Managing Thyroid Eye Disease Treatment Costs

Thyroid Eye Disease (TED) is a rare but serious autoimmune condition that affects the tissues around the eyes, often leading to inflammation, pain, vision changes, and reduced quality of life. As new therapies have emerged, particularly biologic infusion treatments, patients finally have access to improved outcomes. But with these advancements comes a significant rise in cost for self-funded employers and health plans.

Understanding what Thyroid Eye Disease is and why it’s so expensive to treat is essential to sustainable specialty benefits management.

 

What Is Thyroid Eye Disease (TED)?

Thyroid Eye Disease is an inflammatory autoimmune disorder most associated with Graves’ disease, though it can occur independently. The immune system attacks the muscles, fat, and connective tissues behind the eye, causing them to swell.

Common Symptoms of TED

• Eye pain or pressure
• Dryness or excessive tearing
• Eyelid retraction
• Double vision
• Bulging eyes (proptosis)
• Vision impairment in severe cases

TED often progresses in two stages:

1. Active (inflammatory) phase – where symptoms worsen over months
2. Stable phase – where the disease plateaus

Early intervention is key to preventing long-term complications.

 

Why Is Thyroid Eye Disease So Costly to Treat?

TED treatments range from supportive care to advanced biologic therapies. Costs accumulate due to several factors:

1. High-Cost Specialty Medications

Tepezza® (teprotumumab-trbw), the first FDA-approved medication specifically for TED, has been transformative for patient outcomes, yet it is one of the highest-cost specialty biologics on the market.

• It is administered every three weeks for eight infusions.
• When delivered in a hospital outpatient department, costs can escalate due to buy-and-bill markups, facility fees, and reimbursement variability.

2. Complex Treatment Needs

Patients with TED often require:

• Ongoing ophthalmologic and endocrinology care
• Multiple diagnostic tests
• Potential surgeries (orbital decompression, strabismus repair, eyelid procedures)

3. Site of Care

Where the infusion occurs dramatically affects cost. Hospital outpatient settings frequently bill at substantially higher rates compared to home infusion or ambulatory infusion suites.

4. Lack of Generic or Biosimilar Alternatives

Unlike many other specialty conditions, TED currently has no generic or biosimilar substitutes for its highest-cost drug therapies, limiting price competition.

 

How Health Plans and Employers Can Manage TED Treatment Costs

Despite the high cost of TED therapies, strategic management can significantly mitigate spend while safeguarding patient outcomes.

1. Conduct Early Case Identification and Clinical Review

Early detection of members receiving TED infusions allows benefits teams and specialty partners to:

• Validate clinical appropriateness
• Ensure guideline-based use
• Explore lower-cost, equally safe sites of care

2. Optimize Site of Care

Transitioning from a hospital outpatient department to home infusion or ambulatory infusion centers can reduce costs by tens of thousands of dollars per infusion cycle.

3. Coordinate With Providers and Care Teams

Seamless transitions require close collaboration among treating specialists, infusion providers, and patient care coordinators. The right specialty network can ensure no interruptions in therapy during cost-saving transitions.

4. Implement Specialty Drug Cost Management Programs

These programs can include:

• J-code reimbursement optimization
• Prior authorization pathways
• Real-time cost visibility
• Patient-centered support models

 

How GTSN Saved an Employer Over $800,000 on a Single Member’s Tepezza Infusions

A recent case study from Golden Triangle Specialty Network illustrates the impact of proactive intervention.
A member receiving Tepezza in a hospital outpatient setting posed significant financial exposure for the employer health plan. After rapid assessment, GTSN determined the member was an appropriate candidate for home infusion therapy, a safe and effective alternative.

By coordinating the transition and ensuring uninterrupted care, GTSN delivered:

• Over $800,000 in net savings
• No compromise in treatment quality, timing, or patient outcomes

This example highlights how targeted site-of-care optimization and specialty drug management can transform cost curves for even a single member.

 

The Bottom Line

While Thyroid Eye Disease remains a high-cost condition due to its reliance on advanced biologics, employers and health plans have powerful tools at their disposal. With the right specialty partner, organizations can:

• Reduce unnecessary outpatient facility spend
• Improve adherence and patient satisfaction
• Ensure appropriate utilization
• Achieve long-term financial sustainability

Golden Triangle Specialty Network supports health plans and employers nationwide, ensuring members across the U.S. can access safe, cost-effective specialty infusion care.