Tocilizumab and Associated Biosimilar(s)

This policy covers intravenous tocilizumab (Actemra®) and specified biosimilars for outpatient infusion. It applies to FDA‑labeled indications such as adults with moderate-to-severe rheumatoid arthritis, giant cell arteritis, and patients aged ≥2 years with systemic or polyarticular juvenile idiopathic arthritis, among other authorized uses. Coverage is limited to dosing and indications consistent with FDA labeling or recognized compendia/peer‑reviewed evidence (off‑label use requires strong literature or state exceptions), excludes subcutaneous/self‑administered formulations and oncologic indications, and is subject to the member’s benefit plan and applicable state regulations.

"Requested therapy is covered only when proven effective for the relevant diagnosis or procedure."

Sign up to see full coverage criteria, indications, and limitations.