Limited Coverage Drugs - tocilizumab for the treatment of rheumatoid arthritis

Generic Name

tocilizumab

Strength

  • IV: 80 mg/4 mL, 200 mg/10 mL, 400 mg/20 mL
  • SC: 162 mg/0.9mL
  • autoinjector pen: 162 mg/0.9 mL solution

Form

concentrate solution for intravenous (IV) infusion vials, solution in pre-filled syringes for subcutaneous (SC) injection, and autoinjector pen

Special Authority Criteria

Approval Period

For the treatment of rheumatoid arthritis (RA) when:

  • prescribed by a rheumatologist

AND

  • prescribed according to established criteria (as indicated on the relevant Special Authority form below).

First approval: 1 year

Renewal: 1 year or indefinite

Practitioner Exemptions

  • None

Special Notes

  • PharmaCare covers a maximum of 28 days’ supply per fill for the IV formulation, and up to 56 days for the SC formulation when dosed at 14-day intervals

Special Authority Request Form(s)