Tyenne (tocilizumab-aazg) — United Healthcare
Polyarticular Juvenile Idiopathic Arthritis (PJIA)
Initial criteria
- Diagnosis of active polyarticular juvenile idiopathic arthritis
- Patient is not receiving Actemra or Tyenne in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]
Reauthorization criteria
- Documentation of positive clinical response to Actemra or Tyenne therapy
- Patient is not receiving Actemra or Tyenne in combination with another targeted immunomodulator [e.g., Enbrel (etanercept), Cimzia (certolizumab), Simponi (golimumab), Orencia (abatacept), adalimumab, Xeljanz (tofacitinib), Olumiant (baricitinib), Rinvoq (upadacitinib)]
Approval duration
12 months