Actemra (tocilizumab) Subcutaneous — Point32Health
Rheumatoid Arthritis
Preferred products
- Cimzia
- Enbrel
- Humira
- Rinvoq
- Simponi
- Xeljanz
Initial criteria
- Documented diagnosis of rheumatoid arthritis
- Patient age ≥ 18 years
- Prescribed by or in consultation with a rheumatologist
- Documentation of ONE of the following: BOTH of the following—(i) ONE of the following: inadequate response or adverse reaction to one, or contraindication to all, traditional disease modifying antirheumatic drug (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, Simponi, Xeljanz; 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