Tocilizumab subcutaneous — Cigna
Rheumatoid Arthritis – Initial Therapy
Preferred products
- Enbrel
- adalimumab-adbm
- Cyltezo
- adalimumab-adaz
- adalimumab-ryvk
- Simlandi
Initial criteria
- Patient meets the standard Inflammatory Conditions – Tocilizumab Subcutaneous Prior Authorization Policy criteria; AND
- Patient meets ONE of the following (a or b):
- a) Patient has tried one adalimumab product (examples include Humira, Abrilada, adalimumab-adaz, adalimumab-adbm, adalimumab-fkjp, adalimumab-aaty, adalimumab-ryvk, Simlandi, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry) OR a trial of Cimzia, Enbrel, an infliximab product (e.g., Remicade, biosimilars), or Simponi (Aria or subcutaneous) also counts; OR
- b) According to the prescriber, the patient has heart failure or a previously treated lymphoproliferative disorder.
Approval duration
6 months