Tocilizumab Intravenous (Actemra®, Avtozma®, Tyenne®, Tofidence™) non-oncology

IV tocilizumab (Actemra® and biosimilars) is covered for specified FDA‑approved and compendial non‑oncology indications — rheumatoid arthritis, polyarticular and systemic juvenile idiopathic arthritis, giant cell arteritis, adult‑onset Still’s disease, polymyalgia rheumatica, checkpoint inhibitor–related immune toxicities, and acute graft‑versus‑host disease — and is not covered for indications not listed. Coverage requires indication‑specific age limits, diagnosis documentation, prescriber specialty consultation (usually rheumatology), required prior therapy trials or corticosteroid trials where specified (e.g., RA: 3‑month trial of ≥1 biologic or a conventional synthetic DMARD; pJIA: trial of another systemic therapy or concurrent methotrexate/contraindication; GCA/PMR/immunotherapy toxicities: steroid trial), and reauthorization generally requires ≥6 months on therapy (≥1 month for GVHD) plus objective or symptomatic evidence of benefit.

"Rheumatoid arthritis (RA)"