Limited Coverage Drugs - Tocilizumab for the treatment of Rheumatoid Arthritis

Generic Name                                   

tocilizumab


Strength

IV—80 mg/4mL, 200 mg/10 mL, 400 mg/20 mL

SC—162 mg/0.9mL

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

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)