Updated Prior Authorization Criteria for Tzield
Date: September 11, 2026
Attention: All Providers
Effective date: October 1, 2026
Call to action: Texas Children's Health Plan (TCHP) would like to inform providers that Effective for dates of service on or after October 1, 2026, Texas Medicaid will update the prior authorization criteria for teplizumab-mzwv (Tzield).
The U.S. Food & Drug Administration (FDA) has approved teplizumab-mzwv (Tzield) as a treatment to delay the decline in endogenous insulin production in pediatric patients who are 8 to 17 years of age who have recently been diagnosed with stage 3 type 1 diabetes (T1D).
Updated Prior Authorization Requirements
Teplizumab-mzwv (Tzield) is a cluster of differentiation 3 (CD3)-directed antibody. Teplizumab-mzwv (Tzield) therapy may be approved for treatment duration of up to 14 days when the therapy meets the following criteria:
- It is being used to delay the onset of stage 3 T1D in adult and pediatric patients who are 1 year of age or older with stage 2 T1D.
- It is being used to delay the decline in endogenous insulin production in pediatric patients who are 8 years to 17 years of age and have recently been diagnosed with stage 3 type 1 diabetes (T1D). These patients must meet the following criteria:
- The patient has a diagnosis of stage 3 T1D confirmed by the documentation of at least one positive pancreatic islet cell antibody:
- Islet cell autoantibody (ICA)
- Insulinoma-associated antigen 2 autoantibody (IA-2A)
- Insulin autoantibody (IAA)
- Zinc transporter 8 autoantibody (ZnT8A)
- Glutamic acid decarboxylase 65 (GAD) autoantibodies
- The patient has residual beta cell function, as indicated by peak stimulated C-peptide > 0.2 pmol/mL on a mixed-meal tolerance test (MMTT) or by an alternative method if appropriate and MMTT is not available.
- The patient has a diagnosis of stage 3 T1D confirmed by the documentation of at least one positive pancreatic islet cell antibody:
Next step for providers: Providers should share this information with their staff.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.