Tocilizumab Intravenous (Actemra®, Tyenne®, Tofidence™)

EviCore covers intravenous tocilizumab for specified FDA‑approved non‑oncology indications (RA, pJIA, sJIA, GCA) and select compendial off‑label uses (adult‑onset Still’s disease, PMR, checkpoint inhibitor–associated inflammatory arthritis) and excludes oncology uses. Coverage requires indication‑specific prior therapy trials (e.g., 3 months of a biologic or csDMARD for RA; corticosteroid trials for GCA/PMR; corticosteroid plus NSAID for checkpoint‑inhibitor arthritis; specified trials/contraindications for JIA and Still’s), prescribing by or in consultation with a rheumatologist (or rheumatologist/oncologist for checkpoint‑inhibitor arthritis), adherence to dosing/maximum limits, initial authorization of 6 months (renewal 12 months) and ≥6 months on therapy with documented objective or symptomatic improvement for reauthorization.

"Rheumatoid arthritis (RA)"

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