Tocilizumab (Actemra®)

Actemra (tocilizumab) is covered for the listed FDA‑approved non‑oncology indications (RA, pJIA, sJIA, GCA, systemic sclerosis‑associated ILD) and specified off‑label compendial uses (Still’s disease, PMR, checkpoint inhibitor–related inflammatory arthritis, and COVID‑19 cytokine release syndrome); uses outside these indications or that don’t meet the guideline criteria are excluded. Coverage requires indication‑specific prior therapy trials (e.g., RA: 3‑month trial of a biologic or csDMARD), prescribing/consultation by an appropriate specialist, required baseline labs/imaging and age/dosing limits for ILD, documentation of prior trials/intolerances and weight where applicable, and evidence of therapeutic response for reauthorization.

"Rheumatoid arthritis (RA)"

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