Tocilizumab subcutaneous — Cigna

Polyarticular Juvenile Idiopathic Arthritis or Rheumatoid Arthritis – Patient is Currently Receiving Tocilizumab Subcutaneous or Intravenous

Preferred products

Patient meets the standard Inflammatory Conditions – Tocilizumab Subcutaneous Policy criteria; AND
Patient meets ONE of the following (a–e):
a) Patient has Polyarticular Juvenile Idiopathic Arthritis and has tried one adalimumab product (or Enbrel, Cimzia, an infliximab product, or Simponi Aria); OR
b) Patient has Rheumatoid Arthritis and has tried one adalimumab product (or Cimzia, Enbrel, an infliximab product, or Simponi [Aria or subcutaneous]); OR
c) According to the prescriber, the patient has heart failure or a previously treated lymphoproliferative disorder; OR
d) According to the prescriber, the patient has been established on tocilizumab intravenous for at least 90 days; OR
e) Patient has been established on tocilizumab subcutaneous for at least 90 days and prescription claims history indicates at least a 90-day supply of tocilizumab subcutaneous was dispensed within the past 130 days, or if claims history not available, verified by prescriber.

1 year