Actemra (tocilizumab) Subcutaneous — Point32Health
Juvenile Idiopathic Arthritis (polyarticular or systemic)
Preferred products
- Cimzia
- Enbrel
- Humira
- Rinvoq
- Xeljanz
Initial criteria
- Documented diagnosis of polyarticular or systemic juvenile idiopathic arthritis
- Patient age ≥ 2 years
- Prescribed by or in consultation with a rheumatologist
- Documentation of ONE of the following: BOTH of the following—(i) Inadequate response or adverse reaction to one, or contraindication to all, traditional DMARD (e.g., methotrexate, leflunomide, hydroxychloroquine, sulfasalazine), or previous treatment with a biologic agent indicated for the requested use; AND (ii) Trial and failure with two, or contraindication to all, of the following: Cimzia, Enbrel, Humira, Rinvoq, Xeljanz (for polyarticular JIA only); OR patient is new to the plan and stable on Actemra and the prescribing physician has documented that changing to a preferred product would result in adverse clinical outcomes