Thyroid Labs > 30 days ago

4 (31%)

Administrative error

3 (23%)

No oral steroids trial

3 (23%)

Facility out of network

2 (15%)

Patient not euthyroid

2 (15%)

CAS too low

2 (15%)

Smoking status

2 (15%)

No endocrinology evaluation

1 (8%)

Limited visual potential

1 (8%)

Not medically necessary

1 (8%)

If denied, subsequent approval?

Yes

10 (77%)

Days to approval (mean, median (range))

138, 57 (1 - 476)

2 (15%)

Unknown

1 (8%)