Tocilizumab (Actemra®, Tofidence™, & Tyenne®) Injection for Intravenous Infusion – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers intravenous tocilizumab (Actemra, Tofidence, Tyenne) for FDA- and evidence‑supported indications (PJIA, SJIA, RA, GCA, CAR‑T/CD3‑related CRS, steroid‑refractory acute GVHD, and certain immune‑checkpoint inhibitor toxicities) but prefers Actemra/Tyenne and restricts non‑preferred biosimilars unless preferred‑product criteria are met, and tocilizumab must not be combined with other targeted immunomodulators. Approvals require indication‑specific prior‑treatment criteria (e.g., DMARD failure for RA), dosing per FDA labeling, documentation of positive clinical response and prescriber attestations/consultations as applicable, and are generally limited to up to 12 months for chronic uses or up to four doses for CRS/GVHD/ICI‑related toxicities.

"Diagnosis of polyarticular juvenile idiopathic arthritis (PJIA) (initial and continuation criteria specified)"