Actemra (tocilizumab) Subcutaneous — Point32Health

Initial criteria

• Documented diagnosis of systemic sclerosis-associated interstitial lung disease
• Patient age ≥ 18 years
• Prescribed by or in consultation with a rheumatologist or pulmonologist
• Documentation of ONE of the following: inadequate response or adverse reaction to at least two of azathioprine, cyclophosphamide, or mycophenolate mofetil; OR contraindication to azathioprine, cyclophosphamide, and mycophenolate mofetil; OR previous treatment with a biologic agent indicated for the requested use; OR patient is new to the plan and has been stable on the requested agent prior to enrollment