Actemra SC — Medical Mutual

Initial criteria

• Patient has tried one systemic corticosteroid (e.g., prednisone); AND
• Medication is prescribed by or in consultation with a rheumatologist; AND
• Site of care medical necessity is met

Reauthorization criteria

• Patient has been established on therapy for at least 6 months; AND
• Patient experienced a beneficial clinical response from baseline assessed by objective measures OR patient experienced an improvement in at least one symptom compared with baseline

Approval duration

initial: 6 months; reauth: 1 year