Actemra (tocilizumab)

Actemra (tocilizumab) is covered for specified non‑oncology indications — FDA‑approved RA, pJIA, sJIA, GCA, SSc‑ILD — and select compendial off‑label uses (Still’s disease, PMR, checkpoint inhibitor–associated inflammatory arthritis); oncology indications are excluded. Coverage requires indication‑specific prior therapy trials, prescriber specialty or consultation, documentation of diagnosis/dosing/weight and safety labs, objective evidence of benefit for reauthorization (generally ≥6 months on therapy; initial approval 12 months for SSc‑ILD and 6 months for other indications), and specific age/lab/FVC thresholds for SSc‑ILD.

"Rheumatoid arthritis (RA)"

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