Limited Coverage Drugs - Tocilizumab for GCA

Generic Name

tocilizumab                                                          

Strength

162 mg/0.9 mL
Form

pre-filled syringe

Special Authority Criteria

Approval Period

For the treatment of Giant Cell Arteritis (GCA) according to criteria detailed in Special Authority Request form 5496 and when prescribed by a rheumatologist or ophthalmologist.

1 year

Practitioner Exemptions

  • No practitioner exemptions.

Special Authority Request Form