Limited coverage criteria – tocilizumab (for giant cell arteritis)

Last updated on March 24, 2025

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Generic name	tocilizumab
Strength & form	162 mg/0.9 mL 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 HLTH 5496, when a Special Authority request is submitted by a rheumatologist or ophthalmologist	1 year

Practitioner exemptions

None

Special notes

None

Special Authority request form(s)

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Limited coverage criteria – tocilizumab (for giant cell arteritis)

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)