Tocilizumab (Actemra)

Intravenous tocilizumab (Actemra) is covered only for the listed non‑oncology indications — RA, polyarticular and systemic JIA, Still’s disease, checkpoint inhibitor–associated inflammatory arthritis, and COVID‑19‑related cytokine release syndrome — when the diagnosis is consistent with an FDA‑approved or compendial off‑label use; unlisted indications are excluded. Coverage requires indication‑specific prior therapy trials or documented contraindications (e.g., RA: 3‑month trial of a biologic or csDMARD; pJIA/sJIA/Still’s/checkpoint arthritis: the specified prior agents/trials), prescription by or consultation with a rheumatologist (or rheumatologist/oncologist for checkpoint cases), documentation of therapeutic response for reauthorization, weight documentation for weight‑based dosing, and adherence to dosing limits and approval durations.

"Rheumatoid arthritis (RA)"