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

IV tocilizumab is covered for specified non‑oncology indications—rheumatoid arthritis, polyarticular and systemic JIA, giant cell arteritis, adult‑onset Still’s disease, polymyalgia rheumatica, and checkpoint inhibitor–associated inflammatory arthritis—when used for FDA‑approved or compendial off‑label uses; uses outside these indication‑specific criteria are excluded. Coverage requires specialty prescriber consultation (rheumatologist or oncologist for checkpoint‑related cases), indication‑specific age limits and prior‑therapy/step‑therapy (e.g., trials of corticosteroids, DMARDs, biologics or NSAIDs as specified), documentation of response for reauthorization (established on therapy ≥6 months with objective or symptomatic improvement), and adherence to dosing and approval durations (initial 6 months, renewals 12 months).

"Rheumatoid arthritis (RA)"

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