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Actemra Subcutaneous — Cigna

Polyarticular Juvenile Idiopathic Arthritis

Initial criteria

  • Patient meets the standard Inflammatory Conditions – Tocilizumab Subcutaneous Prior Authorization Policy criteria
  • Patient meets ONE of the following (a or b):
  • a) Patient has tried one adalimumab product; OR
  • b) According to the prescriber, the patient has heart failure or a previously treated lymphoproliferative disorder

Approval duration

6 months